Medical education about wounds and other subjects.

 

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About:  These are the presentations, notes, transcripts, or other materials from previous lectures and conferences.  Many of these files are accessible to all users.  If you are asked for a password to access certain of these files, you must get the password from the organization which hosted the presentation.

  

Many of these files are fully annotated with text to accompany each slide, which obviously makes them more understandable and educational.  Alas, many are not, but periodically some notes are added.  The status is indicated, starred *** if annotated.

  

Index

 

 

 

2024, February 19              Phoenix, AZ                        Principles of Wound Healing and Treatment of Complex Wounds

2021, November 20-23     Las Vegas, Phoenix         Ventral & Incisional Hernias:  Safe and Effective Restoration

2020, September 26          Scottsdale, AZ                   Necrotizing Soft Tissue Infections – An Overview for Non-Surgeons

2018, September 20          Phoenix, AZ                        Hypercoagulable Disorders – Implications For Wounds & Surgery

2018, September 15          Houston, TX                        Amniotic Tissue in Complex Hernia Repair & Enterocut. Fistulas

2017, October 27               Phoenix, AZ                        Wound Pathergy – When Not to Operate

2017, June 24                     Boston, MA                         Abdominal Wall  ( 2 parts )

2016, April 13                      Atlanta, GA                          Debridement  ( 2 parts )

2015, May 7-8                      Barcelona Spain                Clinical Use of Integra Dermal Rgeneration Template  ( 3 parts )

2015, April 17                      Napoli, Italy                         In Situ Tissue Engineering - Embryonic Histogenesis in Matrices

2015, March 19                   Phoenix, AZ                        Prime Principles in the Surgery of Repair

2011, January 20               Augusta, GA                       Integrating New Technologies Into Practice

2011, January 6                  Phoenix, AZ                        Wound Pathergy – When Not to Operate

2010, May 7-8                      Baltimore, MD                    Integra Flap Course

2010, February 22-23        Maui, HI                                The Physics and Pathology of Wounds  ( 3 parts )

2009, September 26          Miami, FL                             (Not) Atypical Wounds  &  Integrating New Technologies

2009, November 6             Phoenix, AZ                        Apligraf  –  Re-Engineered Living Skin

 

2006, December 8             St. Thomas, USVI             Integra in Situ Tissue Engineering:  Embryonic Histogenesis

2006, August 12                 Squaw Valley, CA             Surgical Treatment & Reconstruction of Necrotizing Infections

2006, May 19                       Fort Collins, CO                 Hypercoagulability  –  Pre- & Microthrombotic Disorders

2006, May 16                       Scottsdale, AZ                   Angiogenesis as a Regulated Control System (the VT Model)

2006, March 8                     Palm Springs, CA             Apligraf  –  Re-Engineered Living Skin  –  Chronic Wounds

2005, December 14           Bethesda, MD                    Integra Artificial Skin – Geriatric Population

2005, October 29               Phoenix, AZ                        Wounds and Ulcers in Geriatric Patients

 

  

Recent

Transcripts, notes, and slides from the most recent presentations.

 

 

2024, February 19

Phoenix, AZ

  

Principles of Wound Healing and Treatment of Complex Wounds

TED Conference (Endovascular)

Phoenix, Arizona

This was a 10 minute presentation on a large detailed topic, given to vascular surgeons, interventional radiologists, cardiologists.  A focused point of view was taken.  This group of doctors sees and treats wounds of vascular origin.  The message emphasized is : (1) there is a difference in physiology and clinical approach to acute trauma wounds versus chronic and pathological wounds; (2) arteriopathic wounds have a set of treatment principles that reflects that particular pathology and risks; (3) CAP wounds (chronic and pathological) of other origins have their own distinctive and specific pathogenesis and approach to care.

 

Principles of Wound Healing and Treatment of Complex Wounds

      Presentation format, PDF  (pdf 14 MB).  Full page med-res images. No text or annotations.

      Presentation format, PPTX  (pdf 28 MB).  Full page hi-res images.  No text or annotations.

 

2021, November 20

            November 23

Las Vegas, NV

Phoenix, AZ

  

Ventral & Incisional Hernias:  Principles of Safe and Effective Restoration

(They can be prevented, and they can all be fixed.)

Integra Sponsored Lab and Seminar

Surgery Grand Rounds, HonorHealth John C. Lincoln

Section 1 gives an historical perspective on hernia care and surgery, with emphasis on the recent epidemic rise in failed repairs, hernia recurrence, and failed technologies.

Section 2 discusses technicalities of safe and effective abdominal wall restoration.

Section 3 is a gallery of cases illustrating these points.  If these principles are applied during primary laparotomy, hernias can be avoided in the first place.  The cases illustrate though that even after multiple failed procedures, complicatons, and progressive damage to the abdominal wall, it can still be salvaged and reconstructed for a long term durable result.

 

Ventral & Incisional Hernias, and Redo, Complicated, & Failed Hernia Repairs –

How Did We Get into Such a Mess?   (And How to Get Out of It.)

      Presentation format, PDF  (pdf 26 MB).  Full page med-res images.  No text, annotations.

      Presentation format, PPTX  (pdf 77 MB).  Full page hi-res images.  No text or annotations.

 

2020, September 26

Scottsdale, AZ

  

Necrotizing Soft Tissue Infections – An Overview for Non-Surgeons

Rocky Mountain Region WOCN _ Virtual Conference

Necrotizing fasciitis has always been a challenging disease with respect to early diagnosis and then the effort and logistics of post-operative care.  There is an evolving perception that, on top of these problems inherent to the disease, that modern degradations of competent hospital practices are resulting in unnecessary delays of care and increased morbidity and mortality for this disease – we are going backward.  This invitational talk asked to address how nurses and therapists can intervene to help recognize the diagnosis and expedite the correct care of these patients.

 

Necrotizing Soft Tissue Infections – An Overview for Non-Surgeons.

      Presentation format, PDF  (pdf 13 MB).  No text, slides as presented September 26, 2020.

 

2018, September 20

Phoenix, AZ

  

Hypercoagulable Disorders – Implications For Wounds & Surgery

Banner University Medical Center - Phoenix

An update on hypercoagulable disorders.  There are two main sections.  The first presents the usual medical information about physiology, nomenclature, pathology, clinical approach, diagnosis, and treatment.  The second part explores the historical reasons why these disorders remain under-appreciated and under-recognized by physicians, and then the physiological reasons why they remain under-appreciated.

 

Hypercoagulable Disorders – Implications For Wounds & Surgery, Pathophysiology, Clinical Features, Diagnosis & Treatment – AND – Insights About the Historical Understanding of this Subject and Why These Problems Remain Perpetually Under Appreciated, Under Recognized, and Under Treated. Combined With Modern Technology Based Biological Materials.

      Presentation format, PDF  (pdf 29 MB).  No text, slides as presented January 6, 2011.

      Reader’s format, PDF  (pdf 25 MB).  *** Full TEXT annotation: small file, low-res images.

 

2018, September 15

Houston, TX

  

Amniotic Tissue in Complex Hernia Repair & Enterocutaneous Fistulas

Baylor Hernia Symposium 2018.

The author’s contribution to a symposium on abdominal wall and hernia reconstruction and related problems.  This presentation focuses on enterocutaneous fistulas, abdominal wall and hernia problems as they interface with fistulas, and the use of stimulatory and regenerative biologics in the management of these problems.

 

Amniotic Tissue in Complex Hernia Repair & Enterocutaneous Fistulas – Reconstructive Surgery & Wound Care Principles, Applied to a Notoriously Morbid & Difficult to Treat Problem – AND – Insights Into Effective Management & Cure Utilizing Classic Principles of Plastic Surgery Combined With Modern Technology Based Biological Materials.

      Presentation format, PDF  (pdf 15 MB).  Full page hi-res images.  No text or annotations.

 

2017, October 27

Phoenix, AZ

   

Wound Pathergy – When Not to Operate

Continuation of subject from January 6, 2011 (see below), now fully annotated.

This presentation explains the principles of wound pathergy and the general categories of pathology that cause thrombo-infarctive and inflammatory-lytic necrosis and ulceration (vascular, hematological, hypercoagulable, inflammatory, autoimmune).  It then explains problems caused by these diseases, the focus being on the risks for surgery and post-operative wound failure.

 

Principles of Surgery – Wound Pathergy (When Not to Operate) – Situations to avoid that will cause necrosis, dehiscence, wound failure, & related complications.

      Presentation format, PDF  (pdf 16 MB).  No text, slides as presented January 6, 2011.

      Reader’s format, PDF  (pdf 9 MB).  *** Full TEXT annotation: small file, low-res images.

 

2017, June 24

Boston, MA

  

Abdominal Wall

Integra Sponsored Symposium

The author’s 2 contributions to a symposium on abdominal wall and hernia reconstruction.

 

Part 1.  Ventral & Incisional Hernias, and Redo, Complicated, & Failed Hernia Repairs –

How Did We Get into Such a Mess?

Part 1 gives an historical perspective on hernia care and surgery, with emphasis on the recent epidemic rise in failed repairs, hernia recurrence, and failed technologies.

      Presentation format, PDF  (pdf 9 MB).  Full page hi-res images.  No text or annotations.

     

Part 2.  Parastomal Hernias – Principles & Concepts Behind Effective Results.

Part 2 discusses the caveats and difficulties of parastomal hernia surgery, and the technical aspects of effective repair.

      Presentation format, PDF  (pdf 9 MB).  Full page hi-res images.  No text or annotations.

 

2016, May 13

Atlanta, GA

  

Debridement

Integra Sponsored Workshop

These are the author’s 2 contributions to a 6 part workshop on debridement.

 

Part 1.  Biological & Technical Foundations of the Quintessential Modality of

Curtailing Injury and Expediting Cure in Wounds & Injured Tissues

Part 1 explains the conceptual foundations and biological correlations of debridement.

      Presentation format, PDF  (pdf 22 MB).  No text, full page hi-res images.

      Reader’s format, PDF  (pdf 10 MB).  *** Full TEXT annotation: small file, low-res images.

      Part 1:  Presentation format has slides only.  Reader’s version has full text annotation.

 

Part 2.  In Situ Tissue Engineering with Integra and Primatrix.

Histogenesis and Wound Closure Using Regeneration Templates

Part 2 focuses on modalities of wound closure, reconstruction, and regeneration following wound debridement and preparation.

      Presentation format, PDF  (pdf 31 MB).  No text, full page hi-res images.

      Part 2:  Presentation format has slides only.  Full text annotations have not yet been prepared.  The relevant discussions can be found in the Naples presentation below, April 17, 2015, and in other presentations in the Integra section.

 

2015, May 7-8

Barcelona, Spain

  

Clinical Use of Integra Dermal Regeneration Template  ( 3 parts)

Integra International Symposium

This 3-part presentation is a review of the clinical utility of using regenerative matrices in reconstructive surgery and for chronic wounds.

 

Part 1.  In Situ Tissue Engineering, Clinical Observations and Lessons.

Part 1 explains the wound as ats the foundations for understanding the generalities of non-linear dynamics.

      Presentation format, PDF  (pdf 14 MB).  No text, full page hi-res images.

      Part 1:  Presentation format has slides only.  Reader’s versions have full text annotation.

 

Part 2.  Dermal Regeneration Template, Use in Complex Trauma.

Part 2 takes a more conventionpaired wound to the other connective tissue disorder, then concludes with case studies illustrating these principles.

      Presentation format, PDF  (pdf 8 MB).  No text, full page hi-res images.

      Part 2:  Presentation format has slides only.  Reader’s versions have full text annotation.

 

Part 3.  Dermal Regeneration Template, Use in Reconstruction.

Part 3 combines the scilso includes a conspectus of wound histopathological findings that practitioners can use to study, diagnose, and plan treatment for wounds in their own practices.

      Presentation format, PDF  (pdf 11 MB).  No text, full page hi-res images.

Part 3.  Presentation format has slides only.  Reader’s versions have full text annotation.

 

2015, Aprl 17

Napoli, Italy

  

In Situ Tissue Engineering With Integra - Embryonic Histogenesis in Regenerative Matrices

Seconda Universitŕ di Napoli

This is a presentation about regeneration within biomatrices.  It is a histological evaluation of the biology of transformation from an acellular biomatrix to a living lamina of new tissue.  The material studied is Integra collagen-gag matrix.  The meritorious qualities that allow this biomatrix to regenerate in the face of adverse circumstances and to do so without scar derive from its ability to arrest inflammation and normal wound healing, and instead to induce a state of embryonic histogenesis.

      Reader’s format, PDF  (pdf 4 MB).  *** Full TEXT annotation: small file, low-res images.

      Reader’s format, HTML  (html 72 MB).  *** Full TEXT: small size but hi-res images.

      Presentation format  (pdf 32 MB).  Full page graphics, without text.

      Presentation format has slides only.  Reader’s versions have full text annotation.

 

2015, March 19

Phoenix, AZ

  

Prime Principles in the Surgery of Repair

Banner University Medical Center - Phoenix

To be successful and uncomplicated, the “surgery of repair”, the surgery of restoring or reconstructing body integrity after trauma or disease, requires a different set of principles, strategies, and tactics than the “surgery of cure” to control trauma and alleviate disease.  This presentation discusses the quintessential principles of the surgery of repair, the crucial strategies and tactics that ensure success results without complications.

      Presentation format, Powerpoint web  (html 55 MB).  Full page graphics, without text.

      Presentation format  (pdf 23 MB).  Full page graphics, without text.

      Presentation format only, slides but no text.

 

2011, January 20

Augusta, GA

  

Integrating New Technologies into Practice

Joseph M. Still Burn Center Research Consortium

This is an eclectic and philosophical look at the world of new wound products, including an overview of pharmaceutical history and vulnerary medications.  If you are curious how Walden Pond, Kickapoo Indians, turpentine and Frankenstein could all end up in a talk about wounds, read on . . .

      Reader’s format, PDF  (pdf 3 MB).  *** Full TEXT annotation: small file, low-res images.

      Reader’s format, HTML  (html 28 MB).  *** Full TEXT: small size but hi-res images.

      Presentation format, Powerpoint web  (html 30 MB).  Full page graphics, without text.

      Presentation format  (pdf 19 MB).  Full page graphics, without text.

      Presentation format has slides only.  Reader’s versions have full text annotation.

 

2011, January 6

Phoenix, AZ

  

Wound Pathergy – When Not to Operate

Surgery Grand Rounds presentation given January 6, 2011 at Banner Good Samaritan.

This presentation explains the principles of wound pathergy and the general categories of pathology that cause thrombo-infarctive and inflammatory-lytic necrosis and ulceration (vascular, hematological, hypercoagulable, inflammatory, autoimmune).  It then explains problems caused by these diseases, the focus being on the risks for surgery and post-operative wound failure.

      Presentation format, HTML  (pdf 16 MB).  No text, slides as presented January 6, 2011.

      Original review, PDF  (pdf 2.4 MB).  Text & images from original thrombocytosis review.

      Mixed format, PDF  (pdf 18 MB).  The above two combined in one file.

 

See above, October 27, 2017, for fully annotated version.  Listed here are the files for the January 6, 2011 presentation, which are preliminary and not annotated.  (This presentation originated as a review of a case of wound pathergy with thrombocytosis, and these preliminary files are derived from the original review.)

  

2010, May 7-8

Baltimore, MD

  

Integra Flap Course

These are the two presentations given at the Integra Flap Course.  There is no text annotation, just the presentation slides.

 

Part 1.  Principles of Wound Repair Surgery:  Flaps & Regenerative Matrices

Concepts & Techniques.

This begins with a review of flap principles, the focus being on finer points of practice.  Next is a discussion of regenerative matrices and how they solve problems when flaps cannot be done.

      Presentation format, HTML  (html 51 MB).  No text, hi-res images in ppt format.

      Presentation format, PDF  (pdf 25 MB).  No text, pdf format.

 

Part 2.  Principles of Wound Repair Surgery:  Flaps of The Leg (& Lower Extremity).

Design & Execution.

This presentation accompanied the laboratory session.  It is about flaps of the lower extremity, explicitly flaps originating on the leg (plus some discussion of thigh adductor flaps).

      Presentation format, HTML  (html 21 MB).  No text, hi-res images in ppt format.

      Presentation format, PDF  (pdf 10 MB).  No text, pdf format.

  

2010, February 22-23

Maui, HI

  

The Physics and Pathology of Wounds

The John A. Boswick, M.D. Burn and Wound Care Symposium 2010

This 3-part presentation explains the nature of intrinsic wound pathology and wound failure.  Certain chronic wounds fail to heal in spite of all reasonable treatment.  Why?  Furthermore, problems like arterial insufficiency and pressure either injure or impair and thus inhibit wounds, but they are factors extrinsic to the inherent wound healing machinery.  What then are the intrinsic diseases of the wound module?  This series of lectures will explain that the inherent disease of wound healing is of necessity a disease of fibroblasts, angiocytes, vessels, and connective matrix, and more specifically a state of auto-immunization against them.  How it is that this state then makes the wound so refractory cannot be explained via any single cellular or chemical alteration, but rather by the physics of complex systems.

 

Part 1.  The Wound as a System and a Controlled Machine.

Part 1 explains the wound as a closed loop control system.  It includes a precis of fundamental wound anatomy and physiology, then it explains the timewise dynamics of wound healing.  In so doing, it also sets the foundations for understanding the generalities of non-linear dynamics.

      Reader’s format, PDF  (pdf 2 MB).  *** Full TEXT annotation: small file, low-res images.

      Reader’s format, HTML  (html 31 MB).  *** Full TEXT: small size but hi-res images.

      Presentation format, PDF  (pdf 20 MB).  No text, mid size file, full page hi-res images.

      Part 1:  Presentation format has slides only.  Reader’s versions have full text annotation.

 

Part 2.  Auto-Immunopathy and the Intrinsic Disease of Wound Healing.

Part 2 takes a more conventional biological and pathological look at the impaired wound, beginning with a review of hypercoagulable and immunopathic ulcers.  From there, it explains the origins of auto-immunopathy in wounds subject to sustained acute inflammation.  It then elucidates the kinship of the impaired wound to the other connective tissue disorder, then concludes with case studies illustrating these principles.

      Reader’s format, PDF  (pdf 4 MB).  *** Full TEXT annotation: small file, low-res images.

      Reader’s format, HTML  (html 60 MB).  *** Full TEXT: small size but hi-res images.

      Presentation format, PDF  (pdf 44 MB).  No text, mid size file, full page hi-res images.

      Part 2:  Presentation format has slides only.  Reader’s versions have full text annotation.

 

Part 3.  Chronicity and the Physics of Wound Failure.

Part 3 combines the science and engineering of Part 1 with the clinicals and pathology of Part 2 to explain why refractory chronic wounds must be that way.  This understanding cannot be arrived at by conventional biochemistry and cell biology, but rather by an understanding of non-linear and population dynamics.  It also includes a conspectus of wound histopathological findings that practitioners can use to study, diagnose, and plan treatment for wounds in their own practices.

      Reader’s format, PDF  (pdf 3 MB).  *** Full TEXT annotation: small file, low-res images.

      Reader’s format, HTML  (html 36 MB).  *** Full TEXT: small size but hi-res images.

      Presentation format, PDF  (pdf 25 MB).  No text, mid size file, full page hi-res images.

      Part 3.  Presentation format has slides only.  Reader’s versions have full text annotation.

 

The following is a prior presentation which includes some of the same, some different material.  It is comparable to Part 2, and is focused on immunopathic ulcers, coagulopathic ulcers, and the origins of connective tissue auto-immunity and the appearance of lymphoid inflammation.

(NOT) Atypical Wounds  ( Autoimmunopathy and Connective Tissue Disorders:  The True Intrinsic Diseases of Wound Healing )

      Reader’s format, PDF  (pdf 4 MB).  *** Full TEXT annotation: small file, low-res images.

      Reader’s format, HTML  (html 70 MB).  *** Full TEXT: small size but hi-res images.

      Presentation format, PDF  (pdf 39 MB).  No text, mid size file, full page hi-res images.

      Presentation format, Powerpoint web  (html 90 MB).  No text, full page hi-res images.

  

2009, September 26

Miami, FL

  

(NOT) Atypical Wounds  ( Autoimmunopathy and Connective Tissue Disorders:  The True Intrinsic Diseases of Wound Healing )

Baptist Health South Florida – Beneath the Surface, Fourth Annual Wound Care Symposium

      Reader’s format, PDF  (pdf 4 MB).  *** Full TEXT annotation: small file, low-res images.

      Reader’s format, HTML  (html 70 MB).  *** Full TEXT: small size but hi-res images.

      Presentation format, PDF  (pdf 39 MB).  No text, mid size file, full page hi-res images.

      Presentation format, Powerpoint web  (html 90 MB).  No text, full page hi-res images.

      Presentation format has slides only.  Reader’s versions have full text annotation.

 

Integrating New Technologies into Practice

Baptist Health South Florida – Beneath the Surface, Fourth Annual Wound Care Symposium

This is an eclectic and philosophical look at the world of new wound products, including an overview of pharmaceutical history and vulnerary medications.  If you are curious how Walden Pond, Kickapoo Indians, turpentine and Frankenstein could all end up in a talk about wounds, read on . . .

      Reader’s format, PDF  (pdf 3 MB).  *** Full TEXT annotation: small file, low-res images.

      Reader’s format, HTML  (html 28 MB).  *** Full TEXT: small size but hi-res images.

      Presentation format, Powerpoint web  (html 30 MB).  Full page graphics, without text.

      Presentation format  (pdf 19 MB).  Full page graphics, without text.

      Presentation format has slides only.  Reader’s versions have full text annotation.

 

2009, November 6

Phoenix, AZ

  

Apligraf  –  Re-Engineered Living Skin  –  Biotechnology and Chronic Wounds

Based on presentations 2002 – 2009.  Content partially supplied by Organogenesis.

Apligraf is a laboratory grown living skin equivalent.  It is used as a “living pharmaceutical” on select problem wounds.  It has an effect to induce or accelerate wound healing.

      Reader’s format, PDF  (pdf 7.5 MB).  Partial text annotation.

      Presentation format, PDF  (pdf 23 MB).  No text, full page hi-res images.

      This talk is partially annotated.

  

  

Chronological

Transcripts, notes, and slides from older presentations.

  

GAP

 

Files and presentations from this interval are coming soon.  Main subjects include:

 

      Immunopathies and Wounds

      Pediatric Wounds

      Abdominal Wall Reconstruction

      Cadaveric Regenerative Matrices

      21st Century Medicine and Surgery

      Wounds – A Philosophy of a New Specialty

      In Situ Tissue Engineering & the Fourth Paradigm of Surgery

  

2006, December 8

St. Thomas, USVI

In Situ Tissue Engineering With Integra:  Embryonic Histogenesis in Regenerative Matrices.

Wound Healing Science & Industry, 7th Annual Meeting

Slide version  (ppt 6.8 MB).  Not annotated

      Powerpoint web presentation  (html 12 MB).  Not annotated

  

2006, August 12

Squaw Valley, CA

Surgical Treatment and Reconstruction of Necrotizing Soft Tissue Infections.

MSIS – Musculoskeletal Infection Society, 16th Annual Meeting

      Slide version  (ppt 4 MB).  *** Complete, with text annotations.

      Powerpoint web presentation  (html 4 MB).  *** Complete, with text annotations.

      Reader’s format  (html 18 MB).  *** Complete, with text annotations.

      Slides & text  (pdf 5.4 MB).  *** Complete, with text annotations.

  

2006, May 19

Fort Collins, CO

Hypercoagulability  –  Prethrombotic and Microthrombotic Disorders.

      See the Coagulopathy page.

  

Immunopathic ulcers

      Slide version  (pdf 11 MB).  Not annotated.

  

2006, May 16

Scottsdale, AZ

Angiogenesis as a Regulated Control System (the VT Model)

WHS – Wound Healing Society, 16th Annual Meeting

      Slide version  (pdf 16MB).  Not annotated.

  

The Wound as a Non-Linear Control System

      Poster version  (pdf 4.5 MB).  Not annotated.

  

Hypercoagulability  –  Prethrombotic and Microthrombotic Disorders.

      Poster version  (pdf 2 MB).  Not annotated.

  

2006, March 8

Palm Springs, CA

Apligraf  –  Re-Engineered Living Skin  –  Biotechnology and Chronic Wounds

Sponsored by Organogenesis

      Powerpoint version  (ppt 23 MB).  Slides and partial annotation.

      Annotated page version  (pdf 7.5 MB)  Slides and partial annotation.

  

2005, December 14

Bethesda, MD

Integra Artificial Skin – Geriatric Population

CMS - Medicare.

      Slide version (pdf 13.4 MB).  Not annotated.

  

2005, October 29

Phoenix, AZ

Wounds and Ulcers in Geriatric Patients

Arizona Geriatrics Society, 17th Annual Meeting

      Slide version  (pdf 16 MB).  Not annotated.

  

  

  

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