Massachusetts Medical Society's Physician Focus

January 2012

Wound Care

PROGRAM HIGHLIGHTS:

  • A chronic or non-healing wound is one that does not start to heal from conventional treatments within two weeks and is not completely healed within four weeks.

  • Some 8 million Americans have chronic wounds, with the highest incidence of those among patients with diabetes.

  • Besides diabetes, conditions such as venous disease, poor circulation, immobility, and injuries from radiation can lead to chronic wounds.

  • Besides leading to a poor quality of life, chronic wounds can result in amputation if not treated appropriately.

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The human body has a wonderful ability to heal itself normally from injuries and wounds, but certain conditions can impede the healing process. These conditions can result in chronic wounds, and those may require specialized treatment at wound care centers.

Evan Provisor, M.D., a board-certified general surgeon and Medical Director of The Wound Care Center at Harrington, part of Harrington HealthCare System in Southbridge, Massachusetts, defines the problem clearly: “A chronic wound is one that has not started to heal within two weeks and is not completely healed within four weeks.”

Dr. Provisor and Susan Proulx, B.S.N., R.N., Program Director of The Wound Care Center, were guests on the January edition of Physician Focus, describing the specialized area of wound care and how such care is provided at their facility in Charlton, Mass. The discussion was led by program host Bruce Karlin, M.D., a primary care physician.

Some eight million Americans are thought to have chronic wounds, with many of those in patients with diabetes, a disease that affects circulation and the nerves. “Many people with diabetes don’t feel pain, particularly in their feet,” Dr. Provisor says, “so any injury from, say, shoes that are too tight or even stepping on a nail, might go unnoticed. These conditions can fester and form dangerous infections.”

He also noted that chronic wounds can affect those with venous (vein) disease in the legs; those with paraplegia and spinal cord injuries; and people with injuries from radiation, such as those receiving treatments for cancer. Circulatory problems can also present problems, and smoking is a big factor as well, as it puts carbon monoxide into the body, which impairs the delivery of oxygen to tissues, thereby hindering the healing process.

A facility like The Wound Care Center at Harrington is a dedicated treatment center that offers an approach to wound care beyond what a physician may be able to offer in his or her office.

“We take a very comprehensive, coordinated care plan approach,” says Ms. Proulx. “We go through each wound, each patient. We’re looking at vascular and circulatory issues. We look to see if there’s inflammation, edema (swelling), dead material that needs to be cleaned away, or an infection that needs antibiotics.”

“Education is also a big part of our treatment,” says Dr. Provisor. “Nurses spend a tremendous amount of time educating the patient, establishing goals, and working with other agencies, such as visiting nurses.”

Besides ready access to physicians and nurses, a wound care center can offer special services, such as debridement or removal of dead skin or tissue, and orthotic services – especially important for diabetic patients -  which provide custom footwear, temporary foot aids, or custom inserts.

The center also offers advanced dressing materials, temporary casts, temporary skin grafts with artificial skin to promote healing, and hyperbaric (high pressure) oxygen therapy, a treatment where the patient, inside a sealed, pressurized chamber, breathes 100 percent oxygen, increasing the concentration of oxygen in the bloodstream, which promotes faster healing and lowers the risk of amputation.

While Dr. Provisor urges patients with non-healing wounds to look into specialized wound care, he also promotes prevention, especially for those with diabetes or venous disease. “Prevention is really critical,” says Dr. Provisor. “If you have diabetes, look at your feet at least twice a day, because you may not be aware of an injury. If you’ve ever had blood clots in your legs, pay attention to that.”

Ms. Proulx concludes with solid advice: “Our skin is our first line of defense for our body. Take care of it.”

Watch the accompanying video for the full discussion, including conversation about how health care professionals measure healing, the details of treatment with a hyperbaric oxygen chamber, and other advantages of specialized wound care treatment.

Text:
MMS/Richard Gulla

ADDITIONAL RESOURCES
Association for the Advancement of Wound Care

The Wound Institute

Diversified Clinical Services

Harrington Hospital Wound Care Center

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Wound Care PSA


From left: Bruce Karlin, M.D.; Evan Provisor, M.D.;
Susan Proulx, B.S.N., R.N.
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