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Keith Harding calls for increased physician involvement personal in the treatment of patients with healing difficulties the number of chronic injuries seen in hospitals is increasing. he argues that injuries "do not receive the attention they deserve," and that patients suffer from it. Currently, he says, the the majority of patients are seen by nurses but have specialists in a wide range of disciplines. Harding believes that "there is no doubt that [vascular surgeons] have a significant amount to contribute to the management patients with a range of wound problems ", and exposes his arguments to support here.
It is increasingly recognized and accepted that injuries are common and expensive in clinical practice. Recent publications have suggested that up to 10% of NHS [National Health Service] In the United Kingdom, expenditures are devoted to the treatment of patients with difficulty in healing wounds. Although the cost of products used to affect wound healing is significant, most costs are attributable to the inefficient, fragmented, and unpredictable service provided to injured patients.
In recent years, in most parts of the world, medical personnel are not involved in wounds and wound healing problems. This is because wounds are considered an insignificant problem that is given to nurses and other health professionals. professionals, rather than something that deserves the attention of the medical staff. This has had the effect of placing more emphasis on the treatment of wounds and dressings rather than healing.
Wounds observed in clinical practice are caused by a wide variety of clinical problems and are clbadically divided into acute and chronic wounds. The number of chronic injuries is increasing due to demographic change in Western societies and it is recognized that all of these chronic injuries do not heal, but that they do not receive attention. they deserve. With regard to patients with leg ulceration, although most studies suggest that venous disease is by far the most common underlying disease, it should be recognized that there is a wide range of -Comentes can produce chronic ulceration of the leg. It is therefore important to recognize that a diagnosis must be made about this underlying condition and that once this has been undertaken, an appropriate treatment regimen must be offered to these patients. In patients with venous ulceration, there is increasing evidence that the role of surgery in correcting underlying venous disease can have a significant impact on healing.
Despite this, in most health care settings, these patients are seen by nurses who spend a lot of time choosing dressings and bandages to treat these injuries.
Similarly, patients who develop pressure ulcerations, which can be caused by a wide variety of health problems, may require the intervention of geriatricians, dermatologists, rehabilitation physicians, plastic surgeons, microbiologists, neurologists and wound specialists. of the spinal cord. Diabetic foot disease is an increasingly important problem: is it the role of the diabetologist, the vascular surgeon, the orthopedic surgeon or the microbiologist?
For vascular surgeons, there is no doubt that they have an important contribution to the care of patients with a range of wound problems, common sense suggesting that no wound will heal if abnormalities of the vascular system are not corrected. In patients with arterial disease, there is no possibility of healing if the blood supply or oxygenation of the tissues is insufficient. In patients with venous disease, surgical correction, where possible, is an important aspect of healing and preventing recurrent ulceration. Likewise, there are many other situations in which vascular intervention is the cornerstone of good treatment.
Unfortunately, even if the vascular supply and venous return of a wound are optimized, this does not necessarily lead to healing of the patient's wound. A number of problems related to infection, unloading, control of edema and the effect of various drugs on wound healing require the input of a variety of clinical skills.
The main driver of change in wound healing in recent years comes from the industry, which has come up with a number of new and innovative approaches to influence wound healing. However, these approaches lack a solid evidence base upon which clinicians can make the decision to treat patients with effective and proven interventions. It is important to understand that many patients require a range of interventions to resolve wound closure issues, including the choice of dressings, bandages, mattresses and other devices. In addition to these interventions, drugs, surgery and, if we follow trends in the United States, could play a role in biological approaches to healing that will be the next big step in unsuccessful treatment options for the patients. with healing difficulties.
Keith Harding is a professor of wound healing at Cardiff University School of Medicine in Cardiff, Wales, and works at the Skin Research Institute in Singapore. His clinical practice focuses exclusively on the treatment of patients with complex wound healing problems.
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