ACFAS Members Vote Against Dual APMA Membership

The membership of the American College of Foot and Ankle Surgeons (ACFAS) has agreed with the college’s board of directors that renewing members do not have to maintain membership in the American Podiatric Medical Association (APMA).
In the recent vote, 53 percent supported the board’s original decision from last fall. Podiatric surgeons must still be members of the APMA when they join the ACFAS but can drop association membership when they renew college membership. Reportedly 66 percent of the ACFAS membership cast their votes on this issue.
John Giurini, DPM, the President of the ACFAS, notes that the college did not intend for its members to choose between the college and the APMA, and that the two organizations will continue working together.
“It must be remembered that this vote is not an indictment of APMA or dissatisfaction with APMA,” he notes. “It is simply a reflection that the majority of members wish to have a choice. For a certain number of other members, financial considerations entered into their decision.”
Ross Taubman, DPM, the President of the APMA, expressed his regret with the vote, although he commends the ACFAS for continuing to recommend APMA membership to college members. He says the primary focus for the APMA is Vision 2015 and the goal of this initiative is for podiatric physicians to be universally recognized and accepted as physicians as per their education, training and experience.
Dr. Giurini notes that the ACFAS will work with the APMA on the Vision 2015 initiative and other issues such as scope of practice challenges.

What Is The Fallout From The Decision?
Since the ACFAS has changed its policy on APMA membership, they are in violation of the APMA bylaws, according to Dr. Taubman. Therefore, the ACFAS is not eligible to be recognized as an affiliate of APMA.
Lloyd Smith, DPM, a Past President of the APMA, predicts that as the ACFAS is no longer the association’s surgical affiliate, the APMA will seek out a new surgical affiliate. He believes both organizations will suffer due to the decision, calling the ACFAS board of directors’ action “unilateral and very confusing.”
“I am saddened to think that our profession will no longer be served by organizations with a unified structure,” says Dr. Smith. “The election results, confusing and contrary to most parliamentary actions of this sort, will negatively impact our profession. Our ‘separation’ will lead to unintended consequences and the members of both organizations will suffer.”

Editor’s note: For a related article, see this month’s “Forum” column, “Why ACFAS Members Should Stay In The APMA,” on page 89.

Study Cites Benefits Of Soft Silicone Adhesive Dressings
By Brian McCurdy, Senior Editor

Given that dressing changes are a reality for wound care patients, changing dressings should be as painless as possible. A recent study in Wounds UK evaluates the efficacy of soft silicone adhesive dressings in reducing patient pain.
The study included a survey of 3,034 patients in 20 countries who had been treated with advanced traditional adhesive dressings. Patients recorded their levels of pain before, during and after dressing removal, and also recorded wound/periwound trauma. Researchers then applied dressings with Safetac technology (Molnlycke Healthcare) to the patients’ wounds and patients repeated the pain assessment.
Researchers concluded that dressing changes with the Safetac soft silicone adhesive dressings facilitated fewer traumatic injuries to wounds and periwound skin. In addition, the study notes that such dressings are associated with significantly reduced wound-associated pain as measured before, during and after dressing changes.
Eric Espensen, DPM, has treated many patients with skin damage secondary to dressings and the removal of dressings. Noting that patients often participate in their own care, Dr. Espensen says there is a tendency of patients to remove the dressing quickly like a Band Aid. He adds that sometimes home healthcare nursing will do the same. He never applies tape directly to the skin if possible and then only applies paper tape.
Many patients with vasculopathy and severe diabetes have skin with a remarkably thin outer layer that rips and tears easily, according to Dr. Espensen, the Chief of Foot and Ankle Surgery at Providence St. Joseph Medical Center in Burbank, Ca.
Dr. Espensen says the key is instructing patients on properly removing dressings from the skin. He has transitioned away from using adhesive dressings such as the adhesive foams in favor of using non-adherent contact layer dressings with gauze and Kerlix topping to hold the dressing in place. The last choice is to use paper tape on the skin. Dr. Espensen notes that Band-Net is also very helpful in dressing retention.

Emphasizing Regular Evaluation Of Dressing Protocols
Dr. Espensen cites several new technologies, such as Medihoney (Derma Sciences) and Dermaclose (Wound Care Technologies), as getting good results in his clinic. He adds that he has established algorithms for treatment protocols in his practice and constantly evaluates his products of choice for upgrading with newer or different technologies. He also evaluates combination treatment, such as combining a silver dressing with an absorbent cover dressing, to extend dressing change intervals.
“We must continue to strive for improved rates of healing, lower rates of complications such as infection and greater ease of dressing application and maintenance,” says Dr. Espensen.

How Does Diabetes Affect Post-Op Recovery?
By Brian McCurdy, Senior Editor

An abstract recently presented at the annual meeting of the American Academy of Orthopedic Surgeons (AAOS) depicts the complications that diabetes may cause for patients undergoing surgery.
Researchers drew upon data from 65,769 patients with diabetes who had joint replacement surgery between 1988 and 2003. In comparison to patients with type 2 diabetes, those with type 1 diabetes had higher risks for surgical and systemic complications, higher mortality, increased length of stay, and higher hospital charges following arthroplasty, according to the abstract.
Matthew Claxton, DPM, points out that those with type 1 diabetes in the study had a longer duration of disease and this factor increases complication risk regardless of the type of diabetes. When it comes to patients with diabetes, all types of surgery have an increased risk, according to Dr. Claxton, who is in private practice in Belleville, Ill.
He notes that perioperative stress increases blood sugar levels while long pre-op fasting times can make for very low blood sugar. Surgeries are riskier when OR times are longer and larger incisions make for a greater risk of wound complications, adds Dr. Claxton.
Among the common complications for patients with diabetes are wound and infection problems. He cites research showing varying levels of decreased phagocytic activity with increased blood sugar. Dr. Claxton says a blood sugar of 120 mg/dL is implicated with 75 percent decreased activity.

What Precautions Can Prevent Complications?
All of Dr. Claxton’s diabetic patients require medical clearance from their primary care physicians before surgery and he has cancelled “a multitude” of surgeries on patients with poor glycemic control. In addition, he notes that most hospitals and surgery centers use algorithms for preoperative screening. Preoperative antibiotics are necessary, says Dr. Claxton, who adds that more frequent postoperative visits are also helpful in preventing wound/infection problems.
Dr. Claxton also notes that a 23-hour observation admission can be helpful for high-risk patients with diabetes. Patients at risk for DVT require antiembolic stockings and anti-coagulation. Dr. Claxton advocates that for procedures with longer recovery times, such as fusions and major reconstructions, one should plan for 23-hour admissions and extra office follow-up appointments to monitor for possible post-op complications. As he says, the earlier a patient can return to weightbearing, the better.

Editor’s note: For related articles, see “How To Achieve Optimal Perioperative Glycemic Control In Patients With Diabetes” or visit the archives at www.podiatrytoday.com.