Different Perspectives On Debridement And Wound Flora Identification
- David G. Armstrong DPM MD PhD
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Looking at medical disciplines outside of podiatry may give us new perspectives in our approach to wound care.
I was having a chat recently in New York with Marjana Tomic-Canic, PhD, a Professor in the Department of Dermatology at the University of Miami. It triggered an idea that we'd discussed some years ago but I think it rather apropos now.
Perhaps we need to treat wounds in the manner that our Mohs surgery colleagues treat lesions: debride wounds back to clean margins. Obviously, we have discussed and written a great deal about appropriate technique in surgical debridement. However, as we have said for the longest time, we cannot manage what we cannot measure.
Getting accurate bedside “theragnostics” can help us identify when we have margins that are ready to accept cell signaling from the matrix and can cease debriding the wound. I think this era is rapidly descending upon us.
Another potential innovation in the wound care realm concerns flora identification. We at the Southern Arizona Limb Salvage Alliance (SALSA) have been suggesting for some time that we must move beyond the antiquated “Louis Pasteur” method of identifying flora to a “CSI (Crime Scene Investigation)” molecular model.
While Pasteur gave us the germ theory, it seems abundantly clear that what we are identifying is not representative of an entire community. It seems entirely feasible that we may, in our molecular probes of the wound microbiota, identify an “H. pylori for wounds” much as a pioneering group of clinicians and microbiologists did so in Perth, Australia a generation ago for the stomach. This article in Nature News (http://bit.ly/fqXGUy ) summarizes things quite nicely.
This blog has been adapted with permission from previous blogs that originally appeared at www.diabeticfootonline.blogspot.com .