Making An Impact On Chronic Wounds

The avalanche of bad news is unrelenting. The medical malpractice crisis seems to be getting worse. In addition to the 18 states already declared as “crisis” states by the American Medical Association, physicians in another 26 states are facing escalating insurance premiums as well, according to a recent article in The New England Journal Of Medicine. Combine that with dwindling reimbursement for services and even the most dedicated physician would be hard-pressed for an optimistic view. However, in the midst of all this depressing news, there is a very intriguing study that reaffirms the impact that podiatrists are having on the lives of their patients. The study, which was recently presented at the International Diabetic Foot Symposium in the Netherlands, screened over 6,200 diabetes patients at risk for foot ulceration and enrolled 600 in the final analysis over a three-year period. Co-authors Dr. Margaret van Putten and Dr. Nicholas Schaaper found that patients had lower mortality, faster ulcer healing, less severe ulcerations, fewer major surgeries and a 75 percent reduced cost of care when they were treated by podiatrists. It’s on this very uplifting note that we present our Third Annual Wound Care issue, perhaps our strongest theme issue to date. Check out this month’s cover story, “Expert Tips On Wound Bed Preparation,” which is penned by Alexander Reyzelman, DPM, the Chairman of the Department of Medicine at the California College of Podiatric Medicine, and co-author Justin Tidwell, DPM (see page 30). These authors underscore the importance of this essential foundation for successful wound healing and offer an array of practical pearls from their experience. Gary P. Jolly, DPM, the President-Elect of the American College of Foot and Ankle Surgeons, and co-authors Peter Blume, DPM, and Thomas Zgonis, DPM, offer an informative take on soft tissue reconstruction procedures in “A Guide To Closure Techniques For Open Wounds” (see page 40). For example, they discuss how advancement flaps can be utilized to close wounds on the forefoot and large defects. Alan J. Cantor, DPM, emphasizes a case-study driven approach that shows how you can apply these dressings in different clinical scenarios. In his article, “Achieving Adjunctive Success With Wound Dressings,” Dr. Cantor guides the reader through the decision-making process of his wound care team in some very challenging cases (see page 50). In a thought-provoking Point-Counterpoint feature (see page 64), Jason Hanft, DPM, and colleagues square off against Guy Pupp, DPM, and Mark Hellmann, DPM, in debating the cost-effectiveness of tissue replacements. Dr. Hanft and his co-authors point to studies that show the shorter healing times of these modalities and the reduced risk of costly complications. Drs. Pupp and Hellmann counter by detailing scenarios for the potential misuse of tissue replacements and a few persuasive factors that may contribute to improper use. Given the potential ramifications of untreated Charcot arthropathy, John Steinberg, DPM and Pamela Jensen, DPM, provide this month’s continuing education article, “Managing Ulcers On The Charcot Foot” (see page 73). Strongly emphasizing the need for proper diagnosis (especially in differentiating between Charcot and osteomyelitis), the authors address the topic with a pointed efficiency and thoroughness. I’d like to thank all of the authors for their contributions and I’d like to thank all of the readers who continue to fight the good fight in the face of very tough obstacles.