Wound Healing Center
Orange Regional Medical Pavilion
75 Crystal Run Road, Suite 240
Middletown, NY 10941
Monday - Friday
8:00 a.m. - 4:00 p.m.
Inocencia Carrano, MD
Wound Healing Center
Wound Healing Center
The Orange Regional Wound Healing Center, located at the Orange Regional Medical Pavilion in Suite 240, provides a team of specialists who utilize proven wound care methods that are specific to the needs of patients with chronic, non-healing wounds. Led by our Medical Director, Dr. Inocencia Carrano , the Wound Healing Center provides advanced wound healing therapies, used by wound care centers across the country. Our individualized treatment plans result in improved healing rates over shorter periods of time compared to conventional therapies. We use only the most advanced dressings and offer hyperbaric oxygen therapy, graft applications and compression therapy to treat chronic and hard to heal wounds. Our team of experts works closely with your physician, providing regular updates on your progress.
Our experienced staff treats:
- Diabetic wounds that are slow-to-heal or not healing
- Foot, leg ulcers and sores
- Surgical wounds that have opened (or “dehisced”)
- Skin grafts or surgical flaps that are not healing post-surgery
- Open wounds caused by radiation therapy
- Bone infection, also known as osteomyelitis
We are also skilled in treating such internal injuries as:
- Select acute traumatic and crush injuries
- Radiation cystitis or proctitis
- Reconstruction of jaw or bone (related to mandibular osteoradionecrosis)
Individualized wound treatment is dependent upon the type and severity of the wound and includes:
- Advanced wound dressings
- Hyperbaric oxygen therapy
- Antibiotic therapy
- Nutritional counseling
- Surgical debridement (removal of dead tissue)
- Wound pressure relief (known as “off-loading”)
Hyperbaric Oxygen Therapy (HBO)
HBO is a medical treatment used to treat non-healing wounds that are often the result of diabetes, bone infections (osteomyelitis), radiation injuries to bone or soft tissue and burns.
HBO involves breathing 100 percent oxygen under pressure. The patient rests comfortably in a single person pressurized chamber while a certified technician increases atmospheric pressure in the chamber until the patient is at depth as prescribed. . The chamber is approximately 8 feet long by 3 feet wide and is mostly enclosed with acrylic to allow for watching television or viewing the surroundings. The treatment lasts 1 ½ to 2 hours.
How does hyperbaric oxygen therapy work?
The air we normally breathe contains approximately 20 percent oxygen and 80 percent nitrogen. While in the chamber, a patient will breathe 100 percent oxygen and it will be delivered at a higher pressure than normal. The combination of high oxygen concentration and increased pressure causes large amounts of oxygen to enter the blood and other tissue fluids to accelerate the healing process.
How will I feel during Hyperbaric Oxygen Treatment?
Once in the chamber and the door is closed, you will hear the oxygen begin to circulate. Our certified technician will then gradually increase the pressure. This is called “compression.” You may notice some warmth, but this is temporary. A nurse/technician will remain with you during the treatment to adjust the rate of compression according to your tolerance. During the treatment, you may experience a “full” sensation in your ears. It is similar to the feeling you have during the ascent or descent in an airplane. You will be coached on how to clear your ears to eliminate this feeling. The compression generally lasts 7 to 10 minutes.
When you have reached the prescribed pressure, you may rest, sleep, watch TV or listen to music for the remainder of the procedure, which lasts about 1 ½ to 2 hours.
Near the end of the treatment, the nurse or technician will gradually decrease the pressure, which is called “decompression.” At this time, you may feel a popping sensation in your ears as a result of the changing pressure.
Are there any side effects to Hyperbaric Oxygen Therapy?
Side effects from HBO are rare. However, some patients report a “crackling” sensation in their ears between treatments. This may be relieved in the same manner you clear your ears during compression. If the crackling continues, please tell the nurse or technician.
Some other rare side effects may include:
- Barotrauma – pain in the ears or sinuses
- Cerebral air embolism – air or gas bubble that cuts off blood supply to the brain
- Pneumothorax – collection of air or gas in the chest that causes lung collapse
- Oxygen toxicity
- Risk of fire
- Myopia – risk of worsening near-sightedness
- Presbyopia – temporary improvement in far-sightedness
- Maturing or ripening cataracts
- Numbness of fingers
- Ear fluid
How do I prepare for Hyperbaric Oxygen Treatments?
- Please bring a list of all your current medications and vitamins with their dosages. You will be instructed to take vitamin E 400 units daily during the entire course of HBO therapy. This will help protect your body from absorbing more oxygen than it can safely use.
- It is important that you notify us of any symptoms of a cold or flu, fever, sore throat, runny nose, fever blisters, cold sores, nausea, vomiting, diarrhea and general aches. Those symptoms are not helped by oxygen, so the HBO treatments may need to be postponed until the symptoms have subsided and the doctor allows the HBO treatments to resume.
- Stop smoking. Smokers have higher levels of carbon monoxide levels than non- smokers and do not receive the full benefit of oxygen therapy.
- You may not use any products that contain a petroleum or alcohol base prior to your treatment. Please look at your makeup, hair spray, perfume, shaving lotion or deodorant to see if they contain these ingredients. The presence of petroleum or alcohol during HBO treatment can cause a fire.
- You will be provided with 100 percent cotton gowns for your treatment. NO other articles of clothing are to be worn during the treatment. You must remove all jewelry, hard contact lenses and other prosthetic devices before the treatment.
- The nurse or technician in the unit will schedule your treatments on a daily basis. Every effort will be made to accommodate your schedule, but emergencies do arise and your appointment may need to be rescheduled. If you need to cancel or change your appointment please call the office as soon as possible.
Frequently Asked Questions
Q: If I am a diabetic, how important is it to keep my blood sugar in control?
A: It is very important. Diabetes is a chronic condition which prevents the body from using sugar (glucose) properly. This results in high blood sugars that can slow the healing process. If blood sugar is poorly controlled, it may result in nerve damage and circulatory issues, among other problems. The medical term for nerve damage is neuropathy. Patients with a neuropathy have a reduced sense of pain. For this reason, they may not be aware of serious problems in their feet because they have little to no feeling. For example, a serious infection could be present with little to no pain. Narrow arteries restrict the blood flow that is necessary for healing. A weakened immune system allows even minor wounds to become infected and compromises the healing process. If you or someone you know has diabetes, a clear plan for controlling their blood sugar is essential.
Q: What wound care problems are associated with diabetes?
A: In advanced cases, circulation to the extremities - usually the legs, feet and toes - becomes less and less due to narrowing arteries. Because of the poor circulation, even minor injuries like skin blisters may not heal. When sores don't heal, infection can occur. In time, the skin in the infected area can die (called gangrene). When this happens surgery must be performed to remove the dead tissue. In some cases, amputation of the toes, foot, or leg may be necessary. It’s important to be well informed about your condition and listen to you healthcare providers’ directions.
Q: Is amputation inevitable with chronic wounds?
A: No. In many cases, amputation may be avoided with proper treatment combined with other therapies, such as vascular procedures and hyperbaric oxygen treatment.
Q: Do chronic-wounds require treatment for life?
A: No. There are many factors that affect the healing process. Our treatment approaches are customized to your needs and are developed to significantly decrease the time required for wounds to heal completely.
Q: Do chronic wounds require time in the hospital?
A: Unless there are other complicating factors, the majority can be treated on an outpatient basis.
Q: Should I let my wound be open to air?
A: No, healing progresses more rapidly when the wound is kept moist. Your provider will use specialized dressings to maintain just the right amount of moisture; not too much and not too little. It will also protect the wound from contamination.
Q: Can I get my wound wet in the shower?
A: Yes, unless you have sutures (stitches), staples, exposed bone or your doctor has advised against it. Make sure you ask before you shower or bathe. If you need to keep your wound dry, place a garbage bag or a plastic cover over the wound or extremity to keep it dry. Typically, you should not be soaking your wound.
Q: What if I forget to change my dressing?
A: As soon as you remember, change your dressing. Be careful in removing it, just in case it is stuck to the wound. Use enough water to soak it off if it is stuck so that it comes off without causing you any pain. Then re-dress your wound as the doctor has directed.
Q: Can I use a whirlpool to clean my wound?
A: No, water under pressure may drive bacteria (germs) into the wound tissue. We do not recommend use of a whirlpool on a regular basis.
Q: If I get dry skin, can I use lotion?
A: Yes, skin that is kept moist is less likely to break down. However, do not put skin lotion in the wound. If you have dry skin, please ask the doctor for a recommended product.
Q: What kind of skin lotion does the Orange Regional Wound Healing Center suggest?
A: Suggested lotions are any kind of lotion that is an emollient, which puts moisture back into the skin instead of covering the skin as another layer. Do not use petroleum jelly because it forms a separate layer. Ask your wound care physician or pharmacist for the types of emollients suggested for use.
Q: Will the sun's rays or a sun lamp help my skin?
A: No. These will dry out the wound bed and the goal is to keep the wound bed moist. In addition, skin may be burned and cause other problems.
Q: What does it mean if an area of my skin changes color?
A: Some skin changes are not harmful, but others, like redness, can be a sign of problems. Inspect the skin around the wound daily for any changes. Show any changes, especially redness, promptly to your wound care physician.
Q: Can I use betadine, alcohol, or hydrogen peroxide on my wound?
A: No. We do not recommend these solutions because they can kill healthy cells.
Q: What other things should I be reporting to my wound care doctor?
A: Please inform your doctor of any of the following:
- Pain from your wound
- Increase in drainage from your wound
- High blood sugar, if you are diabetic
- Redness in the skin around your wound
- Bleeding from your wound
- Changes in your body temperature, blood pressure or mental orientation
- Need for dressing supplies
- Any new wounds you find on your body
- Any changes in your medications
- Difficulty in completing the prescribed dressing changes
- Any questions or concerns you have about your wound care
Q: Is treatment covered by my insurance?
A: While Orange Regional Wound Healing Center accepts most insurance plans, it is recommended that you check with your insurance company to verify specific benefit coverage before wound care treatment.
Q: I am covered by Medicare. Do I need a physician’s referral to be treated at the Wound Healing Center?
A: If you are covered by Medicare, a physician’s referral is not necessary for our staff to treat your wound. You may walk into our Center and ask for a consult. Please note that other insurance companies may require a physician’s referral and we always suggest that you check with your insurance company to confirm your coverage and what is needed. Our staff will gladly assist you with this.
For additional information, contact our Wound Healing Center at (845) 333-7700.
The information provided in the “Frequently Asked Questions” is not considered to be medical advice, and should not be treated as such. The information provided is general information and is not a substitute for medical advice given for a specific condition after considering a complete history and physical. If you have specific questions about any medical matter you should consult your doctor or a professional healthcare provider.