Health Break | Published June 6, 2011

Hope for Patients with Chronic Wounds

It's very troubling to see how painful and worrisome a non-healing wound can be for a patient. I often see patients who have withdrawn from normal activities due to a chronic wound that just refuses to heal properly. As a wound-care specialty physician, I see many types of non-healing wounds – some are associated with complications from diabetes or vascular disorders. Other wounds may be pressure sores, or those caused by traumatic injury, or late effects of radiation therapy. In all cases, the patient is greatly concerned about the condition of his or her wound and interested in getting it healed so they can return to their normal activities. Developing the optimal treatment plan for a chronic wound is best handled by a team approach where the patient's entire health status can be evaluated. Depending on the cause of the wound, the care team might include a wound specialty physician, nurse case manager, physical therapist, orthotist, diabetes educator, nutritionist, vascular surgeon, infectious disease specialist or a cosmetic and reconstructive surgeon. The patient's primary care physician is also a key member of the team, since many medical conditions – such as diabetes – must be well treated to facilitate wound healing. After an initial assessment, the team will outline the treatment plan and set benchmarks for progress, and discuss these with the patient, so all can work together towards the shared goal of healing the wound. Treatment choices for healing chronic wounds can vary based on the patient's condition and medical status. Patients with blood flow problems in their legs and feet might receive consultation with a vascular surgeon. Other treatment options can include wound debridement, compression therapy, topical treatments and negative pressure therapy. Diabetes-related foot wounds are common and require additional care. Often these patients will be referred to the Mount Nittany Diabetes Foot Clinic for care by a certified orthotist and a physical therapist who will devise ways to off-load the weight on the affected area. Sometimes the leg may need to be casted to protect the area and prevent further injury. Eventually, specialized footwear and patient teaching will be needed to prevent further wounds – both available through our Diabetes Foot Clinic program. The Diabetes Foot Clinic is co-located with the Wound Care Center, making care much more convenient for patients. Hyperbaric Oxygen Therapy (HBO) has become very popular as an adjunct treatment since many studies have proven the validity of this treatment in improving blood flow and circulation. HBO involves the use of oxygen at a level higher than atmospheric pressure. The patient getting HBO treatment is placed into a large pressure chamber where they breathe oxygen at a pressure greater than the atmosphere. This process delivers 15 times as much physically dissolved oxygen to tissues as breathing room air, which in turn promotes the formation of new capillaries into wound areas. Whatever the treatment plan, the goal in the end is to heal the wound and get the patient back to their normal level of activity. W. Stephen Barnes, MD, is the medical director at the Mount Nittany Center for Wound Care. www.mountnittany.org.

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