A Physical Therapist’s Perspective on Select Wound Care Topics: Insights from SAWC Fall

Szu-Ping Lee, PT, PhD, faculty at the most recent Symposium for Advanced Wound Care Fall in Las Vegas, NV, touched down with Podiatry Today about his lecture, and his perspective on select wound care topics related to orthotics and prosthetics, and clinical practice guidelines. Dr. Lee is an Associate Professor at the University of Nevada Las Vegas in the Department of Physical Therapy. 

Q: From your physical therapy point of view, how can clinicians work to balance the functional gains that one might get from orthotics and prosthetics, but still balance that with acknowledging the risk of skin breakdown that can sometimes come along with that?

A: Dr. Lee acknowledged the importance of this concept. He said that first one should work carefully with the individual or entity who makes the device, as the custom nature of these devices makes the fit crucial. 

“Interdisciplinary communication in that regard is really important,” he added.  

Dr. Lee then related a clinician’s question he encountered after his lecture about persistent friction of a prosthesis socket. He shared that this is the perfect example of when to work closely with the prosthetist, but that the wound care specialist’s understanding of friction reduction here is also key. He went on to say that patient and family involvement in skin checks and skin care is an additional part of the team approach, particularly for those with impaired vascular function and skin integrity.

“We see that in physical therapy as well,” he explained. “The patients don’t come (only) to exercise in the PT session, (they have) home exercise programs that they have to follow.” It is important for the patients and their family to know what to do when they encounter skin issues associated with treatment such as exercising with a prosthesis.

 Q: Can you share any pearls in managing that skin-device interface that might have a positive impact that clinicians could use in their practices?  

Dr. Lee shared that the skin-device interface is dynamic, especially due to changes in the volume of the residual limb after amputation.

“It can swell, it can shrink, the muscle will become atrophied and make the volume smaller, and that is normal” he said. “So, in that situation, we at least need to recognize that the management of the interface is a dynamic process. So it's never one device (that’s) made for life. And patients need to understand that.”

Q: Is there anything else you'd like to add that has to do with your session on from SAWC?  

A: Dr. Lee explained that research and development is ongoing in orthotics and prosthetics, and that hopefully this dynamic process will result in upcoming innovations. He shared that heat and moisture retention could one day be mitigated by engineering breakthroughs such as cooling pipes on the prosthetic socket to bring heat away from the device and the skin. 

“But right now those are still in somewhat early stages, still in development, but I think we are going to see a lot of new devices and new solutions in the coming years. The rapidly advancing technology and treatment options further emphasize the need for a clinician to constantly communicate with the other members of the care team.” he said.