What We Truly Need

The 2019 Symposium on Advanced Wound Care (SAWC) Spring, held in San Antonio, Texas, is now history. The meeting was well-attended and had stimulating lectures. It was the place to be if you wanted to learn up-to-date information about taking care of patients with wounds. The poster hall was a source of information and a chance to see innovative research in our field. Many used SAWC Spring as an opportunity to plan for future meetings and research. The meeting also gave everyone time to get together with colleagues and catch up on what is going on in the real world of wound care. There is always something new and exciting to see and hear in the exhibit hall. Personally, I enjoy visiting the smaller booths to see what the companies with only 1 or a few products have to offer. You might be surprised with what you might find tucked back in a corner of an exhibit hall!

With all the new products and new devices available, will we find the one that will truly change the way we treat patients with wounds? The answer is probably not. Many of the new products and treatments are just modifications or improvements of older ones. I think we are all waiting for the next breakthrough in understanding and treating wounds. Unfortunately, it may not be on the horizon, because we may be looking in the wrong place.

A few years ago, I was asked to meet with a group of investigators and researchers to tell them about my would-be “dream treatment” for wounds. I said we needed a dressing that would cure every wound with 1 application within 7 days and, of course, only cost $10. You can imagine the response that comment received. As I described to them the challenges of wound healing and the need to address the problems that caused wounds to be slow to heal, I realized we had no real idea of what we needed. An article by Dr. Gerald Lazarus and other prominent researchers and clinicians addressed what research they felt was needed for the future treatment of chronic venous ulcers.¹ All agreed we need research with better strength of evidence than currently available. When it came to treatments for the venous ulcer, their recommendations for research fell into 3 categories: (1) wound dressings, (2) venous surgery, and (3) systemic antibiotics. What would provide the best evidence-based treatment of venous ulcers in each category would be the goals of future research.

I was somewhat disappointed to read their recommendations. In my opinion, more dressings and treatments may not be what we need, at least at first. Rather than just make more products, why not do the research to find the underlying causes of the venous ulcer? Then, we could make the products or design the treatments to adequately treat them. Rather than just throw a multitude of products at a wound to see if something helps, would it not be more cost effective to first identify the problem that needs treating? An example, at least for me, is the question about venous ulcer etiology. Of course, venous ulcers are associated with venous hypertension, but what about venous hypertension actually causes the skin to break down and form an ulcer? We have been told that excess capillary pressure can result in ischemia, causing the skin to die. Sounds reasonable, but then we have been told there are fibrin cuffs forming around capillaries that cause a problem, but again, maybe not. The most recent thought I have heard is that elemental iron from lysed blood cells in the tissue cause an inflammatory reaction that damages the tissue and results in cell death. Well, which is it? Each of these pathologies requires a separate and unique treatment. Why can’t we invest in the basic science research to find the problem before we run off making multiple expensive treatments that may or may not have any effect?

I understand there is very little money in basic science research compared with what there would be if the “magic” treatment for venous ulcers was found. But how much money are we wasting until we find the answer? It seems to me we are getting the cart before the horse, but what do I know? I shall still attend the SAWC and search the exhibit hall in hopes that what we truly need to treat our wound care patients will be there someday. I’m betting on the next SAWC Fall in Las Vegas!

Terry Treadwell, MD, FACS
woundseditor@hmpglobal.com