Wound Care and Follow Up

by Bruce Kaczander, DPM
Director Podiatric Education
Botsford General Hospital
Farmington Hills, Michigan

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My associates and I just returned from the Midwest Podiatry Conference in Chicago.   Dr. Bruce Kaczander was asked to speak on three topics, two related to wound care.  It’s no wonder... Dr. Kaczander is an engaging, thought provoking speaker who covered the topics with aplomb.

In his PRESENT lecture on “Wound Care and Follow Up”, he focuses on the etiology of non-healing wounds. How does one distinguish between arterial, venous, trophic, neuropathic, or even vasculitic ulcers? A variety of case studies are presented. Dr. Kaczander offers the listener opportunities to formulate plans of care with a critical decision making process and thereby, the listener gains confidence in their clinical judgment skills.

In his lecture, Dr. Kaczander reminds us that a non-healing wound is one that shows no signs of healing after four weeks. At that juncture, the prudent physician must take a step back and determine why the wound is not responding. Perhaps the problem is inadequate off-loading or diabetes that is out of control. Are systemic factors at play? What appears to be a venous stasis ulcer may actually have a vasculitic origin.

Dr. Kaczander suggests that we also consider undiagnosed Osteomyelitis. Is the wound probing to bone? When was the last time a radiograph was taken?  When is it time for an MRI or even a bone biopsy?  Don’t forget to evaluate the nutritional status of your patient. Is the albumin level within normal parameters?

The principle of “Selective aggressiveness” is discussed. Dr. Kaczander advises against debriding an ischemic wound, preferring to use enzymatic debriding agents in these circumstances. He does, however, recommend aggressively debriding most chronic wounds regularly and obtaining appropriate cultures and biopsies. He encourages us to remember that proper recording methodology is important, so any subsequent treating clinician can appreciate the progress of the wound. At each visit, the length, width, and depth of the wound is measured, as well as the peri wound erythema and edema. Odors emanating from the wound should be documented, as well as any undermining of the tissue planes.

Dr. Kaczander discusses wound locations and how attention to this important issue can help determine etiology. When are arterial and venous Dopplers used? When is it time to seek the input of our colleagues in the vascular specialties?  View Dr. Kaczander's PRESENT lecture for a deep (no pun intended) discussion of the principles of treating slow healing wounds.
 

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