CINCINNATI - Retired journalist and teacher Emil Dansker of Hyde Park discovered the area’s specialty in wound care when he pulled out a drawer from his desk, and it dropped on his foot.
“I had never heard of wound care until I had a wound that needed care,” said Dansker. “I went out to the wound care center, and they went to work.”
As millions of Americans confront the debilitation of diabetes, obesity, radiation therapy and other challenges, a demand has grown for specialists who manage the care of wounds that do not heal naturally. Untreated, wounds cut into quality of life and, especially for diabetics, can lead to amputation of a limb.
In the Tri-State, the major medical systems are devoting more time and attention to wound care. Mercy Health’s four clinics — at Clermont Hospital, Fairfield Hospital, The Jewish Hospital and West Hospital — belong to the Healogics network, based in Jacksonville, Fla., the largest private provider of specialty wound care in the country.
When Dansker, 84, dropped that desk drawer on the top of his right foot last year, “it didn’t really bother me at first. But after a few days, it was swelling up, and I clearly needed more attention.”
After surgery to drain the injury, he was referred to the clinic at The Jewish Hospital for 10 weekly visits. At the clinic, his wound was drained, cleaned of dead cells and redressed.
“They even had me wear a special shoe,” Dansker said. “And I’d never had to use crutches before.”
"This should be better by now"
Dr. Robert Cranley, a Mercy Health vascular surgeon (and uncle of Mayor John Cranley) moved into the wound care specialty about three years ago. Difficult-to-treat wounds, he said, are often a factor of other health problems such as diabetes, poor circulation or swelling.
“The family doctor sees the patient and says, ‘This should be better by now, something’s wrong here,’ and tells the patient to go see the wound clinic.”
“We’ve seen a lot of things, where people just put a Band-Aid on it, or like in that movie, ‘I’ll spray Windex on it,’ ” Cranley said. “I’ve seen people put bleach in a wound, full-strength peroxide, alcohol, and they tell me, ‘But I cleaned it out real good!’ Our teaching for that is: Don’t put anything in a wound that you wouldn’t put in an eye.”
Wound clinics bring together many medical disciplines to work on a plan to stimulate healing.
“In my office,” Cranley said, “we have a plastic surgeon, an infectious disease specialist, a specialist in hyperbaric oxygen therapy." The last is a treatment in which a patient stays in a pressurized room inhaling pure oxygen, which amps up the body’s healing processes.
Many wounds require debridement, or the surgical removal of dead cells, which may sound counterintuitive for those of us who grew up hearing parents say, “Don’t pick the scab.” Cranley said that as a wound ages, the body will take it off its fix-it-now list, which allows the wound to fester.
“We’ll debride that wound every week,” Cranley said, “because when we keep after those dead cells, it stimulates the body into thinking it’s a new wound, so it will prioritize that wound and send the cavalry to heal it.”
Why is someone not healing?
Dr. Arti Masturzo has been practicing the specialty for about a decade at TriHealth’s Advanced Wound Care Centers, “because I realized that if I concentrated on this full time, I can get much, much better at it.”
“What I like is that there’s a mystery to solve: Why is someone not healing?” Masturzo said. “Healthy people don’t get chronic wounds. So a chronic wound indicates that there’s something going on within the body. The bottom line then becomes: Now what do I do? How do I fix this?”
Debridement is a valuable tool, Masturzo said, “because wounds have to heal from the inside out,” so a failure to heal means that there’s a real need inside the patient that has to be addressed. Diabetes often provides textbook examples of this disconnect within the body.
Masturzo and Cranley pointed out that one effect of diabetics is neuropathy, or the loss of feeling in the feet, so someone with diabetes won’t be sensing pain signals of a foot wound. Eventually, infection sets in, then gangrene, and the foot must be amputated.
“We do treat diabetic foot ulcers very aggressively,” Cranley said. “If you don’t get in there before the infection of the bone, worse things are coming down the road.” Next page: "Happy and healed"
The goal: Happy and healed
Technology is developing new treatment for wounds. Skin cells from cadaver skin or the amniotic membrane can be laboratory grown, then grafted onto a wound to stimulate healing. Cranley also has seen the positive effects of putting a vacuum suction on a wound.
“Ten years ago, if you had this big abdominal wound that won’t close, people said, we’ll put a vacuum suction on it with a sponge, and people thought you were kind of crazy,” he said. “But now we see that wound vacuum speeds up healing. It’s amazing how much just that device has improved things.”
What Masturzo finds exciting about wound care is the collaborative nature of the practice.
“I like taking on situations that otherwise would be thought unsalvageable and looking for a way to salvage it by working as a team to solve the problem. It’s great to see someone come out happy and healed.”
At the end of his 10 weeks of wound treatment, Dansker said he developed a bond with his care team.
“I was impressed in watching how they operated. It’s like family out there. When I was done, they gave me a ‘sore loser’ certificate. And they sang to me!”
Connect with Anne Saker on Twitter: @apsaker.