Reflections of a Wound Care Fellow: Notes From the Clinician’s Journal (Part 2)

When I last wrote Today’s Wound Clinic, I was in the midst of a 12-month wound care fellowship program at the University of Illinois at Chicago. I have since completed the program, and the passing of time has taught me at least two important lessons. First, I’m reminded that there is no better way to learn in the field of medicine than by exposing oneself to patients who require treatment. My wound care training allowed me to interact with a variety of patients. This experience, though not exhaustive, has given me confidence about my knowledge and skills as a clinician. The second lesson I’ve learned has been about the value of time itself; meaning that I’ve learned, along with my patients, what it truly means to say that wounds “need time to heal.” One patient in particular who had been living with ulcers on both his legs for more than one year quickly comes to mind. He was frustrated that the wounds had not healed after multiple follow-up visits at a previous wound care clinic. Looking back on how our staff started his workup, he required biopsies, venous reflux studies, arterial Doppler exams, and venous ablations. With continued wound care and compression, he has since healed. My last day of training was also his last follow-up visit, so I was able to say “goodbye” to him. He represents one of many patients who have joined me on this journey.

Fellowship Finality

The last six months of my fellowship further strengthened my knowledge and skills in wound care. I continued rotations among different specialties that play important roles in the understanding of chronic wound management. I spent one month with the general surgery staff, whereby I gained exposure to surgeries and patients in the hospital and outpatient settings. This experience provided insight into the care of surgical wounds as well as treatment of the complications that may arise from these wounds. This exposure also allowed me to practice and improve my technique as I assisted in wound debridement.

I learned that some wounds need to be managed surgically for closure. The plastic surgery rotation allowed me to appreciate the different types of flaps used for covering wounds and what the procedure involves. During my time with the plastics staff we cared for a patient living with incomplete quadriplegia, paralysis caused by illness or injury that results in the partial or total loss of the use of all four limbs and torso. Being on hand for the surgical flap coverage of the sacral and ischial pressure ulcers gave me an appreciation for the importance of a patient’s management from the initial workup, to the actual surgical treatment, and the follow-up care. During my orthopedic surgery rotation, I worked closely with a foot-and-ankle surgeon who taught me foot mechanics and how they relate to chronic wounds. Knowing that a wound may not heal, despite wound dressings and debridement, without changing a structural issue was especially eye-opening. I also had the opportunity to work with an orthotist who taught me the differences between orthotics and appliances used for offloading. Spending one full month with dermatology and dermatopathology staff members also exposed me to caring for patients living with various skin lesions and gave me a better appreciation of atypical ulcers as well as a better understanding of how important histologic findings are when biopsies are ordered. Finally, I worked in the physical medicine and rehabilitation department, during which time I learned about spasticity treatments and different assistive devices for ambulation.

Coming Full Circle

I started my fellowship journey with very little understanding of chronic wound care. I have since spent extended hours poring over notes and trying to understand how wounds should be managed. I have learned how to properly hold a scalpel blade to perform a debridement and how to apply a biological graft. I also found “my voice” — verbally and as a published author — which has helped me to clearly express my views with colleagues, patients, and peers. Everything that I’ve learned, however, has taught me to first assess for the cause of a given wound. Dressings are only secondary to identifying the underlying problem(s). I’ve also learned to always listen with a Doppler, as palpable pulses do not mean anything, and to always examine both extremities. There are no shortcuts associated with wound care, and if an answer is not immediately apparent, our duty to our patients dictates that we keep looking for the correct answer.

As I write this, a patient who has lived with ulcers secondary to lymphedema sits just next door to my office. She continues to lose weight and use her CPAP machine for sleep apnea. She also complies with her compression and physical therapy appointments for energy-based modalities. One room down from this patient sits a patient living with a diabetic Charcot foot ulcer that I previously debrided. Saying “goodbye” to these patients will be difficult. I take comfort in the fact that I have helped them move closer toward healing. They, in turn, have given me a clearer sense of my role as a wound care specialist. I am eternally grateful for the past year and look forward to what the first “official” year of my career in wound care will bring. 

Karen Imma Gellada is a former fellow for the section of wound healing and tissue repair at the University of Illinois at Chicago. She finished her family medicine residency at the University of Illinois College of Medicine at Peoria. She is board certified in family medicine and previously worked in primary care and urgent care.

Marissa Ruggiero is a gap-year student from the University of Notre Dame who’s matriculating to medical school in the fall and is currently working at University of Illinois at Chicago as a research specialists in the wound healing and tissue repair department.