Maceration is a common clinical complication that poses challenges in chronic wound treatment.1 Excessive moisture can be trapped on the wound surface, especially when occlusive dressings are overused or when nonbreathable cover dressings are applied for extended periods.
By Thomas E. Serena, MD, FACS, FACHM, FAPWCA
"Oh, keep the dog far hence that's friend to man."
-T.S. Eliot, The Waste Land
The ancients sacrificed a brown dog at the beginning of the Dog Days to appease the rage of Sirius, believing that the star was the cause of the hot, sultry weather. Why a brown dog? I wonder. I think it more appropriate to register a complaint with the concierge that the air conditioner in my room is acting strange and performing poorly. But the dog days of Summer 2016 are upon us with a menacing bark and a harsh bite. I am lethargic. I am uncomfortable. I wondered whether to blog or not.
However, the Rio Olympic games and accompanying tragic injuries awakened the athletic and medical portions of my slumbering neocortex. I spent numerous sleepless nights in the trauma center during my residency at Penn State. Despite the long hours, the experience defined me as a surgeon. I owe a great debt to my patients and mentors. As I watched the French gymnast splayed on the gym floor with his leg askew, I wondered why trauma surgery and wound and hyperbaric medicine continue to function in estranged, isolated silos. It is inexplicable to me. Experts in both fields share the common problems of complex wounds and hypoxic tissue. There are innumerable opportunities for both to improve outcomes and the quality of life of trauma victims.
Obstacles in Collaborating on Wound Care
The primary barrier to collaboration between these services stems from vast differences in our cultures. Trauma surgeons cull their databases, set up registries, and conduct clinical trials. They publish. And they publish again. Unfortunately, the wound care community seems to practice by proclamation. One only has to look as far as the recent National Pressure Ulcer Advisory Panel changes in pressure ulcer definition enacted without any new evidence. Are we surprised that the rest of the medical universe speaks about us in negative terms? In addition, our greatest strength, the multidisciplinary approach, may be our greatest weakness when we attempt to relate and partner with physician dominated-specialties. However, these challenges are surmountable: Research!
"Research," I yell again. At times I fear that my colleagues run for cover every time I begin to say we need more research and more centers interested in advancing our science. Look! Would Medicare scrutinize hyperbaric oxygen therapy with barbaric tools such as preauthorization and pre-payment review if we had a robust body of literature? The trauma surgeons will partner with us if we are willing to study the use of our wound care products and hyperbaric chambers in their patients. However, these are not industry sponsored trials that make up the vast majority of our commercially biased evidence-base. At least in the beginning, the trials will be poorly funded, physician initiated trials. We need clinicians dedicated to wound care who will enroll patients in order to advance our science. Join me.
Gotta go; cycling is on.
About The Author
Dr. Thomas Serena has published more than 75 peer-reviewed papers and has made in excess of 200 presentations worldwide. He has been elected to the Board of Directors of both The Wound Healing Society and the American College of Hyperbaric Medicine (ACHM), the leading academic society in the field of Hyperbaric Medicine. In 2014 Dr. Serena was elected president of the American Professional Wound Care Association (APWCA). Dr. Serena has opened and operates Wound Care and hyperbaric oxygen treatment clinics across the United States.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.