Who, Me?

Everyone knows the treatment of chronic wounds can be difficult. If it were easy, there would not be so many different approaches and products with which to treat wounds. Recently, while reading a few articles, I was somewhat surprised to see several authors directly pointing to the provider as a cause of chronic wound healing issues. In one article, the author said, “…chronic wounds typically occur in patients afflicted with inappropriate wound care.”¹ Two others noted that management of chronic wounds should be mindful of contributing factors by the provider that result in delayed healing, such as knowledge, skill, and access to treatment options.^2,3 At first, I thought that was a bit harsh. However, as I thought about some of my recent experiences with patient referrals, I began to realize there is a place for providers who take care of patients with chronic wounds to be better educated.

It has been known for many years that wet-to-dry dressings are considered “substandard” and “inappropriate” for the treatment of wounds, yet they remain the most common dressing in use.⁴ I was reviewing some records of a wound care physician who was using negative pressure therapy to treat a foot wound following a toe amputation. When asked why they were using that treatment, they responded that it would make the wound heal faster. When the questioning persisted by asking how negative pressure would make the wound heal faster, their only answer was “by sucking on the wound”—they had no idea how negative pressure worked! This general surgeon had been practicing wound care for more than 5 years, was certified in wound care through a major company’s wound care training program, and was even “board certified” in wound care. I began to realize that there may be a need for all of us to dedicate ourselves to learning more about the wounds we are treating and treatments we are using.

We know that wound healing involves a process that is complicated, precise, and stepwise. Everything must happen in exactly the right order and at the right time if healing is to occur. In the chronic wound, there are many things that can interfere with the process, and it is our job as wound care providers to identify these problems and provide the appropriate therapy to get the process back on track until the wound is closed. To effectively do this, we must be able to identify what is preventing healing and know what treatments can reverse those issues. Obviously, we must be willing to spend the time to learn all we can about the phases of wound healing, the problems that can interrupt them, and how to recognize them. Remembering that one size does not fit all, we must be willing to learn about the more than 6000 dressings in various categories available to help correct these problems.⁵ Once we are familiar with what is available, we must learn how each dressing works so that we can choose the most appropriate product for each wound problem and use it correctly. This is not an easy or quick process. It is a daily task to which each of us should commit to so that we can be considered part of the solution to healing chronic wounds, not part of the healing problem

Terry Treadwell, MD, FACS 
Editor-in-Chief, Wounds
woundseditor@hmpglobal.com