Some things in medicine are fairly standardized. If you are going in for a knee replacement, the brand name on the implant may change, but the basics are pretty much the same. If someone suffers a fracture of a bone, the limb is immobilized. The doctor down the hall may like putting people in casts, while I use walking boots. But there’s one field in which there is tremendous variability in how physicians treat the problem. And that is chronic wound care.

In the United States, chronic wounds affect around 6.5 million patients. It is claimed that an excess of $25 billion is spent annually on treatment of chronic wounds. This amount is likely to grow rapidly due to increasing health care costs, an aging population and a sharp rise in the incidence of both diabetes and obesity. Further evidence, the market for wound care products is projected to reach $18.5 billion in 2015.

Wound care is a relatively new field of medicine, practiced by a great number of medical specialties. In all other fields of medicine, there is a formal process in place for the physician to train, certify, and credential. In contrast, with wound care, there is not. As a component of the medical school educational curriculum, it is inadequately taught if at all. A great number of specialties provide wound care, from general surgeons to podiatrists, vascular surgeons, dermatologists, and others. But all of them come from different backgrounds, with different training. Defined standards for the treatment of chronic wounds have not been firmly established.

For the patient, this is all terribly confusing. The huge number of products available for wound care is a testament to the lack of consensus on what is effective and what is not. The field of wound care seemingly contains as many different treatment options and modalities as the number of individual practitioners caring for wounds. Innovation in diagnostic tools has also lagged, creating even more pressure on the clinician to use experience, skill, and training to properly diagnose the root cause for the non-healing wound.

In the future, doctors will not be able to practice wound care “part time”. The amount of new information and massive amount of basic knowledge required will mandate a full-time commitment. Certainly the demand is growing, a result of the aforementioned aging population, and “epidemics” of obesity and diabetes. This, in turn, mandates that all clinicians providing wound care increase their skill sets through formal training, such as with board certification.

New techniques and products are developed regularly, and we are able to save more limbs, and more lives, than ever before. One of the most significant advances is the development of “wound vacs”, in which a specialized vacuum is used to create a field of negative pressure over a chronic wound. One of the effects is to stimulate the development of new tissue, over which skin can more easily grow.

Another important technique in wound care is the application of a specialized cast which removes pressure from a sore on the bottom of the foot. Indeed, we apply an actual hard cast to heal certain ulcers. This is an effective approach for people who have a type of nerve disease, called neuropathy, where they can’t feel their feet properly. This can lead to skin breakdown and an open sore that won’t heal because of the continued pressures of weight bearing, i.e. standing and walking. The cast will remove the pressure, allowing the sore to heal, while still allowing the individual to stand and walk.

Blood flow is one of the keys to healing difficult wounds, and is the primary issue for many chronic wounds. A new device increases the blood flow to the area of an ulcer on a microscopic level, therefore aiding in achieving closure. This technology, invented in Italy, was developed to treat neuropathy, but also benefits wound healing because of it improves blood flow to skin structures.

Removing debris and diseased tissue from a wound is critically important in healing these lesions, a procedure termed debridement. The benefits have been proven in numerous studies; there is no controversy regarding its benefits. Debridement is a requirement to achieve healing of most chronic wounds. Understandably, this can be an extremely painful process. A new device removes the bad tissue painlessly, while also improving blood flow to the area and killing bacteria, all of which are important goals.

In summary, those suffering from a non-healing wound will find themselves confused by the myriad number of options for care, the varying opinions offered in how best to treat it, and the lack of consensus on how to fund their care. The dangers of a wound that won’t heal are significant, with infection and amputation not being the worst case scenario. For those with a less effective immune system, non-healing wounds too often lead to hospitalization and death.

There is hope: great progress has been made in both diagnosis and treatment. The dangers of an open sore that won’t heal are a little less imminent with these new techniques and technologies. If you or a loved one suffers from a wound that isn’t healing in a timely fashion, get evaluated by a physician board certified in wound care. This tells you they are knowledgeable in this complex, rapidly changing field of medicine.

Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming expansion to the Hancock-Houghton area. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.