Reconciling Combination Therapy With EBM: Where Do We Go From Here?

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Clinicians treated this wound with a combination of Panafil for odor control and debridement and VAC therapy.
When it comes to wound care, some of the issues that clinicians need to address include the edema, maceration and depth issues shown above.
By Kathleen Satterfield, DPM

   Combined therapies can also involve combining technological modalities. In the case of VAC therapy, some practitioners report using the VersaJet™ (Smith & Nephew) hydrosurgery wound debridement system for wound bed preparation prior to applying split thickness skin grafts, VAC therapy or synthetic skin replacements such as Dermagraft (Smith & Nephew) or Apligraf (Organogenesis).

Emphasizing Informed Choices About Combination Therapies

   Granted, the acceptance and expectation of EBM has rightfully become pervasive in the schools. While some practitioners may be reluctant to mix medications and modalities without research evidence, the reality is the majority of us still use the mainstays of medicine: our personal clinical experiences, recommendations from mentors and the never-ending pursuit for better answers.

   If indeed a combined therapy appears to be a better solution for a patient’s problem, it will be to the advantage of the medical community to examine it anew under the standards of EBM. However, until that point in time, what physician will turn his or her back on a better answer for a patient?

Dr. Satterfield is an Adjunct Clinical Associate Professor at the University of Texas Health Science Center at San Antonio.

Dr. Steinberg is an Assistant Professor in the Department of Surgery at the Georgetown University School of Medicine in Washington, D.C. He is a Fellow of the American College of Foot and Ankle Surgeons.


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