Making The Right Call In Wound Healing

Consider the dizzying array of choices one must make when a patient presents with a non-healing wound. In some cases, determining the etiology can be a daunting challenge. In their guest column for Diabetes Watch, Damieon Brown, DPM, and Javier La Fontaine, DPM, discuss the difficulties of detecting diabetic autonomic neuropathy and provide an illuminating case study that reflects the subsequent challenges of treating these patients for chronic wounds (see page 20). Within this month’s continuing education article, “How To Detect And Treat Infected Wounds” (see page 68), John S. Steinberg, DPM, Khurram Khan, DPM, and Jonah Mullens discuss post-op wounds and an array of possible contributing factors that range from obesity, smoking and less than optimal circulation in elderly patients to anemia, localized edema and malnutrition. Of course, discovering the true etiology of the wound is just one part of the puzzle. There are many other choices to be made as far as arriving at an appropriate treatment course and ensuring patient compliance. Given the numerous decisions clinicians make in providing wound care to their patients, we present our Fourth Annual Wound Care Theme Issue this month. Leading off the issue is our cover story, “What You Should Know About Nutrition And Wound Healing,” penned by Patricia Abu-Rumman, DPM, and Robert A. Menzies, BSc(Hons), MChS, SRCh (see page 36). Assessing a patient’s nutritional status may not be a standard component of an initial evaluation, but the authors make it clear that nutrition can affect a patient’s ability to heal from lower extremity wounds. Drs. Abu-Rumman and Menzies discuss key diagnostic signs, screening tools and other methods for determining if malnutrition is a factor and whether the patient should be referred for nutritional intervention. They also provide an insightful guide on various vitamins and minerals that can play a role in wound healing. Staying in the multidisciplinary mode, Alan J. Cantor, DPM, and Keith Burger, PA-C, provide the informative article, “How To Assess And Manage Burn Injuries Of The Foot” (see page 46). With burn wounds, the patient may be a little boy who has reached up and yanked a hot plate off a countertop. One may also see a fair share of elderly patients with more severe burn injuries due to poor agility, preexisting medical conditions, atrophic skin and/or other predisposing factors. In addition to providing a solid overview of the different depths of burn wounds, the authors discuss common complications of these injuries, like digital edema and contracture deformities of the MPJs, and offer insight into treatment options like skin grafts and flaps. While there has been a lot of buzz in recent years about more advanced wound healing modalities, appropriate wound bed preparation is essential in setting the stage for healing. Accordingly, Jonathan Moore, DPM, and Pamela Jensen, DPM, have written the feature, “Assessing The Role And Impact Of Enzymatic Debridement,” which takes a closer look at how papain-urea and collagenase-based debriding agents fit into the picture of wound bed preparation (see page 54). Rounding out our theme issue is the aforementioned continuing education article, which offers a thorough review of detecting and treating infected ulcerations and infected post-op incision sites, two of the more common infected wounds DPMs see in practice. If one thing links these disparate articles on wound care, it’s the authors’ practical approach. They take you inside their decision-making process for determining an appropriate treatment course and ultimately arriving at a healed wound.