PHYSICIANS AND SURGEONS regularly see patients with non healing lesions, often in combination with acute infection, gangrene and pain. Everything has been tried — nothing works. But is that really true? Has the patient already received aggressive wound treatment, or merely conventional wound care?

The failure to heal a lesion on a patient's foot becomes an enormous quality-of-life and financial burden for the patient, and a huge financial liability for the Canadian health care system. The therapist needs to have enough different tools available to turn up the treatment intensity until a positive healing response is achieved, and not merely classify the wound as unhealable. Heroic effort is justified!

The problem is that not all clinicians have the needed familiarity and training with the techniques that can really make a difference. Instead of trying to coax a difficult wound to heal with standard wound care, special skills and an inventive attitude are needed to effectively turn around the situation and induce a positive healing response. Many specialists are expert only in their area. Being admitted to a large teaching hospital does not guarantee satisfactory wound treatment!

If you have been sending your high-risk patients to a wound or foot clinic, here are some points that you can ask about to find out if these patients have really "been there, done that." If you are not satisfied, go somewhere else and try again.

How many times have you treated this type of patient?
It is OK to work with beginners. Everyone has to start somewhere — IF they are properly trained, equipped and supervised.

What specialized training did you receive to do this work?
Each profession (nurse, physiotherapist, massage, chiropodist) has one to four day seminars every year on various aspects of wound therapy. At least one such recent workshop would be minimal; hearing a presentation at an annual convention would not usually be considered enough training.

What is the typical outcome for your patients?
It depends on the overall health of the typical patient in this clinic. In most outpatient clinics with the right equipment and expertise, the cure rate should be in the upper 90 percents. But if many patients are very elderly or in poor health, expect less success.

Will the patient get therapy at home?
Equipment can often be set up at home so that patients will benefit from daily treatment. 

Travel by the patient to a clinic with the needed therapeutic expertise and equipment is well justified. As well as the ability to give high-quality wound care, to do wound bed preparation and to apply specialized dressing systems, eight modalities are important in wound therapy. The experienced clinician will successfully justify and acquire the needed equipment.

Eight treatment modalities
What to Look for in Wound Therapy for your Patients with Non-Healing Foot Ulcers (pdf)

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