A Persistent Problem

by Kelley Granger, April 25, 2008

A burgeoning rate of diabetes coupled with an aging population has brought a consequence of age and the disease to the forefront of a number of regional hospitals during the past decade—the chronic wound. Defined as a wound that will not heal by conventional means during a three to four week period, a chronic wound is tissue trauma that endures a stalled healing process due to underlying conditions that can include diabetes, poor circulation, infection, and immobilization.

“We’ve seen an unusual rise in the number of chronic wounds in the last several years and that’s mainly due to the rise in diabetes and elderly patients,” said Dr. Daniel Goldman of Vassar Brothers Medical Center’s Wound Care and Hyperbaric Center, which began operating the first wound care center of the area in 2000. “Our patients are a mixture of a lot things. Over 65 percent of our patients are on Medicare, so they’re on the older side of our population. Forty percent of them are diabetic and a good majority of them have venous insufficiency, maybe 60 to 70 percent some of them have a certain degree of arterial insufficiency. So we have a good deal of mixed settings that prevent a wound from healing rapidly or normally.”

While these are primarily issues associated with the diabetic and aging, Goldman said that infection, which could happen regardless of age or other factors, is also a key cause in triggering a chronic wound. “Infection is a common culprit that makes a wound advanced because it gets stuck in an inflammatory phase,” he said. “A young, healthy guy could fall and cut himself and it gets infected and he has a problem wound. That infection has to be controlled for that wound to heal, and the longer that goes on the harder it gets to heal that wound.”

Goldman said that the Wound Care and Hyperbaric Center at Vassar Brothers has an array of treatments to help patients repair injuries. “We have everything at our fingertips to use that’s state-of-the-art in wound healing,” he said. “We have vascular surgeons, plastic surgeons, podiatrists, and general surgeons all working in concert to help get these patients through healing. We use standard classical wound care, we use advanced modalities of wound care, and we use hyperbaric oxygen when indicated.”

Goldman said that the hospital’s classical wound care approach is based on the basics of wound care as they’ve grown through the centuries. This involves cleansing, removing devitalized tissue, maintaining a moist wound environment, controlling infection, maintaining adequate nutrition and blood supply, and off-loading pressure while controlling venous hypertension. A number of new wound dressings have been introduced to the market that allow more infrequent bandage changing, helping avoid more hindrance to healing. “There are dressings that can stay on the wound for three to five days and they keep the moisture in and keep the temperature up to prevent the wound from cooling,” Goldman said. Vassar and other hospitals in the area also use a wound VAC (vacuum assisted closure) machine which uses a negative pressure system to draw out harmful fluids and accelerate wound healing. Hospitals are also using electrical stimulation and ultrasound machines to help in the regenerative process as well.