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New ways to treat wounds

Doctors abandon failed conventions that focus on caring for bruises at the surface for methods that reach the source.

May 26, 2003|Hilary Waldman | Hartford Courant

For most people, wound care means slapping on a Band-Aid.

But for those who suffer from certain chronic diseases, a little blister or a bump on the shin can cause wounds that require months of treatment, including surgery, daily dressings or weeks breathing pure oxygen in a hyperbaric chamber.

If all that fails, a little bruise can blossom into a hideous tissue- and bone-eating infection that can only be cured by amputating the injured limb.

It sounds barbaric. But only recently have scientists, physicians and nurses begun to develop new approaches, equipment and materials that are replacing the hacksaw in the last-ditch assault on stubborn wounds.

"Wound care has been something of an orphan child," said Dr. Kenneth Dobuler, medical director of the Comprehensive Wound Healing Center at Griffin Hospital in Derby, Conn.

Until recently, people with wounds that did not heal in four to six weeks might be treated by a variety of practitioners, including family doctors, vascular surgeons, dermatologists and podiatrists.

But about five years ago, experts from those disciplines and others, including dietitians and infectious disease specialists, banded together to deliver more comprehensive wound care.

Griffin opened one of Connecticut's first wound-care centers in 1998, and the number of such centers around the nation has grown since then.

Dr. Daniel Schwartz, a surgeon with offices in Meriden and Wallingford, Conn., joined the faculty of the Wound Care Center at Bradley Memorial Hospital in Southington this year, in part because he was frustrated by his inability to successfully treat patients with chronic wounds.

A patient with a nasty wound would be referred to him, and he would clean the area with Betadine, an antiseptic liquid, wrap it in clean bandages and prescribe antibiotics, as he had been taught in medical school. The wound usually got worse.

At the wound center, he learned that Betadine and other cleansers such as hydrogen peroxide are among the worst things you can use on wounds because they break down healthy skin. He also learned to look beyond the sore spot to find the source of the problem.

The first step in wound care is to determine why the spot will not heal, said Dobuler, of Griffin Hospital.

Blood-vessel disease is among the most common causes of non-healing wounds. Swelling from untreated varicose veins is another leading cause.

Perhaps the most common cause, however, is related to diabetes. And that is bound to make wound care a growth industry. Diabetes is a major epidemic. More than 16 million Americans -- about 6% of the population -- have diabetes, although about one-third don't know it.

Recently, a better understanding of how cells grow has led to development of a pump that applies vacuum pressure to stubborn wounds, allowing skin cells to assume their normal, multi-dimensional shape and thus grow more easily.

In addition, last month, Medicare started paying for hyperbaric chamber treatment for diabetic patients whose wounds have not healed in 30 days with conventional treatment.

Hyperbaric therapy promotes healing by stimulating the growth of new blood vessels in wounded tissue.

During the treatment, best known for helping people suffering from carbon monoxide poisoning, patients are rolled into a sealed, clear acrylic tube where 100% oxygen is delivered at a pressure of 2.5 atmospheres.

All of the advances in wound care depend on a simple revelation that when it comes to healing, conventional wisdom was wrong. Drying out wounds and wiping them with antiseptics does more harm than good. Moisture is essential. Even new Band-Aids are designed to lock-in moisture.

"We had to change our habits, learn new paradigms," said Schwartz.

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