It’s Time to Do Battle

For the past several weeks, I have had the opportunity to travel all around attending wound care meetings. From the World Union of Wound Healing Societies meeting in Florence, Italy to the Symposium on Advanced Wound Care (SAWC) Fall in Las Vegas, Nevada, to the Clinical Congress of the American College of Surgeons meeting in Washington, DC, and to the High Risk Diabetic Foot Conference, the Desert Foot in Phoenix, Arizona, I have been with people interested in wound care.  As we have discussed in this column and other venues in the past, it seems that most feel they have a good understanding of how to treat wounds based on either what they learned in school many years ago or what has worked for them recently. Unfortunately, evidence-based information seems to have little to do with some of the providers’ practices. The quotation from Jessamyn West seemed to have more meaning at some of these meetings than I thought possible: “We want the facts to fit the preconceptions. When they don’t, it is easier to ignore the facts than to change the preconceptions.” 

I think it may be time for us to change our approach to wound management. It is time we approached wound evaluation and treatment as seriously as if we were going into battle; no more “Mr. Nice Guy” approach. If we were going into battle, we would want to do 2 things before committing to any action: 1) We would want to know as much about our “enemy” as possible, and 2) we would want to know what we had to “fight” the enemy and how each “weapon” could be best utilized. 

For the first, there is no question that defining the etiology of each wound is critical if the appropriate treatment is to be applied. If you think you can identify all wound types just by looking, I would encourage you to attend the Unusual Wound lecture given by Dr. Robert Kirsner at most every SAWC meeting. This may be a humbling experience to those who think they can identify all wound types! Beyond that, we must remember that we are treating the “whole patient” and not just the “hole in the patient” (Dr. John Macdonald). We must know every factor involving the patient that might affect our treatment. We quickly think of diabetes mellitus and some of the other chronic illnesses, but don’t forget medications, genetic issues, social issues, and the myriad others problems influencing your treatment. 

We also must learn what is going on in the wound itself if appropriate treatment can be done. Bacterial content, protease levels, healthy cells, and blood supply both from the large and small vessels must be considered. Unfortunately, we currently don’t have ways to check everything we need to check, and, in some cases, we don’t know what we need to check! More basic science research is needed so that every factor affecting healing can be identified. Until that occurs, we are at a great disadvantage when trying to treat these hard-to-heal wounds. 

The second thing we need to do is to learn about the “weapons” we have at our disposal in order to treat the wound. We must become familiar with each class of dressing and bandage available so that we can appropriately choose what is needed to treat that particular problem with the wound. Most dressings will do specific things for the wound and wound bed. If we choose the wrong one, we are doing nothing to heal the wound. It is surprising how little some practitioners know about the products they are using. We know many of the new dressings are very expensive, so choices must be made wisely. I have commented that the most expensive dressing that can be used is one that does not work!  

As we look to the future, I hope that we will all take a more aggressive approach to identifying, evaluating, and treating wounds. It is time to plan our approaches as seriously as if we were going into battle — know everything we can about the “enemy,” get our researchers to provide us with more “intel,” and learn everything possible about our “weapons” so that we can “battle” our “enemy” effectively.