Clinical Application Guide for Successful Healing
What to Look for in Wound Therapy for your patients with 
Non Healing Foot Ulcers
Ideally, the wound clinic needs to have several modalities available because each patient's need is different. Patients may not all respond adequately to each method. In a physician-run clinic, the physician can determine which methods are appropriate for the wound therapists to use, depending on whether the central issues are infection, blood flow or wound closure.

The status of the wound after four weeks is generally a good predictor of final healing potential. So, if a wound has not shown a healing response after four weeks of wound care, then a more aggressive approach is indicated. A more intensive program should produce a positive healing outcome.

With a results-driven and patient-focussed approach, the successful, well-trained wound therapist puts out the effort to achieve successful outcomes and therefore is able to further contribute to the evidence base of good wound practice. Since these modalities are all time-tested and well supported by clinical research data, you can ask for published reports that validate the techniques being used.

Some questions can be helpful in determining a course of action:

1.    Why is the lesion not healing? — Ischemia, neuropathy, infection, tumour?

2.    Is the vascular status of the foot documented with non-invasive vascular tests?

3.    Is the neurological status documented?

4.    Have appropriate cultures been taken?

5.    Is osteomyelitis present? With the answers to these questions, the proper role of reconstructive surgery, end-diastolic boot 
       therapy, multi electrolyte solutions, local antibiotics, maggots and local hygiene becomes apparent.

A chronically diseased foot causes pain and anxiety which produce an autonomic response that restricts peripheral blood flow and further inhibits healing. A psychologist or biofeedback technician, using computerized, multi mode biofeedback methods, can teach the patient how to produce a relaxation response that increases peripheral blood flow and warms the feet. Video tapes are available with a similar purpose.

Wound therapy cases will benefit from diagnostic techniques, including Skin Perfusion Pressure, Doppler and tcPO2. Because it measures the blood pressure in the micro circulation adjacent to the wound, Skin Perfusion Pressure is preferred as the best predictor* of wound healing potential, and as an ideal secondary measure to verify the effects of therapies intended to increase peripheral blood flow. Since healing progress often can be a delayed response, measurements showing increased circulation can be a strong motivating factor for the patient to continue with the course of treatment until achieving success.

Are all of these diagnostics and therapies justified for the patient? Definitely! Even the resection of a deeply infected ulcer or the amputation of a toe is not a natural expected disease progression; rather it is usually the failure to apply timely and appropriate therapy. It is the beginning of a never-ending series of clinic visits, home-care, chronic pain, further amputations, hospitalizations, prosthesis fittings and disability. The provincial healthcare systems in Canada cannot afford to sustain overly cautious wound care!

In contrast, successful healing of the lesion results in restored quality-of-life and independence. It is extremely rewarding and satisfying for the patient, the therapist and the physician!

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