From the Editor: A Call for Innovation

The July issue of Ostomy Wound Management for years has featured products and services to supply your care armamentarium. What began as our Buyers Guide (now available and continually updated at www.wounds360bg.com) became an opportunity to focus on specific innovative devices and unique approaches for the management and prevention of wound, ostomy, and skin problems. Medicine is as much art and creativity as it is science; our niche is a microcosm of the ingenuity and persistence needed to maintain and/or achieve health and healing. Clinicians in this field seem especially willing to try anything (using evidence-based methods, of course) when nothing seems to work.   Three feature articles in this issue underscore the importance of thinking out of (or adjunctive to) the standard care box. Campbell and Campbell’s retrospective review explores an older and oft-considered unconventional treatment: maggot therapy. When a patient is not a candidate for or not responding to more frequently used debridement strategies or the expense of antibiotics and potential for antibiotic resistance is high, pushing past the yuck factor may offer a feasible care option.

Somewhat more modern technology in the form of extracorporeal shock wave therapy, well-investigated for addressing musculoskeletal disorders, also can play a role in soft tissue healing. Taradaj et al’s review of the literature concludes that this noninvasive modality is mostly painless and apparently safe for use in a variety of wounds.

Another “electrical” approach to wound care is presented by Yarboro and Smith in their case report of a patient with a lower extremity wound. Because the patient’s peripheral arterial disease and numerous comorbidities were not amenable to surgical intervention, transcutaneous electrical nerve stimulation was initiated, helping heal a stubborn wound as well as increase the patient’s ankle brachial index.

The July columns also encourage resourcefulness. Clinicians continue to find new applications for medicinal honey; in this issue, A Clinical Minute presents two cases where nonhealing amputation wounds are reinstated to the healing trajectory with the use of honey. In My Scope of Practice, clinicians are reminded to champion the individuality of each patient, carefully choosing battles and accepting whatever cooperation is attainable from reticent patients who may need a bit of coaxing to get on board with plans of care. A sampling of inventive products and comments from satisfied customers rounds out the issue.

But with all that is being done on the front lines to manage and innovate, glaring gaps remain. A recent plea from the National Necrotizing Fasciitis Foundation (NNFF) reflects the inadequacies of the current standard of care for flesh-eating bacteria. According to NNFF Executive Director Jacqueline Roemmele, the NNFF is initiating a campaign to raise awareness of the tragic inadequacy of the current standard of care for flesh-eating infection and pushing for the adoption of new treatments for this deadly condition. The Association for the Advancement of Wound Care and the American Professional Wound Care Association have been recruited to review the evidence supporting the use of new approaches to treatment and then work with the NNFF on guidelines for their members to improve the standard of care. The Centers for Medicare and Medicaid Services have been asked to evaluate new treatments for necrotizing fasciitis and to approve their reimbursement under Medicare and Medicaid.

The current standard of care involves inundating the body with heavy doses of intravenous antibiotics while cutting away the dead tissue. Unfortunately, the toxins typically keep eating away tissue, requiring more and more surgery, and eventually many limbs are amputated. A much-needed new standard of care could be based on a ground-breaking treatment described in a recent case study by Crew et al,¹ published in our sister journal WOUNDS: neutralize the toxins that eat flesh by irrigating the wounds with hypochlorous acid (HOCl), a natural chemical produced by white blood cells shown in laboratory studies to offset the toxins and stop the spread of the dying tissue. In Crew et al’s study, HOCl used in combination with negative pressure wound therapy successfully saved a patient’s life and limbs.

The cross- and interdisciplinary nature of wound care can be an obstacle as well as an incentive for innovation. Wound care is sometimes an afterthought of a larger, more immediate problem — a stepchild to life-saving surgery or addressed as merely involving more attention to support surfaces. But while advances in wound care may not be as glamorous or headline-catching as some other medical triumphs, finding and implementing a safer way to debride or to salvage limb and life requires no less creativity or perseverance. Here’s to innovative clinicians and authors and the lucky patients who reap the benefits of their efforts.

This article was not subject to the Ostomy Wound Management peer-review process.