Improving Care. Improving Business.

60,000 Miles

Mile 3: Let's Talk Pressure

On November 16th, 2017, the National Pressure Ulcer Advisory Panel (NPUAP) created an initiative to bring awareness to our communities by announcing a “celebration” of World Wide Pressure Injury Prevention Day. Celebration may not be the best word to describe this day; however, a simple increase in attention and renewed sense of urgency to lessen the chance of injury will be a move in the right direction. The logo created this year was a stop sign in hopes of bringing attention to this significant issue that is sorely in need of further education and awareness.


The following are some staggering figures regarding the state of pressure ulcer related injuries:

  • 2.5 million individuals in the US suffer with pressure injuries annually
  • Average US comprehensive cost of $9.1 billion to $11.6 billion per year for treatment
  • General average for Stage 3 pressure wound treatment can cost $5,900 to $14,840 (or more)
  • General average for Stage 4 pressure wound treatment can cost $18,730 and $21,410 (or more)
  • Hospital reimbursement is discontinued or denied for any charges related to hospital-acquired conditions, this included pressure injuries as one of the conditions.
  • Additional charges due to a pressure wound can be up to $700,000 if patient is hospitalized
  • Lawsuits regarding pressure wounds are increasing and can average up to $250,000


It is estimated that up to 60,000 Americans die annually as a direct result of pressure wound related complications.

Day to day management of their wound can also take a significant toll in many aspects of the patient’s emotional and mental quality of life which further impacts their wound healing. Sadly, the patients chronic wound and management of that wound can also take a toll on family and friends around them as they support and care for the patient. Many people may have encountered people throughout their life who have suffered with this unfortunate disease. As a wound care nurse, I see all these facts and figures listed above on a first-hand basis. I generally see patients after the wound has occurred or skin damage has happened. In a review of 76,435 pressure wound patients, the most common area for pressure wounds was the patient’s coccygeal region (47%), 17% were located on the buttock, 14% on the heel, and 13% were located on other bony prominences. When assessing patients, I begin not only with a wound assessment,but a much more detailed assessment, including nutrition, turning and positioning, moisture, friction and sheering, and comorbidities. Lastly, we factor in any other non-wound related patient specific information we need to review.

Each patient is different and requires individualized treatment modalities to meet their specific needs.

The attention to each patients’ wound is crucial and can be very time consuming. That is why the World Wide Pressure Injury Prevention Day was so refreshing. I spent my time at a level 1 trauma center where the wound care nurses and a team of chosen representatives and administration conducted a prevalence study on every patient in the hospital. They looked at every bony prominence, assessed every patient’s skin, and took their time to also review prevention, treatment, and make assessments of each patient admitted to their hospital. These staff members are such a great testament in making a commitment to pursue better patient outcomes. It was inspiring to see this commitment and I hope that sharing this experience can be my small part of spreading the importance of World Wide Pressure Injury Prevention Day.

PRUventor™ Heel Off-loading Device

In pursuit of better patient outcomes, my clinical assessment regularly includes documenting products used, this also means I get to utilize many different types of products on the market. DeRoyal has products available to help with prevention (or even treatment if that is needed) for multiple different pressure risk locations on the body. From heel offloading boots, protection boots and elbows protectors, cushion bed pads, wheelchair cushions, patient positioners, to advanced wound care products for those wounds that need treatment as well as protection.

Multidex Maltodextrin Wound Dressing

Please contact our Customer Service representatives at 1-800 DEROYAL for questions or be directed to a sales representative in your area.


Theresa Alvarez, RN,BSN,CWOCN

Theresa is the global wound care clinical specialist for DeRoyal. Her primary roles are to provide evidence and knowledge based support for the DeRoyal advanced wound care, burn care, and negative pressure wound therapy product lines. She is a clinical support for our sales teams and customers with assisting with product training, trials, implementations, and general assistance when requested.

This article is provided for informational purposes only and reflects the opinion of the author. For complete product information, including instructions for use, please visit our Medical Products section.

Mile 2: Jetox™ - a solution for patients who cannot tolerate sharp debridement

Have you treated or cared for a patient who could not tolerate sharp debridement due to pain intolerance? Or, have you found that the next step for a patient was to take them to the operating room to remove the devitalized tissues present on their wound bed? After almost a decade of being involved with wound care treatments, I know that this situation is very prevalent.

“With the introduction of Jetox™ into our clinic, we are now able to debride 5 patients on a weekly basis whom previously did not tolerate sharp debridement. What a godsend! I can tell you that patients are grateful for having found a modality which allows appropriate debridement with much reduced (or no) pain.”  Harvey Hashimoto MD, Medical Director, Lodi Health Wound Treatment Center, Lodi, CA

As many know, debridement is an appropriate treatment to transition a chronic wound to resemble an acute wound by improving the protease and cytokine levels. If a wound has necrotic tissues present, it is not considered a healthy wound bed, which can increase healing times for the patient. With sharp or surgical debridement being the quickest and most effective option for debridement, many patients have pain at their wound bed and cannot tolerate this option of debridement. As a clinician, we want these wounds to have the best chance at healing as quickly as possible. The less time it takes to heal, the less chance the wound has to get infected or cause further issues for the patient. Other options for debridement include autolytic, mechanical, enzymatic/chemical, and bio-surgical. I have listed some of the features of each type of debridement along with potential downfalls from each of these:

  • Autolytic debridement is the destruction of necrotic tissues that use the body’s white blood cells and natural enzymes to digest the devitalized tissues while leaving healthy tissues intact. This can be a very slow process, as some patients do not have a sufficient amount of white blood cells to complete this process. While this is the least invasive method of debridement, it can also be the slowest.
  • Mechanical debridement is a non-selective form of debridement. Force is used to manually remove a dressing with hopes that the necrotic, or non-viable, tissues are removed along with the dressing. This form of debridement can be very painful and, since it is non-selective, the chance of removing healthy tissues along with the non-viable tissues is high.
  • Enzymatic/Chemical debridement products dissolve necrotic tissues. Currently, there are only 1-2 products in the wound care market that meet standards for enzymatic debridement. From my experience, these products can also take a long time to reach the treatment goal, often requiring sharp debridement in conjunction. Another negative is that these products can be very expensive and many times are not covered by insurance.
  • Bio-surgical is the medical use of live maggots (fly larvae) for treating non-healing wounds. Medicinal maggots have three mechanisms of action, 1) they debride (clean) wounds by dissolving the dead (necrotic), infected tissue; 2) they disinfect the wound by killing bacteria; and 3) they stimulate wound healing. This process can be time consuming as well as not widely accepted by patients. Although it is an effective debridement tool, it is not widely utilized due to regulatory restrictions in many places.

Jetox™, a high powered jet lavage treatment from DeRoyal, allows for a debridement option that is effective in removing devitalized tissues without the use of extra tools or products. Your treatment options after debridement can vary based on the needs of your patient; however Jetox™ gives you a debridement option that is quick, with little to no mess and has been reported by patients to be virtually painless. Jetox™ is effective in removing unwanted necrotic tissues which helps stimulate the wound bed for healing purposes. This product does not require or need suction due to the minimal amount of fluid necessary to get the desired results and has been assigned a CPT code that may be appropriately billed in many settings.

Jetox™ is ideal for use on patients who cannot tolerate sharp debridement. It can also be used in conjunction with other therapies for debridement (e.g. primary dressing choices). Clinicians have mentioned how easy Jetox™ is to set up and use, but more importantly they and their patients have been very impressed by the results they are seeing with their wounds!

© 2014 DeRoyal Industries, Inc. All Rights Reserved. Jetox™ is used under license by DeRoyal.

Theresa Alvarez, RN,BSN,CWOCN

Theresa is the wound care specialist for DeRoyal. Her primary role is to provide evidence and knowledge based information on our wound care products and to assist in sales calls, product trials and implementations.

This article is provided for informational purposes only and reflects the opinion of the author. For complete product information, including instructions for use, please visit our Medical Products section.

Mile 1: The Vulnerable Ankle

I probably speak for more than myself when I say Fall is my favorite season. In addition to cooler temperatures and the beautiful changing color of the leaves, Fall means FOOTBALL! From youth to high school and collegiate to pro, thousands of athletes take to the gridiron to participate in this great American past time. Unfortunately, with the coming of Fall and football, also come injuries.

There is perhaps no other sport that places a higher demand on the body as football. While head injuries and concussions may have recently received the most attention, injuries to the lower extremity remain the most common football injury. In my twenty years of sports medicine practice and coverage of numerous high school and youth football games, injuries to the knee and ankle have by far proven to be the most prevalent and, in many cases, the most challenging conditions to manage. In addition to lost playing time for the player, these injuries pose a challenge for the healthcare practitioner working to rehabilitate the injured player and safely return them to competition.

In considering lower extremity injuries, torn ACLs (Anterior Cruciate Ligaments) and cartilage/meniscus damage that affect the knee may receive more attention due to the fact that in most cases these injuries result in surgery. However, it is the ankle sprain that is a more common problem. A sprain is the over-stretching of a ligament. Ligaments are connective tissues that connect bone to bone and are critical towards providing stability to a joint. In the case of the ankle, the lateral aspect is the most vulnerable to sprain. That said, medial sprains (primarily involving the Deltoid ligament) and high ankle sprains (involving the Syndesmotic ligaments) can also occur.

As a sports medicine clinician, my goal is to implement all the tools I have to effectively and safely return the athlete to play. In the case of a football player with an ankle sprain, bracing is a vital part of treatment. While I have and continue to tape many ankles, a quality ankle brace that can be easily donned by the player is typically included in all of my return to sport plans for injured ankles. Particular attention needs to be paid to the Subtalar joint given it is the joint in which inversion (the most vulnerable position for ankle sprains) and eversion occurs. Therefore, an effective sports ankle brace needs to incorporate design features to provide stability to this aspect of the ankle.

The DeRoyal® Element® Sport Ankle Brace with the Boa® Closure System is an excellent selection for ankle sprains and other foot & ankle related injuries. First of all, it is easy to don & doff and fits comfortably in a shoe/cleat. A brace is of no use if the player will not wear it due to poor fit or difficulty in applying it. Clinically, it provides sound Subtalar stability through its heel control strapping system and rigid medial and lateral uprights. This mimics components of a sound taping job of the ankle and protects against the all too common lateral ankle sprain. Lastly, the Boa® Closure System is unique and allows the athlete to easily adjust for a secure fit. This provides added compression to increase proprioception and comfort.

So, enjoy Fall, football, and throw a few of these braces in your training bag!

Boa® is a registered trademark of Boa Technology, Inc.

John D. Staley, III, PT, CSCS

John is a licensed Physical Therapist (PT) and Certified Strength & Conditioning Specialist (CSCS). His primary areas of practice include orthopedics and sports medicine. He is a Credentialed Clinical Instructor through the American Physical Therapy Association.

Web site:

This article is provided for informational purposes only and reflects the opinion of the author. For complete product information, including instructions for use, please visit our Medical Products section.

60,000 miles a year…

In the early days, our Owner and Chairman, Pete DeBusk, was covering this enormous territory while talking to countless customers and clinicians as a salesman. All of this time honing his skills and listening to what his customers and patients needed put him at the crossroads of innovating the cast boot, which would lead to the dream of starting his own company - DeRoyal.

Our goal with this blog is to continue our legacy of dialogue with our customer by offering relevant articles from expertise in the clinical and business world that will complement our products while opening up discussion and interaction.