Wound Warriors
Coping with a chronic wound doesn't have to be life sentence.
The specialists of Overlook's Wound Healing Program can help.

Any injury has the potential to be scary, but when a wound just won't heal, it can be both frightening and frustrating. In fact, although healing is often taken for granted, chronic wounds are a major medical challenge.

All wounds are not created equal, and treating a wound begins with understanding the wound. "There are many types of wounds, and each patient has unique concerns," explains Denise Brenner, RN, BSN, CWCA, nurse manager for the Outpatient and Inpatient Wound Healing Program at Overlook Medical Center. Although the Wound Healing Program mainly treats patients with chronic wounds—classified as a wound that shows no improvement with traditional methods after four weeks—the program's services are available to any patient who needs help managing an open wound. The program frequently treats patients with venous insufficiency, arterial disease, diabetes, pressure ulcers, and many other conditions that stall the healing process.

In addition:

• patients with acute wounds who need advanced wound-healing treatments to stimulate healing, and/or who need their wound infections treated, or simply need appropriate wound-drainage management;


• oncology patients suffering from tissue damage due to compromised circulation during or after radiation treatments are appropriate patients for hyperbaric therapy;
  


• ostomy patients who need support pre- and post-surgery (for stomal marking, trouble-shooting, appliance fitting, and managing skin irritations);
  


• patients dealing with autoimmune disorders that delay wound healing;
  


• patients taking medications that tend to suppress the immune system; and
  


• any patient with an open wound that shows symptoms of infection, including fever, severe pain, redness, swelling, or drainage.

The Diabetes Connection

People with diabetes comprise a large part of the patient population within the Wound Healing Program, and for good reason: "Diabetes is a metabolic disorder that impedes healing and the formation of new, healthy tissue," explains Brenner. Here's what happens: high levels of glucose (blood sugar) can damage arteries and compromise a patient's circulation, limiting the flow of blood and oxygen to such extremities as the lower legs and feet. So if a diabetic develops a diabetic ulcer or pressure ulcer, it is more difficult for blood and oxygen to reach the afflicted area and deliver the body's natural healing components. Additionally, diabetes can lead to neuropathy, a condition in which the patient loses feeling in an affected area; this makes wounds harder to catch in the early stages. Long-term oxygen deficiency can result in stubborn anaerobic infections in which the affected tissue is subject to bacteria that live where oxygen is not present. This creates a significant threat of amputation for the patient. "Any wound, once healed, has a loss of tensile strength, which means that the wound has approximately a 70 percent chance of reopening at another time if that tissue is compromised again," adds Brenner. Another concern is that diabetes tends to occur in conjunction with other conditions that place the arteries at risk, such as high blood pressure, obesity, and high cholesterol.

It's this confluence of potential complications that places diabetics at an increased risk for complex, chronic wound ulcers, typically on the lower legs and feet. Brenner reports that 15 percent of diabetics have foot ulcers, and 84 percent of diabetic amputations begin with an open wound on the lower leg or foot. "Controlling blood sugar, improving circulation, and getting precious growth factors to a wound are key," she explains, "and when traditional methods fail, we're able to offer several advanced modalities that have been proven to promote healing and minimize amputations."

Healing at Overlook

One advanced option for healing is a bio-engineered skin substitute, which can help close a wound while delivering targeted healing factors right where they're needed most. But after four weeks of wound care, the most effective and widely used advanced treatment probably is hyperbaric oxygen, which is delivered in a high-pressure environment similar to an assimilated dive down 1.5 to 2 atmospheres. When patients breathe 100 percent oxygen under pressure, the oxygen is able to circulate to parts of the body compromised by diabetes or other complications. This ideal condition for healing spurs the beginning of a crucial process known as angiogenesis—the development of new blood vessels. Says Brenner, "Hyperbaric oxygen stimulates the growth of these vessels and can also kill some of the bacteria present in a wound, especially in cases where the injured tissue is no longer living." Recent efficacy studies have shown, too, that the immense healing benefits of hyperbaric oxygen continue well after the course of treatment is finished, so patients remain on the road to recovery.

Patients come from far and wide for the wound-healing services at Overlook, Brenner reports, and it's easy to understand why. "Our program employes six Wound Ostomy Continence nurses who are certified to care for wound and ostomy patients," she says. "Ninety-five percent of our full-time staff is also certified by a variety of other nationally recognized programs.

"In January 2010 we received a Joint Commission certification for disease-specific wound care, making us the only facility in New Jersey with this distinction," Brenner continues. "Additionally, we're just one of three facilities in the state to have a hyperbaric program accredited by the Undersea and Hyperbaric Medical Society. Taking on this certification means we agree to maintain standards of patient care that go above and beyond industry requirements, and we vigilantly monitor to ensure we're always in compliance." Additionally, says Brenner, "we place a great deal of emphasis on research and are very innovative and aggressive when it comes to improving patient outcomes." For example, the Wound Healing Program offers annual wound-healing and hyperbaric symposiums to educate physicians, nurses, and wound specialists on the latest treatment options. The program initiated nursing research related to the development of an educational program designed specifically for the venous ulcer patient; the idea is to decrease the time it takes for patients' wounds to heal and to minimize the recurrence.

The specialists of the Wound Healing Program at Overlook Medical Center realize that patients are more than their wounds. The staff takes a holistic approach to wound care, taking into consideration a patient's complete medical and personal profile. "We look at the whole patient to uncover any underlying issues that may be interfering with healing," says Brenner. "Then we work with our interdisciplinary panel of physicians—including representatives from dermatology, plastic surgery, podiatry, vascular surgery, and infectious diseases—to create a treatment plan for each patient based on their unique needs."

For more information on the Wound Healing Program at Overlook Medical Center, call (908) 522-5900.