What You Should Know About Starting A Wound Care Clinic
- Volume 21 - Issue 11 - November 2008
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Dr. Wu says a good pathologist can help confirm osteomyelitis and ulcers secondary to other possible underlying causes such as pyoderma gangrenosum and vasculitis. A good pedorthist will work with her patients on appropriate shoegear to alleviate pressure and help prevent ulcer recurrence. Dr. Wu also works with rheumatologists and diabetologists when necessary.
One day a month, a dermatologist visits Dr. Fife’s clinic to assist in the care of patients with vasculitis or wounds of unusual etiologies. She frequently performs biopsies for quantitative cultures and pathology.
However, Dr. Fife notes that she may also ask dermatology to perform biopsies and subsequently assist in managing the patients afterward. Dr. Fife points out that one of the best dermatopathologists in the country reviews her clinic’s specimens and he can also examine photos of the wound in context with the biopsy specimen.
Dr. Fife’s facility also has a monthly consult from a plastic surgeon, who sees all the patients who might be ready for flaps or grafts. She and the plastic surgeon see the patients together so she can present their cases. Often the patients are getting negative pressure wound therapy and she and the plastic surgeon will decide whether they have reached maximum benefit from that modality, and whether the patients are good surgical candidates since many have multiple comorbid conditions.
Q: Do you have any words of advice for those new to wound care practice?
A: Dr. Fife emphasizes teamwork. For example, she greatly relies on the judgment of her nurses and one also needs a good team of medical specialists including dermatologists, vascular surgeons, plastic surgeons, general surgeons and infectious disease specialists. Dr. Fife says it is important to work well with referring physicians to manage patients' underlying medical problems, and emphasizes regular communication with referring physicians.
While wound care can be rewarding, Dr. Wu notes patients are often depressed and frustrated with their condition. This can make communication difficult.
Dr. Wu also notes that the high-risk wound care patient population is often plagued with comorbidities and is prone to wound infections.
“Be patient and alert,” says Dr. Wu. “Wounds do not often respond to therapy despite our efforts so patience is a must. One should be alert to ensure the alleviation of other factors that may impede proper healing.”
Dr. Suzuki also emphasizes patience. He notes that some patients with wounds may not follow medical advice on matters like quitting smoking. Patients may also have comorbidities that prevent them from improving. He has been treating some wound care patients for two years with palliative care but they have avoided leg amputation, and they are happy about that.
Dr. Fife counsels those who are just getting started in wound care not to let new modalities obscure the fundamentals.
“I do not jump on every new thing that comes out. I am happy to try new products but they never substitute for good basic care,” explains Dr. Fife. “Sometimes we have to remind ourselves to stick to the basics. Learn the basics very well and then build on that foundation little by little.”
Dr. Fife is an Associate Professor in the Department of Anesthesiology at the University of Texas Health Science Center in Houston. She is the Director of Clinical Research at the Memorial Hermann Center for Wound Healing and Hyperbaric Medicine.
Dr. Wu is an Assistant Professor in the Department of Surgery at the Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science in Chicago. She is the Director for Educational Affairs and Outreach at the Center for Lower Extremity Ambulatory Research (CLEAR) in Chicago.