MDNews - Mid Hudson

Cover Feature "The longer wounds stay open, the more likely adverse complications such as infection can occur, making wounds more difficult to heal. When physicians refer patients to us, we take comprehensive histories and physical exams, as well as nutritional and medication assessments, because all of these factors affect wound healing. Primary care providers may not have time for this in their practices, and we are able to assist them to achieve positive outcomes." care, but also more closely monitor patients' compliance to prescribed treatment regimens, which is especially important when managing diabetic patients. "Patients undergoing hyperbaric oxygen therapy have their blood sugar levels checked every day," Dr. Hatter notes. "If their blood sugar isn't controlled adequately, we can be an additional resource to referring physicians to provide that information. These are patients who are typically seen by primary care physicians every three to six months. Because another concern regarding patients with diabetes is non-compliance, we can provide direct feedback to physicians, helping them manage their patients." making the Call Because patients with diabetes present a challenge in terms of developing chronic wounds, Dr. Hatter recommends referring them to wound care centers throughout Health Quest's system as soon as possible. "Primary care providers have the means to take care of wounds on a basic level," Dr. Hatter says. "After four to six weeks, if no progress has been made, patients should be referred to a wound care specialist. In some cases, patients should be referred even earlier. We know that diabetes-related wounds or wounds in patients on steroids will be difficult to heal because the patients have — Francine h. Brooks, mD, decreased immune function. These wounds FaCEP, interim medical Director are notorious for not healing quickly." at Vassar Brothers medical In the early stages of wound development, Center's Wound Care and physicians may be able to treat patients withhyperbaric medicine Center out the use of HBOT or vascular procedures. Dr. Hatter notes that physicians in Health Quest's hospital-based wound care centers provide special topical treatments typically not available to general practitioners. In addition to meticulous debriding to clean out infected or dead skin from the wound site, Health Quest wound physicians offer collagen-based products applied directly to wounds to promote healing. They also provide skin substitutes, a beneficial alternative to using the patient's own skin, to cover a wound. Skin substitute products can be made from either the mucosa of baby pig intestines or cultured human foreskin. Both methods rely on cells very early in their formation so they are easily adaptable and can differentiate when applied to specific body parts. "These products and techniques can be used when wounds that appear healthy, but the skin just won't advance over the wound," Dr. Hatter says. "Their contents greatly promote advancement of skin formation over the top of the wound." Community Care Adam Semegran, MD, FACS, Associate Medical Director of the Center for Wound Healing at Putnam Hospital Center, notes that while early referral is greatly beneficial to patients and can prevent wounds from progressing to the point where amputation is necessary, a large number of patients still fail to receive treatment. "We're helping a lot of people, but there are more out there," Dr. Semegran says. "Every year, the number of referrals we get to the wound care center increases." Dr. Hatter explains that patients with any kind of wound unresponsive to treatment should be referred immediately for treatment, not discounted as a typical complication. "In the past, chronic wounds have been undertreated and patients have been underserved," Dr. Hatter notes. "There's almost an acceptance of chronic wounds in some of these patient populations, but we offer a different approach. We don't accept these wounds as being chronic and inevitably persistent. We offer a place where patients can receive treatment for these wounds and be healed." For more information about the Health Quest system's wound care capabilities, please visit www.health-quest.org. ■ Dr. Victor stelmack, Dr. Jeffrey hatter and Dr. John Zboinski of the Wound Care and hyperbaric therapy Center at northern Dutchess hospital 10 | Mid Hudson MD News ■ mDNEWS.COm

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