Whatever the reason, and there are many, thousands of Americans are living with chronic wounds. These are openings in the skin that don’t heal in a timely fashion. Cut your finger in the kitchen? For the great majo rity of us, this will heal via the normal and expected stages of wound healing. But since there are so many of us with wounds that don’t, over the last two decades this has become a topic of intensive study. The science and medicine of wound care has been born.

Population studies reveal at least 2%, probably more than one out of fifty people (of the developed countries) suffer from a chronic wound during their lives. That equals 6.5 million Americans who are living with one. Clearly, there is a need to better understand and treat these oft-seen, challenging conditions. These are unique problems, requiring specialized techniques and therapies to resolve, demanding patience, often considerable expertise to heal. But a hundred years ago, wound care as a specialty did not exist.

There were fewer chronic wounds since there was less obesity and heart disease, less diabetes and kidney disease. And fewer people. Maybe most important, more people were more active during more of their lives.

Clearly, this is a significant and frequently occurring problem, but it generally goes unspoken; who wants to have a casual chat about their draining painful wound? Various sorts of providers are currently available in US healthcare, all of which might be sought for care of a wound, ranging from physical therapists to nurses, vascular surgeons, general surgeons, podiatrists, and others. A common question is why such a variety of practitioners? Who best to see for care of an opening in the skin which isn’t healing?

Unlike most medical specialties, wound care has only recently been recognized as an area of specialization. But confusion reigns still in who should be providing the care since medical providers have performed this type of care haphazardly, the patient often referred to anyone willing to take on the task. Physical therapists have been a frequent provider of wound care in many hospitals. Nurses, often working under a surgeon, provide much of the hands-on care for chronic wounds with the physician directing what is done and what medicines used.

Standards have been set by the governing bodies of wound care as to how best to evaluate and treat many types of chronic wounds. Unfortunately, too often those individuals actually providing the care have not been enlightened as to what are the best practices, the most effective therapies. Numerous examples of inappropriate or improper wound treatments can be seen in clinics and hospitals across the globe.

Approximately 75% of all chronic wounds are venous ulcers, nearly always occurring below the knee. Another sizable category of non-healing skin ulcers occur to people with diabetes. These are typically found on the bottom or sides of the foot. Wounds that won’t heal because of inadequate arterial blood flow are called ischemic ulcers and are primarily found on the toes, foot, or lower leg.

Consequently, since the great majority of chronic ulcers occur below the knee, podiatric physicians have become leading providers of wound care.

An important part of the training for a podiatric residency program is devoted to their care. There are numerous seminars devoted to the topic. Podiatry has long had a concentration on diabetic foot care, a population frequently experiencing these challenging sores.

Wound care is an important part of many podiatric practices. But for reasons more than just anatomy. Because a large part of the practice of podiatric medicine is surgical, we are comfortable wielding a scalpel. This is important to wound care since the removal of dead tissue is often necessary to heal these wounds. Studies reveal the more often an ulcer is “trimmed” (technically called debridement), the faster it heals.

Some of the healthcare providers mentioned, like physical therapists and some nurses, are not licensed to perform debridement, and the patient may be deprived of this vital service.

An integral part of this discussion relates to supply and demand. Because many communities don’t have access to wound care specialists, a primary care provider is often called upon to care for the skin injury. They may not be familiar with the recommended practices of wound care, which of the thousands of wound care products to apply, what material to cover it with, what additional treatments are appropriate.

Surprisingly, most doctors specializing in wound care do so well after their residency. Although podiatric residencies generally entail in-depth training in this area of medicine, there are no residencies specifically for wound care. Frequently, an experience with a patient who has a wound stirs an interest in better methods. Seminars are available on the topic, workshops, texts, and numerous other methods of learning.

The research into how best to heal these common lesions has been extensive. The healthcare dollars at stake prodigious. This interest has led to a number of new medications, revolutionary techniques and technologies. Without a dedicated focus on this specific topic, many consequential methods go underutilized. This in essence means we heal fewer wounds and heal others slower. This generally equates to more infections, higher costs, greater morbidity.

Wound Care has entered the space age and now requires more than simply applying a dressing. From ultra-sonically charged mist to the application of fish skin, from specialized lasers to the use of lab-grown skin, healing of these potentially deadly conditions has improved incredibly. Closing these unhealing skin lesions means a drastically reduced risk of infection. And that means limbs are saved.

If you have a skin injury that isn’t healing, or a family member with one, don’t minimize the potential consequences. Get specialized care and get it healed.

Dr. Conway McLean, DABFAS, FAPWHc, has offices in L’Anse and Marquette. He is a physician who specializes in treating lower leg, ankle and foot problems.