New Year’s Resolutions In Wound Care: Reflections And Looking Forward

Q:What do you feel you have learned the most about, or, what has had the most impact on you in your wound care practice in 2021?

A:

Most of the panelists cite the COVID-19 pandemic as a common thread impacting their wound care practices last year. Kazu Suzuki, DPM, CWS shares that patients deferring care and mental stress on both patients and health care workers were dominant themes. He adds that his hospital system is over capacity and has been for months. Christine Miller, DPM, PhD, FACCWS, CWSP says that although her team routinely faces challenges due to socioeconomic issues, the pandemic led to the extra burden of staffing shortages.

“We have learned that a dedicated team mentality is key to healing, despite facing many hurdles,” she says.

Karli Richards, DPM, FACFAS, CWSP relates that, for her practice, patient fears of medical clinics and hospitals due to COVID-19 had the biggest impact in 2021. She says that many hospital admissions resulted from patients not following through on routine care or wound care visits, in part due to fear of COVID-19.

“When these patients finally make it to our ED, they are septic and usually end up losing part of the foot or the leg,” she explains. “Last year was devastating for patients with diabetes and foot concerns. I have seen too many preventable diabetic foot ulcers lead to below-knee amputation and even death from sepsis in 2021.”

Patrick McEneaney, DPM, FACFAS shares that a focus on educating non-podiatric colleagues had a significant impact for him last year.

“I have been working with local wound care doctors to educate them on what I can do surgically to help their patients,” he continues. “Most wound care docs by me are not surgeons and they don’t know how a simple flexor tenotomy or extensor tenotomy and capsulotomy can help their patients with ulcers. I educated them on how hallux limitus affects pressure and ulcer formation and then performed a simple cheilectomy to get motion back. Lastly, the tendo- Achilles lengthening or gastrocnemius recession are extremely powerful procedures for forefoot and midfoot ulcers.”

Q:What are you most excited about and/or what would you like to aim for in 2022 in your wound care practice?

A:

Dr. Richards feels that, in 2022, it is essential to decrease “COVID fear.” As patients with diabetes need close monitoring to prevent severe infections, she would like to see increases in patient education about the importance of diabetic foot care.

“I would aim to encourage COVID-19 vaccinations and boosters for all of our patients with diabetes so that they feel more comfortable coming to their podiatry and wound center appointments,” she adds. “Preventative care and education is key for 2022.”

Dr. McEneaney is looking forward to adding new and exciting ancillary services to his wound care practice. He points out that innovative technology continues to become more mainstream and that wound care has evolved beyond simple application of an ointment or use of a skin substitute. He cites modalities used to assess blood flow to a wound, alternative debridement methods and testing to check bacterial burden as options he finds optimistic. Additionally, he says having a pedorthist on his team will likely have an impact in 2022.

“I have found that so many wounds are not appropriately offloaded,” he explains. “Patients have simply been dispensed a surgical shoe or CAM walker boot, many without any type of offloading within the device. There is so much more that can be done in the acute phase. Additionally, I like to focus on ulcer prevention after the wound heals. Modifications like rocker-bottom shoes, offloading cutouts in the shoes, and solid ankle cushioned heel (SACH) modifications are just a few of the things that can be performed besides custom molded inserts.”

Other panelists are looking forward to new research efforts. Both Dr. Suzuki and Dr. Miller share upcoming initiatives focused on limb preservation.

Q:What solution to a problem in the realm of wound care/ limb preservation do you hope will find a solution in 2022?

A:

Dr. Suzuki feels that changes in 2022 are more likely to take place on a gradual basis.

“I do hope to work on better peripheral arterial disease (PAD) screening and diagnosis, as well as better awareness of wound care and limb preservation among patients as well as health care professionals, such that, the patients in need are referred to us sooner, where we can make more positive impact,” he says.

Dr. Miller hopes that focusing on strengthening a multidisciplinary team approach, that her practice will continue to improve patient outcomes. She shares this could include enhancing educational and support programs with a mindset towards prevention.

The ability of patients to obtain appropriate offloading diabetic shoes and insoles is a problem that Dr. Richards would like to see a solution to in the upcoming year. She points out that the many hoops that patients and providers have to jump through for patients to obtain these devices is arduous even under the best of circumstances. As a prescription from a podiatrist alone isn’t enough, she finds that obtaining supporting certification statements from primary care physicians often takes months or may not happen at all.

“At that point, the patient has given up and does not get the required shoes,” she says. “This can lead to more ulcerations, infections and hospitalizations. If we could find a solution to the diabetic shoe prescription problem in 2022, it would greatly benefit our patients and decrease diabetic foot infection rate and hospitalizations.”

Turning the discussion to venous insufficiency care, Dr. McEneaney thinks compression garments are still a significant challenge. Accordingly, he hopes that this year will bring a new option that addresses patient and provider concerns.

“Many patients are not able to effectively don the garments themselves,” he says. “Compressive wraps are helpful, but they can slide down, causing additional pressure on the skin. I find FarrowWraps (Jobst) to be the most successful, but they can be very expensive and buIky. I still feel that there is room for improvement. I hope to see a new style compression garment that is affordable, easy to get on, and comfortable.” 

Dr. McEneaney is a Fellow of the American College of Foot and Ankle Surgeons and the President of the Illinois Podiatric Medical Association. He practices in Crystal Lake, Ill.

Dr. Miller is a Fellow of the American College of Clinical Wound Specialists and is Co-Director of the Limb Salvage program at the University of Florida, College of Medicine – Jacksonville, in Jacksonville, FL.

Dr. Richards is a Fellow of the American College of Foot and Ankle Surgeons and is a Certified Wound Specialist Physician. She practices in Chambersburg, PA.

Dr. Suzuki is the Medical Director of the Apex Wound Care Clinic in Los Angeles. He is also a member of the attending staff of Cedars-Sinai Medical Center in Los Angeles. He can be reached at Kazu.Suzuki@ cshs.org.