Editorial Message: “Offal” Wound Care?

Dear Readers,   Many times in this space I have discussed quality wound care and what it takes to provide such care to our patients. We have talked about the personal responsibility involved in wound care, about reading to become informed, about attending conventions and other meetings to learn the current state of wound care, and other similar topics. I think the time has come for us to discuss “offal” wound care. Notice the spelling; I did not say awful wound care. The term “offal” is derived from Middle English meaning “off fall,” a term referring to the entrails of an animal that no one wanted that have fallen off during butchering process. These were the parts of the animal that were felt to have no use and were to be thrown away or used for animal feed. Some of those parts included the thymus, pancreas, liver, tongue (at least in the case of a cow), and other “unmentionable” parts of the bull.¹ For some strange reason, through the years these parts have become delicacies and are rarely discarded. With some thought, we might consider wound care in that same vein (pun intended!). For many years, and even many times today, nobody wanted anything to do with wounds and their treatment. But in the past 10 to 15 years, most everyone wants to be involved with wound care. Wound centers as special places to treat wounds are springing up everywhere. Centers are vying with one another to recruit patients. Nearly every health care specialty is bringing their expertise to the table to treat patients with wounds.   There are other benefits of this sudden interest in patients with wounds. There is more interest in basic science research to learn what causes wounds and what we can do to treat them appropriately. There is more interest in development of new treatments for wounds. Think of how many treatments, dressings, and bandages we have today that did not exist even 15 years ago! Negative pressure wound therapy, growth factor therapy, and tissue engineered skin therapy, therapies we depend on each day in the treatment of our patients, are relatively new to wound care. New developments in diagnostics are allowing us to evaluate proteins and other molecules in the wounds themselves that, just a few years ago, we did not know existed. As we accumulate more knowledge about an individual’s wound, custom wound care treatments designed to treat the deficiencies or problems specific to these wounds are being developed. The future of learning about and treating wounds is very bright and exciting.   With this new acceptance of the “offal” comes responsibility. It is our responsibility to be sure the treatment of patients with wounds, and the search for even better products, leads us in the best possible direction.   Unfortunately, this does not seem to be the case. It appears that wound care research and development, just like that in other fields of medicine, are driven by the economics of what is popular today. It is unfortunate that we know more about the role of bone marrow stem cells in the healing of wounds than we do in what really causes a venous stasis ulcer. In many cases, proposed treatments seem to be running ahead of our knowledge of what we are trying to do with those treatments.   I would propose a consensus panel of wound care leaders from every specialty involved, both the clinical side and the basic science side, meet to determine the important problems in wound care and where our efforts should be concentrated for the next 5, and maybe 10, years. Everyone should be given the opportunity to have input into what is important for patients and how these needs might be met. This might provide some surprising but important insight into the future direction of wound care. The last thing we want to happen is for our newly recognized offal wound care to become awful.

Reference

1. Elias, S. Vein: 5 years of offal news? Vein. 2012;5(4):6 https://www.veindirectory.org/magazine/article/vein_5_years_of_offal_news. Accessed July 1, 2013.