Wound centers can offer greater expertise and improved outcomes
Concentrating resources can boost care
A decade ago, the notion of special centers devoted to caring for chronic wound patients was unheard of. Today, a sizable industry is building itself around the core of wound care, and clinics are central to its growth.The concentration of specialized resources at these centers has served to advance the knowledge of wound care and to provide comprehensive care in an area of medicine that is often disjointed and full of conflicting notions of proper protocol.
"Wounds have been lumped together as a wound is a wound is a wound,’ so a venous stasis ulcer is often treated the same as a diabetic ulcer and a pressure ulcer," says Jeffrey Jensen, DPM, director of the Diabetic Food and Wound Center in Denver. "A lot of wound care is product-oriented — mainly dressings — and I think that’s because wound care is not taken as seriously as it needs to be. Dressings are adjunctive therapy to the rest of the needs of the patient."
Jensen stresses that wound patients must be evaluated and treated systematically in order for wounds to heal. Without a comprehensive approach to care, wounds won’t heal regardless of the dressing applied. For example, if a patient with a pressure ulcer is not rotated to relieve pressure on the lesion, healing will be suppressed.
Wound care centers facilitate the application of a more holistic and therefore more successful approach to healing wounds, Jensen says. A key component is the coordination of multiple disciplines made practical by a wound center’s concentration of specialists.
At Jensen’s clinic, for instance, a patient with an infected diabetic foot ulcer and some degree of peripheral vascular disease will undergo wound debridement followed by an evaluation by an endocrinologist. A vascular surgeon might then be called in to revascularize the affected area. "All along we have infectious disease specialists involved to ensure that we’re taking care of the bacteria in the wound," Jensen explains.
After discharge, home health care takes over. If necessary, patients make regular visits to the clinic and also may see physical and occupational therapists. When healing is complete, a pedorthist fits the patient with appropriate shoes and inserts to decrease the chance that a wound will redevelop.
"If everybody cooperates and provides the portion of the treatment that they know best, then the patient’s needs will be met," Jensen says. Failure to put the pieces of the wound care puzzle together properly can prolong patient suffering and cost inordinate amounts of time and money, he adds.
Many times, diabetic patients entering Jensen’s clinic have been under home health care for many months with no signs of wound healing. Often it turns out that the patients never received appropriate vascular work-ups or other crucial evaluations. Once a complete patient work-up is done and the right specialists are brought in to correct the blood supply problem, the wound often heals quickly, Jensen says. "But we’ve lost six months because the patient was not properly triaged to the proper facility," he adds.
The proliferation of wound care centers has helped to dispel many of the lingering misconceptions and reduce the treatment errors related to wound care, says Bruce Mast, MD, a plastic surgeon and director of the Shands Wound Clinic at the University of Florida in Gainesville.
"All of the centers, whether they’re associated with a university or are free-standing centers, have a staff that is devoted to wound care, whereas treatment out in the community is often suboptimal because the physicians don’t have much training in wound care," he says.
One of the biggest problems is that many clinicians improperly select wound dressings or apply one type of dressing to all wounds, Mast says. And he still sees questionable practices, including the use of topical agents such as diluted bleach and betadine solution on wounds, both of which are toxic to the cellular healing process.
But Mast also acknowledges that many important advances have occurred in recent years, such as the understanding that a moist wound environment is better than a dry one for promoting healing. Such knowledge tends to radiate from specialty wound care centers, which help disseminate the latest information to wound care clinicians throughout the country.
As have so many wound care specialists, Mast sees many patients come into his clinic with wounds that have not healed for months or even years. Often, the previous care was provided by physicians and nurses whose best efforts failed because they were not trained in the latest wound care techniques. Wound care centers are poised to help alleviate the dearth of knowledge.
"The growing interest in wound care will make the situation for patients better," Mast says. "At our center, we have a large volume of patients coming into a controlled setting, and we have an ability to study these new dressings and modalities to see what really works."
For the next several years, the number of specialized wound care clinics will explode, Mast predicts, along with a commensurate increase in the amount of wound-related advertising, and a major push by the pharmaceutical industry to find chemical agents that accelerate wound healing. "I hope the continued growth in the field will result in better and more appropriate treatments but at the same time is absent of any type of gimmickry, which is a danger when a field becomes commercialized," he says.
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