Teamwork Earns Award

Teamwork Earns Award

Torrance Memorial’s Burn, Wound and Amputation Prevention Center is awarded the RestorixHealth Clinical Distinction

Written by Kimberly Durment Locke | Photographed by Philicia Endelman

Torrance Memorial Medical Center’s Burn, Wound and Amputation Prevention Center is a prime example of the medical achievements possible when a multidisciplinary team of health care professionals works together for patient safety and healing. The comprehensive center earned the RestorixHealth Clinical Distinction this past June for its 90% patient healing rate, median patient healing time of 32 days and 96% patient satisfaction rate.

Wounds from head to toe—including those resulting from burns, diabetes, peripheral vascular disease, skin cancer and radiation—are treated at the center. The RestorixHealth achievement wouldn’t have been possible without the highly qualified team of experts representing a variety of health care specialties. Its multidisciplinary team of physicians, nurses and physical therapists have advanced training in wound care and effective treatment plans.

The center includes plastic, burn and general surgeons and podiatrists. Additionally, nurses and physical therapists play a critical role in treating the whole patient and counseling them on nutrition that promotes healing. Treatment plans may include infection control, restoration of blood flow, debridement (dead tissue removal), offloading (taking the weight off the wound area), skin substitutes, compression therapy, foot reconstruction and skin grafting.

Karen Shum, DPM, is the medical director of the hospital’s Amputation Prevention Center, and Matthew “Max” Reiss, MD, is the medical director of the Burn Center. The two centers make up the wound healing center. Together Dr. Shum and Dr. Reiss lead a team of dedicated health care professionals whose primary objective is restoring patients’ health to the fullest extent possible.

Dr. Shum, a fellowship-trained podiatrist, has experience with limb salvage and wound care from below the knee and extending into the foot and toes. “We specialize in helping patients with limbthreatening conditions such as diabetic foot ulcers, infections and peripheral arterial disease,” she says.

Her goal for the wound healing center is to be at the forefront of the wound care community. “This means following a set of wound care metrics for exceeding the average time it takes to heal wounds and preventing major amputations,” she says. “We review our data on a quarterly basis to see how we are doing in relation to other wound centers nationally. The metrics include our healing rate average and major leg amputation rate, which we strive to keep to a minimum.”

For Dr. Shum, success is helping patients’ wounds heal fully and restoring the foot or feet so they are fully functional, can be walked on and fit into a shoe. Her motto, “time is tissue,” speaks to the criticality involved with patients seeking medical assistance as soon as they notice a leg or foot ulcer that has difficulty healing, a change in color, drainage or malodor. If any of these symptoms occur along with a fever, pain or leg swelling, a patient should go to the emergency room, Dr. Shum emphasizes.

Delaying care, she says, usually results in increased damage to tissue, which can lead to tissue loss and even major limb amputation. A majority of lower limb amputations, says Dr. Shum, are the result of foot ulcers that occur due to complications from diabetes.

The toughest wound care cases at the Amputation Prevention Center are wounds on the bottom of the foot. “With these wounds, we have to find ways to alleviate pressure on the foot using a variety of methods including casts and padding. This is where art and medicine intersect as we seek to find innovative ways to avoid concentrated pressure on the foot so it can heal. For instance, we sometimes use a total contact cast that redistributes pressure on the foot so it can heal,” explains Dr. Shum.

Medical advancements for wound treatment largely focus on different types of cellular and tissue-based grafts. One of the newest types of grafts is donated human umbilical cord graft.

Oscar Gallardo – Wound Healing and Amputation Prevention Patient

“I found the confidence I needed and received lifesaving care.”

What started as a superficial scratch on 51-year-old Oscar Gallardo’s toe last June turned out to be much more. After several days of self-care, he noticed the discoloration at the scratch site had spread throughout his forefoot. Being diabetic, he saw his physician. He was given creams and told not to wear shoes so his foot could heal.

After nearly five months of treatment, an infection developed. Gallardo feared he would lose his entire foot. At this point, he sought help at Torrance Memorial Medical Center’s comprehensive Burn, Wound and Amputation Prevention Center, where he found lifesaving and limb-saving care.

“From the moment I met Dr. Karen Shum, I told her I would do anything to save my foot,” says Gallardo.

Dr. Shum quickly diagnosed a vascular blockage previously missed, which prevented healing. A vascular procedure to clear the vessel blockage was done. Dr. Shum performed a transmetatarsal amputation to remove the infected toes and try to preserve as much of his foot as possible to enable ambulation.

From proper diagnosis and problem-solving to surgery, Gallardo found the care at Torrance Memorial to be very good and personal. The center’s team reassured him he was getting the right treatment. “I found the confidence I needed and received lifesaving care,” Gallardo says.

Dr. Shum even arranged for state-of-the-art hyperbaric oxygen therapy to prevent further infection and promote healing. Gallardo is making a full recovery.

He started exercising routinely and improving his diet and has since lost nearly 65 pounds. Gallardo has returned to work and credits the center’s team for saving his foot and enabling him to walk again.

Patient Oscar Gallardo received life-saving and limb-preserving care from Dr. Karen Shum.

There are also fish skin grafts, porcine collagen and porcine intestinal mucosa grafts.

Another wound treatment method is called hyperbaric oxygen therapy, which helps stimulate new blood vessels and aids in the healing process. There’s also negative pressure wound therapy whereby a sponge-like material is placed on the wound, and a vacuum pump is then applied to the area to bring blood to the tissue’s surface. “This method promotes tissue growth by helping the wound contract, thus stimulating blood flow,” Dr. Shum explains.

“We have the latest noninvasive vascular device available to assess tissue oxygenation levels,” she says. “It’s a portable device with a near-infrared camera that takes a picture of the wound and tells us how well the tissue is oxygenated. This helps guide our treatment plan. If the oxygenation is on the lower end, we consult a vascular specialist who can determine the need for a stent or performing an angioplasty or bypass surgery to help restore blood flow.”

Torrance Memorial is the only Torrance hospital affiliated with a larger amputation prevention network using proven techniques and protocols of the Amputation Prevention Centers of America.

“Not all clinics carry this range of treatment options, but here at Torrance Memorial we have a wide spectrum of wound care options depending on the type of wound being treated and the severity of the wound,” she explains. “The team works to educate patients on ways to optimize wound healing. That team includes surgical podiatrists, plastic surgeons, vascular surgeons and/or interventional cardiologists with advanced training in procedures to help patients avoid major amputations.”

The COVID-19 pandemic has had an impact on wound care, as many patients have delayed treatment or could not access the care they needed due to the increased demands on hospital staffing during the height of the pandemic. “Unfortunately, this led to an increase in more acute cases due to wound neglect or inadequate self-care, and by the time they came in, we couldn’t save their leg,” says Dr. Shum.

While there is no conclusive data for the results of patients who delayed wound care during the past year’s pandemic, Dr. Shum believes there has been a growing number of patients who required major leg amputations due to delayed care.

Although Dr. Shum originally considered going into sports medicine, she ultimately decided it would be more fulfilling for her to apply some of the treatment options she learned from wound care and limb preservation specialists to nonathlete patients. “When I saw hospital patients who could lose a leg or foot, I decided to focus on limb salvage and wound care so I could help them end up with a successful recovery,” she explains.

The five-year mortality rate for patients who undergo a leg amputation is 50% to 60%. “This is a life-changing event that affects the patient’s quality of life in many ways. If we can extend their life and improve the quality of their life, it means everything,” says Dr. Shum.

Dr. Reiss, who has a master’s degree in public health, is a burn and reconstructive plastic surgeon. In his role as the medical director of the hospital’s Burn Center, he puts a strong emphasis on getting the word out about ways to avoid burns and how to best treat them.

“It’s about outreach to the community and letting them know we are here should they or someone they know need to be treated for a burn,” says Dr. Reiss, who also ensures the center stays current on the latest burn prevention tips and burn treatments as a member of the American Burn Association.

He explains the Burn Center he manages overlaps with the Amputation Prevention Center led by Dr. Shum and supplements patient treatment depending on the case. “We also offer such procedures as porcine and placental membrane grafts on an outpatient basis, and plastic and reconstructive surgery for acute burns on an inpatient basis. Our goal is to make our patients better and help them return to as normal a life as possible,” he adds.

While not all cases involve a suite of specialists, there are those patients who, after being assessed, require critical care. For example, the patient could have been in a house fire and suffered smoke inhalation, in which case a camera will be inserted into the patient to assess damage to the lungs and other vital organs. Dr. Reiss says the Burn Center offers not only specialty physicians such as reconstructive surgeons but also a comprehensive care team of psychiatrists, psychologists and therapists including physical, occupational, speech and respiratory.

He was inspired to become a burn specialist and plastic surgeon because of the endless challenges in reconstructive surgery and the huge variety in burn patient treatments overall. Those burn treatments include placenta-donated membrane grafts and a relatively new treatment called synthetic skin grafts. In some cases, a sample of a patient’s skin is sent to a lab where sheets of new skin are grown and then sewn onto the burn area where the graft is needed. Smaller skin grafts, he explains, can be created from cells grown in a petri dish or in the operating room and, after some processing that includes enzymes, are sprayed on the burn area in as little as 15 minutes.

Celebrating success is important for the patients and the treatment team. To that end, the hospital—in nonpandemic times—hosts an annual holiday party where former and current patients gather with staff members to reconnect and share information. Helping make these successes possible are Vimal K. Murthy, MD, burn surgeon and certified wound specialist with the Association for Advanced Wound Care, and John K. McKissock, MD, plastic surgeon.

Both Dr. Reiss and Dr. Shum share the same perspective on success. “Seeing our patients reintegrate back into their routine as much as possible so they can lead happy, healthy lives is our goal.” •

Burn Survivor Gives Back

This Torrance Memorial volunteer plans to support fellow burn survivors.

Six years ago on September 3, 2015, Dustin Varela of San Pedro was severely burned in a building fire in Harbor City. With burns covering 70% of his body, Varela was taken to Torrance Memorial Medical Center’s Burn Center, where burn surgeon Vimal Murthy, MD, burn and reconstructive plastic surgeon Matthew Reiss, MD, and plastic surgeon John K. McKissock, MD, provided lifesaving—and later, lifeenhancing—treatment.

“I don’t remember much about my hospital stay, but I was told I was in a medically induced coma for about six weeks, my lungs collapsed, and they almost lost me a few times,” says Varela. “I had to relearn how to walk, talk, swallow and eat.”

Dr. Murthy, who managed most of Varela’s acute inpatient care, says Varela, then age 30, was fortunate to survive. “Dustin was young and healthy at the time of the accident. If he had been older or had other health problems, his injuries may have killed him.”

Comprehensive Burn Care

As one of only three certified burn treatment centers in the region and under the leadership of Dr. Murthy and Dr. Reiss, the Burn Center at Torrance Memorial provides comprehensive burn and wound care for children and adults. The center has received the 2021 Clinical Distinction Wound Center Recognition from RestorixHealth for wound care excellence.

The Torrance Memorial Burn Center team includes board-certified burn and plastic surgeons, physical, occupational and speech therapists, social workerscounselors, respiratory therapistsm and psychiatrists who specialize in helping patients recover physically and emotionally.

As Varela began his recovery journey, the focus of his treatment changed from lifesaving to life-optimizing. Varela received most of his burn and reconstructive care from Dr. Reiss, while the Burn Center nurses attended to his everyday needs, as well as the needs of his loved ones.

“The support I received from the nurses was unreal,” says Varela. “My mom was practically living at the hospital while I was there, and the nurses took care of her just as well as they were taking care of me.”

All told, Varela’s inpatient stay at the Torrance Memorial Burn Center lasted six months. Since Varela’s discharge from the hospital, Dr. Reiss has performed surgeries every three to six months for the past six years to enhance Varela’s mobility and improve his quality of life.

Learning to SOAR

During Varela’s hospital stay, he met with a volunteer from Phoenix SOAR (Survivors Offering Assistance in Recovery), a program run by the Phoenix Society for Burn Survivors to connect survivors and their families with others who have experienced similar trauma.

“I didn’t know what to expect when I was discharged from the hospital,” said Varela. “The SOAR volunteer answered my questions about medical care, life and everything in between.”

When Varela returned to the Burn Center’s annual holiday party to visit with the physicians and nurses who saved his life, several nurses told him he should think about becoming a SOAR volunteer. “I thought, ‘If I can just help one person through SOAR, then it would be worth it,’” he says.

“Despite his injuries and adversities, Dustin is an affable, charismatic, loving and generous human being,” says Dr. Reiss. “For Dustin, SOAR is a gateway to help other people.”

“Dustin’s strong family support system and resiliency are reflected in his interest in giving back to others,” says Dr. Murthy.

Finding a New Path for Giving Back

After several days of training provided by Phoenix SOAR, Varela was ready to help. But unfortunately, the COVID-19 pandemic delayed his plans. As of the time of publication, pandemic-related restrictions have prevented Varela from connecting with his first burn survivor. But staying true to his upbeat, “never-give-up” attitude, Varela has found another way to give back.

“Even though SOAR was on hold, Dustin still wanted to serve,” says Mary Matson, director of service excellence, patient experience and volunteer services at Torrance Memorial. “He volunteers every week as part of our escort services program, which assists with discharging patients and errands around the hospital—and he is a great member of our team.”

Varela, now age 37, enjoys spending time with his family—especially his parents and his 10-year-old niece, whom he credits with providing unwavering support and encouragement. And through his volunteering at Torrance Memorial, Varela is able to stay in contact with what he refers to as his “Torrance Memorial family.”

“I spent so much time at the hospital that it became like my second home, and volunteering allows me to keep in touch with people and give back to the hospital that saved my life,” says Varela.

Dustin Varela and Matthew Reiss, MD, give back to others while celebrating Dustin’s remarkable recovery.