Lancaster Physician Spring 2017 - 7

SPRING 2017

Wound Care

P

racticing wound medicine as a
primary care physician allows
me to approach wound care
differently than my surgical
colleagues. My interest in wound care
started in residency, and my goal was
to learn more so that I could help my
at-risk patients prevent wounds, provide basic wound care, and learn when
to refer patients to a wound specialist.
Apparently I showed a little more interest
than the average trainee and was offered
the opportunity to do some specialty
training. After I finished residency, I
joined the team at Heart of Lancaster's
Wound Healing Center in 2015. My
primary goal remains wound prevention.
Problem or chronic wounds are
wounds that don't follow the expected
pattern of healing. Chronic wounds are
usually characterized by being active for
more than six weeks. It is common to
have underlying comorbidities associated
with these wounds, such as diabetes
mellitus, peripheral vascular disease,
lymphedema, and general poor nutrition
or debilitation.
Typical wounds that we treat at our
facility include diabetic foot ulcers,
arterial and venous ulcers, and pressure
related injury/ulcers.We also assist
in management of poorly healing or
dehisced (ruptured) surgical wounds.
These issues are becoming increasingly
more common in patients with a BMI
above 35 undergoing routine surgical procedures like hernia repair and
cesarean section. Certain autoimmune
conditions and other chronic inflammatory and metabolic conditions can be
associated with atypical skin lesions and
wounds like pyoderma gangrenosum,
calciphylaxis, and cutaneous malignancies like basal cell and squamous
cell carcinoma.

Factors that limit wound
healing include infection,
swelling, and an inadequate
supply of essential nutrients
at the wound bed.
wound healing are: adequate blood supply
and return to manage vascular pressure and
volume changes; adequate tissue oxygenation; and appropriate cellular matrix to
manage infection, stimulate angiogenesis,
and facilitate epithelialization. We utilize
specialty dressings designed to re-establish
a matrix that promotes wound healing and
balances factors that may be missing due
to one of the above conditions. Often,
we need to evaluate for adequate vascular
supply, and the patient may need surgical
intervention to re-establish arterial blood
flow or reduce venous hypertension.
Another modality we can use in specific
conditions is hyperbaric oxygen, which
increases the tissue oxygenation. Hypoxic
wounds are unable to achieve the cellular
function and angiogenesis required for
wound healing. Additionally, many anaerobic bacteria that often contaminate wounds
and complicate healing cannot survive
with these tissue oxygen concentrations.

Delayed wound healing is often
multi-factorial. An initial approach
includes evaluating timing and duration of
wounds, examining for signs of infection,
recognizing underlying conditions that
may be present, starting basic wound care
aimed at reducing the risk of infection by
keeping wounds covered and not open to
air, and controlling underlying comorbidities. Simple interventions we can make
in primary care are to be more aggressive
with blood sugar control as wounds have
better outcomes if average blood sugars
are below 180mg/dL. Also, reducing
lower extremity edema with appropriate
compression garments and elevating the
extremities accelerate wound healing in
patients with chronic venous insufficiency
and lymphedema. If you are making these
changes but do not see a reduction in
surface area of the wound, we would be
happy to work with you and your patients
to achieve wound healing.

Fusion Integrative Health & Wellness, LLC
The Whole Person Approach to Wellness

Factors that limit wound healing
include infection, swelling, and an inadequate supply of essential nutrients at the
wound bed. All wounds have a unique
microbiome that requires an optimal
environment for healing. Basic needs for

Lancaster's only integrative and functional medical nutrition therapy practice
Our providers are in-network with many local health plans

270 Granite Run Drive | Lancaster, PA 17601
Dana Elia, MS, RDN, LDN

717-917-5259 | www.FusionIHW.com

LANCASTER

7

PHYSICIAN


http://www.FusionIHW.com

Table of Contents for the Digital Edition of Lancaster Physician Spring 2017

Lancaster Physician Spring 2017 - 1
Lancaster Physician Spring 2017 - 2
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