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COVER FEATURE THE VALUE OF WOUND CARE AS JAYESH R. MODI, M.D., RVT, FACS, wound care specialist and vascular and general surgeon, Medical Director of the Center for Wound Healing, and Director of the Department of Surgery at Saint Francis Hospital, explains, the comprehensive approach to care at the Center for Wound Healing is not only encouraged by patients' results, but also founded in evidence- based practices. Numerous pieces of literature, including a study from a multidisciplinary foot clinic on the impact of care in patients with diabe- tes, demonstrate the power of wound care to decrease the need for drastic measures of care, such as amputation. The study, published in the American Diabetes Association's journal Diabetes Care, tracked patients receiving care through the limb preservation service at a military medical center. The service developed an examination pro- tocol based on the recommendations of the American Diabetes Association that clinicians performed regularly as a preventive tool. The seven-part exam covered clinical and diabetes histories; a thorough foot examination, includ- ing evaluation of motor, sensory and vascular function, and skin and nail condition; an assignment of risk; an assessment of the patient's footwear; diabetes and foot care education; and the development or updating of an individual management plan. Based on the service's use of the exam, the study recorded a significant decrease in the number of lower- extremity amputations over a five-year period, even as the program was experiencing an increase in patients with diabetes. The number of patients with diabetes went from 3,340 at the study's start to 4,940 at its conclusion, while the rate of amputations in the same patient population declined from 9.9 every 1,000 patients to 1.8 every 1,000 patients. James Nichols; J. Keith Festa, M.D.; Brian Pribeck; Judi Dixon, R.N.; and Meghan Johnson, EMT, HBO technician osteomyelitis, osteo and soft tissue radionecrosis, compromised skin grafts and f laps, acute peripheral arterial insufficiency, acute traumatic peripheral ischemia, progressive nec- rotizing infections, crush injuries, and delayed or late-effect radiation injuries affecting various parts of the body. "When, for example, the head and neck areas are treated for cancer with radiation, the surrounding soft tissues and bone may exhibit delayed damage. Patients often require dental procedures and have difficulty with these procedures," says Dr. Modi. "Hyperbaric oxygen therapy has a defi- nite role in assisting patients in healing before and after dental procedures." The Heart of Wound Care The complementary element of the team's care stems from the more lifestyle-oriented aspects of patients' wounds, such as their underlying and often chronic medical conditions. A patient with venous insufficiency, for example, can develop an ulcer due to recurrent leg swelling. Physical therapy, nutritional consultation, medical management and other very concrete management techniques, such as the use of compression stock- ings and regularly elevating the legs, are all part of the team approach. Dr. Modi stresses that for a dia- betic patient with a foot ulcer, a 10 | Mid Hudson MD NEWS ■ MDNEWS.COM multidisciplinary approach is also imperative and needs to be part of all aspects of the continuum of care, including acute care, home care, sub- acute care and physician and wound center visits. Lifestyle, psychological and quality-of-life evaluations are addressed as appropriate. Diabetes con- trol is supported through coordinated and collaborative management. Wagner explains that many patients with these chronic, wound-contribut- ing diseases are likely to return to the Center for Wound Healing. As such, the wound care team concentrates on building strong, personal relationships with the patients. Nurses follow up with regular phone calls, missed appointments, diagnostic testing results, transportation issues and financial matters. Analysis of every element of a patient's case helps ensure they are covering each piece of the puzzle — clinical, emotional, financial and social — properly. "We go the extra mile to make patients feel relaxed and welcome," says Wagner. "Whether it is a kind word or a hand on the shoulder, we develop great patient relationships. We are constantly thinking of how we can improve their care." To learn more about the resources available at the Center for Wound Healing and Hype rbar ic Medic ine, vi s i t www. SF h o s pit a l .or g. ■