From the Editor: Lower-Limb Preservation

  We’re approaching the first official day of summer, but I still haven’t totally distanced myself from the chill of snowy Denver, where many of us recently participated in another magnificent meeting of the Symposium on Advanced Wound Care and the Wound Healing Society. We heard many great comments about the program, the venue, and the city. I’ve been inundated with phone calls, emails, and text messages from fellow providers, some of whom are calling the event our best ever! It truly was a great program that featured many new and returning speakers and clinicians who are all dedicated to helping their patients heal their wounds and improve their quality of life by, in many instances, preserving limbs.

Saving Limb ‘Salvage’

  To that end, with this issue of Today’s Wound Clinic, we too are focused on lower-limb preservation — the goal of all outpatient wound centers. Recognizing the presence of and making the commitment to address the limb-threatening diseases and comorbid conditions that our patients live with is essential to our decision-making as wound care practitioners. Peripheral arterial disease (PAD) of the lower limbs is an often-overlooked cause of poor wound healing (particularly among the elderly) and affects roughly 12-14% of the general population — with increasing risk associated with age. Michael Cioroiu, MD, FACS, CWS, and Jeffrey M. Levine, MD, AGSF, discuss other related risk factors, prevention methods, diagnosis, optimal wound care delivery, and alternative diagnoses to be entertained in the event of delayed healing beginning on page 18. Understanding the differences between those who provide endovascular services is becoming just as important as understanding the disease processes themselves. How should we choose interventionists when referring to cardiologists, radiologists, or vascular surgeons? Unfortunately, differences in quality will arise and people may claim to be “endovascular and limb-salvage specialists” with varying degrees of experience and knowledge. In an effort to guide providers through this maze, TWC editorial board members Desmond Bell, DPM, CWS, and Leah Amir, MS, MHA, have addressed strategies for defining and identifying appropriate endovascular services in your community. Read this piece, which begins on page 10, for vital information that readers need to know.

Proper ‘Heel’ing

  Helping our patients heal does not fully define the role of the wound care specialist. We need to help them remain healed, and when it comes to offloading or fitting for the right shoe post-transmetatarsal amputation, we should seek the services of a prosthetist or an orthotist. An expert on this topic, Amy Rosetta, CPO, LPO, makes a special contribution as an author to TWC with her article “Utilizing Orthotic & Prosthetic Intervention in Wound Care” beginning on page 14. This feature offers insight that will assist in writing the most appropriate prescription for your next patient, so be sure to check it out. As we gear up for SAWC Fall, our focus on limb preservation will gain a boost from an exciting educational collaboration with the PAD Coalition to co-develop a comprehensive, one-day track on critical limb ischemia (CLI). The PAD Coalition, an alliance of leading health organizations, vascular health professional societies, and government agencies that have united to raise public and health professional awareness about lower-extremity PAD, is a prime ally in the creation of “CLI 2013.” A major focus of the PAD Coalition is to raise awareness of CLI as well as the need for urgent medical care for this condition. Through the newly established partnership, SAWC and the PAD Coalition seek to improve the prevention, early detection, treatment, and rehabilitation of people with or at risk for CLI through continuing medical education beginning at SAWC Fall 2013.