Defining Wounds and the Goals of Wound Care

Peter L. Salgo, MD: Wounds, they can be acute, they can be chronic. For chronic wounds, especially, it’s important to understand the cause of the wound, as the etiologies should be considered when deciding on the treatment plan. With so many variations in wounds, there are also many variations in treatment options, and it’s often difficult to find a standard of care that’s consistent among doctors and institutions. We’ve got a panel of experts here today to help identify the treatment protocols and the challenges in wound care.

I am Dr Peter Salgo. I’m a professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons, and I’m the associate director of surgical intensive care at New York-Presbyterian Hospital in New York City.

Today I am pleased to be joined by Dr Michael Kazamias. He’s a microbiologist and podiatry specialist who founded 2 companies utilizing telehealth technology to enhance wound outcomes for patients enrolled in managed care plans, in Boynton Beach, Florida;

Dr Robert Snyder, a professor and the director of clinical research, and the director of the Fellowship Program in Wound Healing and Clinical Research at Barry University School of Podiatric Medicine in Miami Shores, Florida, and the past president of the Association for the Advancement of Wound Care and the American Board of Wound Management;

And Dr Samuel Young, the previous senior medical director at Medicare in Jacksonville, Florida.

I want to thank all of you so much for being here.

One of the questions that comes up all the time, it’s often unspoken, is what’s a wound? Is it simply a cut? Is it something else? How do you define a wound? Anybody want to jump in on it?

Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: A wound is basically a breach in the skin, or a breach in the epithelium. It could be caused by a number of things. Certainly, trauma is one of them, but we see it very often in patients with disease, like diabetes, who have numbness in their feet, or peripheral neuropathy. We can have acute wound or chronic wounds. Acute wounds heal in a very orderly fashion. Chronic wounds do not. I think by definition, a chronic wound is anything that stays open between 2 and 4 weeks.

Peter L. Salgo, MD: We’re going to be talking more about chronic wounds here. Everybody has had the opportunity to nick themselves shaving, that’s a wound, and that usually heals by dinnertime. That’s not what we’re talking about. When you’re dealing with these wounds that hang out for a while, for weeks at a time, what are your goals in the management of these wounds? Anybody got a set of goals for me?

Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: Certainly the goal is to first and foremost heal the wound. That may seem like a very simple process, but unfortunately the patients who have diseases, underlying comorbidities as we say, particularly diabetes and peripheral arterial disease, it becomes often a very challenging event and requires a multidisciplinary approach.

Peter L. Salgo, MD: The goal is to heal this darn thing.

Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: To heal it.

Peter L. Salgo, MD: My sense is the wound’s fighting back.

Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: That’s correct.

Peter L. Salgo, MD: Who is impacted by these wounds? Is there a group of people more so than others who are affected by these wounds that are lasting weeks to months and sometimes even longer?

Michael T. Kazamias, MS, DPM: Well, the patients themselves are, the caregivers, the family members. I would say the treatment team and society.

Peter L. Salgo, MD: Why society?

Michael T. Kazamias, MS, DPM: In many of these instances the cost of these raw wounds is borne by payer groups, society in general, through tax allocation for the care of these patients. Society does have an impact on the treatment of wounds.

Peter L. Salgo, MD: I think it’s difficult sometimes if you don’t have one of these comorbidities, and we’ll get into these comorbidities in a moment, to wrap your head around the fact. I mean, people heal. That’s one of the salient features of Homo sapians and other species. You cut yourself, not only does the skin come together, even the skin creases match up. It’s tempting I think for practitioners to say, “Ah, it’s a cut, it’s a wound, it’ll get better.” But it doesn’t. That is something you need to get your mind around. Have you seen this in practitioners? They don’t really get it.

Robert J. Snyder, DPM, MSc, CWSP, FFPM RCPS: Absolutely. We particularly see this in the offices of the family practice physician or the general practitioner who really is looking at this, to your point, as a cut.

Patients who have wounds that don’t heal obviously have an underlying cause, an underlying comorbidity as to why that doesn’t occur on a normal wound healing trajectory. Very often we see this in the diabetic population. We see it in patients with vascular disease, and we see it in patients who spend long periods of time in bed or in a wheelchair, who are constantly having pressure on those areas so that those wounds will not heal.