Innovations in Wound Care: Advancements in Wound Care: Burns & Biofilms, Part 2

Wound Care Wednesday in July focuses on the care and treatment of burn wounds, including the importance of removing biofilms. Join Dr Jonathan Johnson and esteemed guest speaker Dr Lynnette Morrison for this week’s conversation on best practices, case studies, and clinical practice pearls related to wound care.

 

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Dr Jonathan Johnson: Hello everyone, this is Dr Jonathan Johnson, also known as Dr Wounds. I am a board-certified wound care surgeon, and we are super excited for everyone to join us on another Wound Care Wednesday, sponsored by HMP.

Super excited to have a great guest today. Dr Lynette Morrison is very well known in the wound care community, and we want to have a fun, engaging, and relaxing conversation today. So, grab your glass of wine, grab your coffee, your tea, your water, and let's dive into a couple awesome concepts in wound care.

Now, we're going to talk about 2 topics today that focus on the time of year that we are in. It's the summer: vacation, traveling, going places, fireworks a couple of weeks back at July 4th. And what we need to make sure we're doing is not burning ourselves.

So, we're going to talk a little bit about burn wound management. We're going to talk a little bit about what burns are and how to effectively treat them.

But first, let's meet our guest, Dr Lynette Morrison. Dr Morrison, thank you for joining us. Tell us a little bit about yourself, where you are, and your practice.

Dr Lynette Morrison: Absolutely. Well, thank you so much for having me on. I was really honored that you asked me to be here. This topic really aligns well with my practice.

I'm a family doctor. I was a health education specialist for a while, and then I attended our alma mater, Meharry Medical College in Nashville.

Dr Jonathan Johnson: All right.

Dr Lynette Morrison: And then I went on to a career in rural family medicine. I trained in West Virginia and after that worked in urgent care for about 7 or 8 years, then primary care. And now I'm full-time in wound care.

I'm also wound-care certified, and I work in Northwest Arkansas. I'm a regional medical director for Restorix Health and then also the medical director of a hospital-based outpatient wound care and hyperbaric center. And then I also cover some critical-access hospitals in rural Oklahoma. So, I'm familiar with acute burns and then some of the sequela that come from those burns and also chronic wounds in general.

Dr Jonathan Johnson: I bet. I mean, first of all, that is an extensive work experience. That CV is great.

And what the main focus of wound care is is that we are also multi-specialty, right? I mean it's not just surgeons, it's not just family doctors, it's not just NPs and PAs and physiotherapists. We have such a wide range of practitioners that participate in making sure wounds heal.

So, with that being said, you having a great history of urgent care and family medicine Dr Morrison, tell us a little bit about what burns are and how do we effectively initially treat them.

Dr Lynette Morrison: Right. So now this is July, as we know. And also in Utah, there's a July 24th holiday. There's some state holidays that we celebrate. And those are all firework holidays. And we see quite a few firework injuries from not picking them up when they're cool or being too close to exploding fireworks.

It's also bonfire time. So, we see a lot of campfires or injuries from that. And in general, just picking up hot items that can also cause it.

And sunburns are another big thing. In our northwest Arkansas area, we're really big into water sports, kayaking, and all of those can create different types of burns.

There's thermal burns, which are created from the hot surfaces. You also have water-based chemical burns—hat's another thing we can't forget—from being exposed to acids and really harmful chemicals.

So, first thing we want to do if you have any kind of skin injury, usually it's the top surface of the skin will start feeling hot or red or painful. First thing we want to do is cool that area. So, we want to flush the area with some– not hot water, not cold water, not ice, but lukewarm, room-temperature water to get any contaminants off the surface and cool it down slightly.

Dr Jonathan Johnson: Got it. And so really what we need to understand is, when you first initially have the burn, the most important concept is to number 1 identify it, right?

Dr Lynette Morrison: Yeah.

Dr Jonathan Johnson: And number 2, check it out, right? And then you want to use some lukewarm water, or some water temperature that's in the middle, to help to remove that top layer of probably dead skin, right?

Dr Lynette Morrison: Yes.

Dr Jonathan Johnson: And then assess the wound, right?

Dr Lynette Morrison: Yes.

Dr Jonathan Johnson: So, when we're looking at burns and what to do with burns and how to treat burns, there's different classifications of burns. Dr Morrison. Tell us a little bit about the different classifications of burn wounds. Which ones are extensive? Which ones have neuropathic issues? Tell us a little bit about those.

Dr Lynette Morrison: Yeah, so we used to use the term first-degree burn, second-degree burn, third degree, fourth degree. Those have fallen out of favor. We don't use those terms quite as much anymore. They are still in common parlance, but in the wound care world we usually think of things as partial thickness or full thickness in terms of how deep it goes into the skin structure.

So what we used to think of first-degree burn would actually be the surface or the epithelial layer of your tissue.

The second-degree burns now we think of as more partial thickness, which means that it goes past that first layer, that top layer that tends to flake off when you have a burn, and then we start seeing some blistering. The blistering usually is the layers of skin that have been damaged separating from each other and forming that fluid sac, which we know as a blister.

So, when third degree, when we talk about third-degree burn, that means that it's gone more into the full thickness. So it's going into deeper layers. And that can usually need a higher level of care. Usually when it's getting to that layer will need to be seen at a wound care clinic or burn center or hospital, because those can get infected very easily.

Dr Jonathan Johnson: Right, definitely. So, you know, audience, we understand that there is a different classification system, but really it's observing the anatomical area or the area of your body that is burned, and treating it aggressively initially is very, very important.

So, Dr Morrison, you working in the urgent care side and the family medicine side, did you have any interaction with any younger patients that had burns? How did you treat them? And do you treat the younger patients differently than you do older patients?

Dr Lynette Morrison: Yeah, we do see, in urgent care clinics, that's usually our first line of treatment. So, we do see parents coming in with young ones that have gotten burned. Sometimes it's been some hot liquids. Sometimes it's been from our teenage population on motorcycles or motorbikes. They could get exhaust burns on their legs. In our little kids, we can see burns from playgrounds, either walking on hot surfaces or getting onto playground equipment that was too hot.

So, wound care clinics are usually a referral center. They're not usually the first ones to see these kinds of injuries, but in primary care and urgent care, we're usually the first ones. So, I would treat our young patients very similarly to our very old patients, our elderly population, because the skin is a lot more fragile in those populations. Adult populations usually have a little bit more subcutaneous fat, so that serves as more of a buffer so that if there is a deeper burn, it doesn't get all the way through. But in younger kids and our elderly populations, you can get a very significant burn, even with more of a minor type of exposure.

Dr Jonathan Johnson: Yep, very important. And, you know, we also want to understand that burns are not necessarily just fire or fireworks or you're grabbing something hot with your hand. We have to also remember that injuries on motorcycles or mopeds or even bikes, and what we call “road rash” typically also are burns where that skin is removed, that epithelial skin and the dermis layer are literally road rashed off, and we need to treat them aggressively as possible as well, because it's really important to understand burns can also come from friction, right? And one of the major classifications of burns that typically can be adverse quickly are thermal burns or chemical burns, right?

Dr Lynette Morrison: Yeah.

Dr Jonathan Johnson: As well as electrical burns. So, have you had any experience, Dr Morrison, with any electrical burns or any type of chemical burns, and how did you treat them?

Dr Lynette Morrison: Yeah, in our urgent care setting, we did have some occupational injuries where we had folks who had electrical exposure, had electricians that were injured on the job. We also had folks in food service industry or cleaning industry who sustained burns from the chemicals that they were using.

So for those, depending on where it was, if it was exposure in the eye, you can get a chemical burn in the eye, so those had to be flushed out very quickly with water and then we referred them emergently to an ophthalmologist for additional care.

In some settings, it's not easy to get someone to a burn center. So, we would need to stabilize someone in a smaller hospital or a smaller setting until they're able to recover or until they're able to be transferred to a higher level of care.

Dr Jonathan Johnson: Got it. Got it, of course. It's important to make sure we're meeting the patient where they are, right? And making sure we're using our resources to treat the patient effectively.

So, you have a patient that comes in, Dr Morrison. They have a burn to lower extremities, they have a burn to their upper extremities, and there's burns on multiple other places. Tell us a little bit about first-line treatment that's more aggressive than just cleaning the wound with lukewarm water. What are our next steps after that, after we've cleaned it with lukewarm water?

Dr Lynette Morrison: So, depending on how severe this is, we have something called the rule of nines, which is really to identify how much of the body has been burned. And that relates to body surface area. So, if someone has extensive burns, they can lose fluids very quickly. So, we want to get those patients to a burn center or a hospital very urgently so that they don't get dehydrated.

In the setting where it's more minor, and we still have more to do but not quite at the level of a burn center, we can start using some gels. We use something called a hydrogel, which is a water-based cream or a water-based solution, we’ll say. It's a gel called hydrogel, and that adds moisture to that area. It cools it a little bit, and it really protects the skin from losing so much fluid.

We also want to have our patients drink as much as they can, if they're able to. They may need some IV fluids because when you disrupt the skin barrier, you can lose a lot of body water.

Dr Jonathan Johnson: Very true. So, you said something, Dr Morrison, that was very interesting. And our colleagues are probably very well versed in this, but we do have our patients that are listening. And remember, this podcast is about making sure that our patients and our colleagues stay well informed.

So, can you help us understand a little bit more about the rule of nines? You said that it's the percentage of body area that is affected by the burn. What does that mean, and how can we convey the importance of understanding that to our patient population that's listening?

Dr Lynette Morrison: So, even though a burn may not be that deep, if it's a large part of the body, you still may need to go to a higher level of care. So, the rule of nines basically estimates how much of your total body surface area has been affected. We consider the whole body is 100%, and then we compartmentalize the parts of the body into 9%.

So, for example, the head and neck would be 9% of your total body surface area. Each arm would be about 9%. Each leg, since legs are a little bit longer—now the bottom portion is about 9%, your thigh to your knee is about 9%, so the whole leg would be about 18%. So, all of those will add up, there's 10 of those different regions, and then the genital area makes up 1%. So, all of that creates the 100% of the total body surface area. And if enough of these areas are burned, even if it's not a deep burn, they still will need a higher level of care.

Dr Jonathan Johnson: Great point. Great point. And one of the major equations—because I know everyone loves math, we all did great in math, and we all were A students in the front of the class—but we need to understand the Parkland formula.

And you know, the Parkland formula focuses on utilizing the right amount of hydration via IV fluids to make sure that we're keeping the patient hydrated and to replace the loss of fluid depending on the percentage of body—as we're talking about, the rule of nines—that was affected. So, there's a specific equation. We don't really need to dive too deep into the calculations, unless you would like to, Dr Morrison, but typically we use the formula to help assist us in hydrating the patient based on the surface area that is burned. So, you can talk a little bit about that.

Dr Lynette Morrison: Yeah, correct. It's, well, there won't be a quiz at the end, but...

Dr Jonathan Johnson: No, no quizzes. No quizzes here, guys. No quizzes.

Dr Lynette Morrison: But it's just an estimate of how much fluid someone would need based on their body weight and based on the total body surface area that was burned. And usually, you would give a certain amount within 8 hours and then the next amount over 16 hours. And this is mainly for IV fluid resuscitation, but it can also apply to oral hydration.

So sometimes we'll use a modified way in the outpatient setting to say, "Hey, you just got this burn. It's pretty severe. It covered a lot of your body. If you can, you need to drink this amount within 8 hours and drink this amount over the next day.” So, I've done a modified amount for patients who do have a pretty high amount of their body that's been burned. It may have been only a first-degree burn, but they still need to drink a pretty good amount of fluids or get IV fluids.

Dr Jonathan Johnson: Right. Very important. So, we've discussed the different classification of burns. We've discussed some of our first-line treatments of burns. We've discussed the types of burns that we really need to make sure that we're monitoring. Again, the electrical burns and chemical burns may not be as well-known as the thermal burns, but they can be just as devastating. So, we need to make sure we're cognizant of that.

And we need to make sure we're utilizing the right resources when we triage these burn patients, right? Based on the specific area of where the burn is. Remember, the face, hands, the feet, the pubic area, we need to make sure we aggressively treat those at a specialty center that can make sure that we're utilizing the correct initial treatment to prevent any adverse effects.

The rule of nine is important, and making sure that we're hydrating our patients with the Parkland formula is definitely important, specifically when the burns are more aggressive.

So, Dr Morrison, we've talked about the burn side. We understand a lot that it’s July and people are going to enjoy themselves. We just want to make sure that they're very, very cognizant of all types of burns and making sure they're taking care of themselves.

So you patient that comes in, extensive burns, they're in the ICU, we've taken them to surgery to remove some of the devitalized tissue, which we'll talk a little bit about as we progress through the show. And now the patient is starting to heal. Tell me a little bit about any postoperative burn wound care treatment that you've experienced, administered, managed. How did you treat those?

Dr Lynette Morrison: Yeah, absolutely. Thankfully, we have great surgeons and really knowledgeable staff that are able to take care of our patients and keep these burn areas clean.

Dr Jonathan Johnson: Mm-hmm.

Dr Lynette Morrison: One of the issues that we see with burns is cleaning them. And whether it's on the outpatient side or the inpatient side, sometimes we may not be using the appropriate cleansing solutions.

Dr Jonathan Johnson: Mm-hmm.

Dr Lynette Morrison: I've seen folks use rubbing alcohol or hydrogen peroxide. While these are helpful to reduce bacteria on the surface, they're really not helpful for overall wound healing as they can be cytotoxic, so they can damage some of those new cells starting to grow.

So, the first thing I would say in a hospital setting is do no harm. So, we want to use some non-toxic cleansers or things that are not going to make us go backwards.

Once we have that clean, free-from-debris surface, then we can start helping to grow some new tissues. So, we can use collagen products that can help start those cells to granulate or start to develop their normal skin barrier form.

Also, we can use cellular tissue products. So, we have a whole group of cellular, acellular, matrix-like products, which I know you've talked about before, and skin grafting. So those are all more advanced options that can be placed on patients right away, and they can do very, very well to close over that open skin area, prevent some of that fluid loss, so that patients can get back to the function that they had before.

Dr Jonathan Johnson: Yep, great points, all great points. I think I would also add in that, as wound care providers, sometimes we see patients after the wounds have epithelialized, but there's still adverse issues, right? Hypertrophic scarring,

Dr Lynette Morrison: Yes.

Dr Jonathan Johnson: keloiding,

Dr Lynette Morrison: Yes.

Dr Jonathan Johnson: issues with intermittent areas where the skin will slough off and then re-epithelialize.

So, understanding how to treat those advanced post-wound issues and adverse effects are very key, right? I mean, you want to try to decrease keloiding as much as you can and decreasing hypertrophic scarring—corticosteroids, Kenalog injections can help with that at times, compression with silicone can help with that at times—as well as mobility issues, right?

Dr Lynette Morrison: Yes.

Dr Jonathan Johnson: I mean, we're seeing patients that have contractures at joints. We're seeing patients that have contractures in normal anatomical locations, obviously, that they didn't have before. So, sometimes it's physical therapy.

I remember treating a patient that had adverse pain, but also the physical deformity can be an issue as well, right? So, making sure that from a psychological standpoint and a self-confidence standpoint, the patients have the best resources as possible.

Did you ever, Dr Morrison, were you ever involved with a patient that you had to start on anxiety medications or refer to psychiatry because they had such adverse post-wound issues that extended beyond wound care?

Dr Lynette Morrison: Definitely. My background as a family doctor has been a benefit in that case because I can help patients with depression and anxiety and some of the other issues that are not just related to the wound.

And we do see that a lot. There can be a lot of fear of, certainly, amputation if wounds get deep enough. There's fear of resuming certain activities because something had happened and patients don't want it to get worse or happen again. Or even just the fear of having a dressing change. So fortunately, I'm able to help a little bit with that.

But for some patients, they have required a referral to counseling or psychiatry. In some of our rural areas, psychiatry isn't as easy to come by. So, I have referred to psychologists, different behavioral health or mental health care providers in the area that the patient's in.

Dr Jonathan Johnson: Great. And really, this speaks to the progressiveness of our wound care field and our specialty, right? We're all encompassing. Again, family medicine, not just surgical, plastic surgery, et cetera. So, we all need to work for the continuity of care for our patients. And sometimes once the wound is closed, you're also the advocate for your patient.

Dr Lynette Morrison: Absolutely.

Dr Jonathan Johnson: So sometimes it's hey, there's a great psychiatry-based resource that's available for the patient to see, because we want to treat the whole patient and make sure we're taking care of them as much as possible.

So, again, it's July, it's the summertime, and we have the burn, we have devitalized tissue that's on the burn. One of the major issues with changing the dressings with burns is something called biofilm. And biofilm is kind of the byproducts of bacteria that sit on the wound bed, and obviously this is prominent in burns, but biofilm is seen in most of our wounds, if not all, right?

So, Dr Morrison, tell us a little bit about what biofilm, devitalized tissue, bioburden, what is that and how do we treat it?

Dr Lynette Morrison: So, in the wound care world, biofilm is like our supervillain. We see it in burns, we see it in chronic wounds. You can even see it in more acute wounds. It's surface bacteria that get together and form a community and secrete more of a slime to help them grow together and help them to fend off their rivals or their enemies, which in this case with bacteria would be us trying to clean it from that wound. They want to stay on their host and continue to feed on the tissue, to the detriment of the patient.

So, if you've had animals before or dogs or cats or cattle, it can be seen as a film that grows along the animal's water bowl. That's one pretty common thing we can see in biofilm.

Dr Jonathan Johnson: Ah, good point.

Dr Lynette Morrison: Also, if you have those trendy water bottles with the cups and the handles, we won't say the brand name, but we all know them. If you don't clean those very well, it can develop that film on them, that's biofilm, and you really have to scrub to get that off.

Dr Jonathan Johnson: Right.

Dr Lynette Morrison: And that's the same thing that's forming on those surfaces is forming on the wounds. So, we really have to be aggressive to get it off so that our patients can heal.

Dr Jonathan Johnson: Great points. Again, I love the way that you put that, as far as biofilm is concerned, it's basically our enemy in wound care healing, right? We want to make sure that we remove it as much as possible.

So, how do you train, or how do you teach, how do you educate the providers that work with you, the nurses that work with you, about how to remove the biofilm and how to identify it?

Dr Jonathan Johnson: So, at our alma mater at Meharry, a neurology professor once taught me, he said, "The eyes see what the mind knows.” So, if you don't know what you're looking for, if you don't know how to identify biofilm, you're not going to see it and you're not going to address it.

So, we look for biofilm everywhere. It could be a shiny surface of a wound, it could be a tan, gelatinous covering to a wound, or it could be non-visible to the eye, but it's just a sign that the wound is not healing. And even though we've done everything by the book and followed all the protocol and the wound is still not progressing in the way that we think, it's probably biofilm to blame.

And I know in the surgical community, we know biofilm can affect the surgical joints, like our hip replace, our knee replace, those kinds of joints can also be coated with biofilm that we may not be able to see.

So, the first thing is knowing that it can always be there even if we don't see it, but especially if we do, we have to address it.

Dr Jonathan Johnson: Of course. And again, understanding that the biofilm, bioburden, devitalized tissue is always present in the wound.

So, what I typically like to do is to make sure that I'm massaging the wound bed every time I see the patient. It's important to do that because, Dr Morrison, and I would agree on this, blood flow and oxygen is key to make sure the wound heals. But the biofilm and bioburden actually acts like a wall that prevents the wound from granulating. It prevents the wound from progressing and healing. And it also prevents the wound from reducing the amount of infectious process that could happen at the wound site.

One of the major things about biofilm, Dr Morrison, is that bacteria continues to eat at the competent and great tissue and healing tissue and the great granulation tissue that it's sitting on, but it also starts to progress into a resistant form or a resistant strand of bacteria. They're almost like communicating with each other to say, "Hey, let's make sure we prevent this PO,"—which is by mouth—"or IV-based antibiotic from working.” So, it's doubly important for us to remove the biofilm to make sure that our antibiotics when we do need to use them are effective as much as possible.

So, you're in a clinical setting, Dr Morrison, and you're seeing a patient, you remove the dressing. How do you remove that biofilm? What's your clinical treatment? What's your management when you see biofilm?

Dr Lynette Morrison: Right. So, the most effective way to remove biofilm is what we call in our community is sharp surgical debridement, which means we have to scrape it off. Just rubbing with a gauze may not be enough to get through that thick layer of slime that goes into all of the microscopic nooks and crannies of the tissue. So, using a scalpel or a curette, or there's some other plastic or fibrous-base modalities, but something that's going to physically disrupt that communication of the bacteria. Just wiping it with a gauze is not enough.

Dr Jonathan Johnson: Agreed, agreed. And I think, focusing on massaging the wound tissue to make sure you remove that biofilm, again, is key, right?

Now, surgical and sharp debridement, you know, should be our standard of care when trying to remove biofilm, but there can be effects sometimes, right? I mean, the patients could have, you know, increased risk of bleeding, or they could be extremely adverse to pain, or some of their comorbidities and mobility issues may impede sharp debridement.

So, utilizing a wound brush or some type of effective resource to remove that devitalized tissue is 100% key, right?

Dr Lynette Morrison: Yes.

Dr Jonathan Johnson: Because we do not want that wound stalled in the inflammatory phase. Would you agree, Dr Morrison?

Dr Lynette Morrison: Absolutely. We have to progress it to more of a healing, proliferative environment. And we also don't want our patients to have adverse effects like bleeding or severe pain. So, it's really an individualized plan. Every patient may not need a scalpel to their wound.

Some patients, we may need to do something gradually. Some patients, if it's severe enough, they may need to have a debridement done under anesthesia.

Dr Jonathan Johnson: There's different forms of, obviously, treatments, but again, it goes back to us being competent and compassionate providers. We need to focus on meeting the patient where they are and assessing their pain level and understanding their comorbidities to effectively treat them from a wound care standpoint without issue.

So, again, remember this biofilm and devitalized tissue can re-accumulate every 24 to 48 hours. So almost every single time you're doing a dressing change, you want to address the biofilm area.

And one of the other focuses is not just making sure the wound does not get infected or making sure that the wound can progress through the 4 stages of healing effectively, we want to prepare the wound bed to make sure that we can move on to other standards of care as far as treatment, right? We're moving to our primary dressings, we're moving to our cellular tissue products, we're moving to our skin grafts, we're moving to our ultrasonic and ultrasound-based mist therapies, right?

We want to prepare the wound so it does have a chance to progress effectively through those 4 stages of wound healing.

Dr Lynette Morrison: Absolutely, absolutely. If there's biofilm present, we wouldn't want to add more cells for it to eat away or more tissue for it to feast on. So, we really want to make sure that the wound bed is clean, free of biofilm before we put anything new on it.

Dr Jonathan Johnson: 100%. It's really important to address that effectively initially to make sure that the wound has a strong viable chance of improving.

And really communicating that to the patient as well to understand that, “Hey, we need to massage this area, you're going to feel a little bit of pressure. If there's any pain issues, we will definitely let you know.” But meeting the patient where they are and using the right resource, as we know, is 100% key. So, the more that we do that, the better.

So, Dr Morrison, I really love to wrap up our Wound Care Wednesday podcast with learning a lot about our guests. And, I think it's great that we bring on different experts in different fields within the wound care umbrella and within the wound care community.

So, tell me a little bit about what inspires you about wound care.

Dr Lynette Morrison: Well, in my practice, I'm a family doctor, family-physician trained. And usually, you think of family doctors as being in primary care clinics, and there's only so much that you can do to impact patients in terms of wound care in that setting.

In addition to my practice, I also do medical missions. I've gone on 16, I believe, volunteer medical missions around the world, and that showed me that family practice really can span in underserved or in remote locations. Family physicians can really do quite a bit, including different surgeries, including things you would not traditionally see in the US, which really led me into the impact of wound care in remote locations.

When I was in Uganda, actually, I saw a patient with a very severe wound and had no way of treating it. It was a young man with a trophic ulcer, and he was just wrapping it with gauze that he had made from cut-up clothing. And he really didn't have a lot of resources.

So we had, you know, a modest amount of wound care supplies with us on this medical mission trip. And we were able to clean his wound as best we could, dress it. And, you know, that really led me to see how much wound care specialists are needed worldwide.

Dr Jonathan Johnson: Definitely. We want to learn more about these medical missions. You're one of the leaders in our wound care community in reaching out to underserved populations, number 1, but also international populations, to make sure they have the resources needed in order to be treated for wound care. So, we definitely got to have you back on the podcast to talk a little bit more about medical missions.

Dr Lynette Morrison: You know my niche really is rural and remote locations, both in the US and internationally. You won't see me too comfortable in a big city, that’s for sure.

Dr Jonathan Johnson: Ah, those big city folks. No, I get it definitely. 100%. So, with that being said, you being in the medical mission community, and I know you just talked a little bit about your patient from Uganda. Tell us about a case involving either a burn or involving biofilm or just a wound care case in general that had a positive or maybe a negative effect and how did you handle that and how did you treat it?

Dr Lynette Morrison: So, one thing I was probably not prepared for is seeing in certain areas in West Africa, we were seeing—and these are on different medical mission trips—we were seeing burns from people trying to bleach their skin. And that was something that I had never encountered before. It was something I really hadn't prepared for.

And trying to, certainly we provided wound care and burn care, but really trying to convince patients that that's really not what they needed to do. They didn't– culturally, they felt like it was needed to lighten their skin, but in damaging their skin in the process. And so it was something, in terms of a social context, was very difficult for me to approach.

Dr Jonathan Johnson: Makes sense. I mean, again, we're back to effectively treating chemical burns, right?

Dr Lynette Morrison: Yeah.

Dr Jonathan Johnson:  Which is a totally different type of burn than someone at a bonfire or someone with a firecracker or fireworks injuries.

Dr Lynette Morrison: Yeah.

Dr Jonathan Johnson: So, understanding the type is 100% key.

Dr Lynette Morrison: Yeah. And, in understanding that and then trying to accommodate your treatment to your patient's social and cultural needs was really difficult.

Dr Jonathan Johnson: Definitely, definitely. So, I think our audience understands that, again, wound care is such a multi-specialty and it's a huge umbrella of different care providers that focus on their individual specificity to make sure wounds heal.

We understand the cost of wound care, we understand that if we effectively treat wounds, we keep patients away from amputation and keep them out of the hospital. We keep them alive and healthy and mobile. And so we need to make sure we effectively use all the resources we can to make sure our patients heal.

Dr Lynette Morrison: I was going to say, I know we have the Olympics coming up, but wound care really is the ultimate team sport.

Dr Jonathan Johnson: Ah, great way, there you go, great way to pull that in. Have you been watching the Olympics at all? Or any of the, not Olympics, but have you been watching any of the pre-Olympic or any of the Olympic trials?

Dr Jonathan Johnson: No, not yet. Usually, I get into it when it starts. I like to see the ceremonies and all the different countries represented.

Dr Jonathan Johnson: 100%, 100%. Well, I mean, it's a great worldwide sporting event, and we wish the best to all the countries that are out there competing.

So, Dr Morrison, I would like to thank you for being part of this great Wound Care Wednesday. I think we had a great informative and educational session, and we can't thank you enough for coming on today.

So if you'd like to say anything to the team or anything to our audience before we let you go, now's the chance.

Dr Lynette Morrison: I was just so honored and so grateful that you were inviting me on to chat with you. I was surprised when you asked me and I'm just so honored.

Dr Jonathan Johnson: Sounds good. Well, hey, listen, we’ve got to make sure that we keep all of our colleagues encompassed in our wound care community. And it's great to hear everyone's voice and how they treat patients. Because at the end of the day, that's 100% what it's all about.

So, I would like to thank everyone for listening in on another excellent Wound Care Wednesday. This Wound Care Wednesday was sponsored by ExtremityCare, and we'd like to thank our sponsor for partnering with us on this podcast. And we are super excited about our next Wound Care Wednesday.

I want to make sure everyone has an excellent summer. Be safe. Watch yourself with burns. Remember to remove the biofilm. And this is Dr Jonathan Johnson, also known as Dr Wounds, signing off, and we'll see you on the next Wound Care Wednesday.