Current Insights On Treating Gangrenous, Odorous And Painful Wounds

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Clinical Editor: Kazu Suzuki, DPM, CWS

   “Wound dressings and the rules and regulations regarding their use and prescription seem to change almost daily,” says Dr. McGuire. “What we are all interested in are dressings that do what they say they do and are cost-effective for our clinics and our patients.”

   As Dr. McGuire says, some of the new cost-effective and efficacious dressings are hydrophobic dressings for microbial management and hydroconductive dressings for fluid management. He also cites a new collagen dermal template manufactured from sheep forestomachs, which may help wounds heal to the point where more costly tissue supplements may not be necessary. Regardless of the complexity of the dressing, Dr. McGuire emphasizes that offloading and protection of the wound surface, especially for podiatric patients, are still key.

   For Dr. Bell, dressings are still the least important aspect of wound care and are no substitute for addressing the underlying cause of a wound as the focus of treatment. That being said, he feels dressings should be comfortable for the patient and ideally should help maintain an environment that is conducive to optimizing certain aspects of wound healing, such as promotion of angiogenesis, autolytic debridement, and protection of the wound from the bacterial burden of the external environment.

   It is also important to minimize the number of dressing changes, especially when drainage is not a major issue, according to Dr. Bell.

   “A number of dressings perform optimally when they are changed every few days versus several times per day. This tends to make everyone involved happier and can be more cost-effective,” says Dr. Bell.

   Dr. Bell is a board certified wound specialist of the American Board of Wound Management. He is the founder of the “Save a Leg, Save a Life” Foundation, a multidisciplinary, non-profit organization dedicated to the reduction of lower extremity amputations and improving wound healing outcomes through evidence-based methodology and community outreach.

   Dr. McGuire is an Associate Professor and Wound Center Director at the Temple University School of Podiatric Medicine. He is a Fellow of the Academy of Physicians in Wound Healing and certified in wound care by the Council for Medical Education and Testing.

   Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo. He can be reached via email at .

   Editor’s note: For related articles, see the online case study, “Addressing A Gangrenous Fifth Digit,” at and visit the archives at .

1. Drucker M, Cardenas E, Arizti P, et al. Experimental studies on the effect of lidocaine on wound healing. Am J Surg. 1998; 22(4):394-7; discussion 397-8.

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