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"Among experts we focus far too little on the basics"

"Among experts we focus far too little on the basics"

Photo: Doctor Stephan Eder, smiling man in a white coat asked Doctor Stephen Eder, Director of the Vascular Surgery Clinic, Schwarzwald-Baar Clinical Center Villingen-Schwenningen and Managing Director at the German Institute for Wound Management (DIW), what kind of progress in the care of chronic wounds can be noticed and which requirements should be taken into account to improve the situation of chronic-wound patients.

At the MEDICA WOUND CARE FORUM from 16.-19. November 2011 the German Institute for Wound Management (DIW) will inform about recents topics on wound care for the first time. Doctor Eder, in a time of maximum medical health care options, chronic wounds are still a big problem. Why is that?

Stephan Eder: Wounds are among the fundamental medical problems among the general public. There are very many diseases where wounds don’t represent the cause but the result. Older people in particular are affected by this and are therefore a section of the population that is strongly growing.

The topic is currently everywhere in the public eye, also since a long-term treatment costs a lot of money. Yet the problem has always been around. These days we have good treatment options to heal chronic wounds. That’s why we try to integrate affected patients speedily in a cause-related wound care treatment. Is there actually a need to catch up for health care personnel or physicians in terms of effective wound treatment?

Eder: The treatment of wounds is a specific medical field which encompasses different medical problems. In this case a comprehensive collaboration between medical disciplines is necessary. Chronic wounds frequently cannot be reasonably treated without vascular diagnostic and treatment. The need to catch up for many health professionals results from a simple fact: for the average family doctor’s office, the chronic wound problem is not very relevant in terms of numbers. That’s why we try to sensitize physicians more.

At the same time we would like to inform care providers with important information about effective wound care. They are a crucial multiplier, because they are constantly communicating with medical practices, the patients and their relatives. For large long-term care facilities this topic is becoming more and more important as well, since increasingly aging residents are frequently affected by this.

Photo: Bandaged foot 
Diabetics are among an
important high-risk group
and therefore have to be well informed
on subjects like neuropathy;
© Jacobs What kind of chronic wounds are most common?

Eder: Chronic wounds can be divided into three large areas: first of all I would like to mention decubitus ulcers or bedsores (pressure sores). It’s especially older and bed-ridden patients who are affected by getting bedsores. This is a wound that heals poorly due to the pressure problem. The second issue is “leg and foot ulcers“, the medical term for this is ulcus cruris. The cause for this is mostly vascular problems of veins or arteries. As a third core area I would like to mention the “diabetic foot“. In this case, diabetic neuropathy with pronounced sensory disturbance results in unnoticed pressure marks on the feet, usually triggered by ill-fitting footwear. And if there is an additional obstructive arterial disease, treatment is very difficult and the healing rates are decreased. What patient group besides diabetes patients is especially affected?

Eder: Vascular patients oftentimes suffer from chronic wounds. Due to cigarette smoking, diabetes, high blood pressure and lipometabolic disorders, vascular diseases and therefore the risk to develop one of the mentioned chronic wounds increase. Needless to say, this will particularly pertain to the aging population. Is there a chance to preemptively protect yourself from chronic wounds?

Eder: To prevent decubitus ulcers, regular controls of how a patient is lying down should take place. Nursing homes and intensive care units continue to intensively try to solve this problem. If the patient is not bed-ridden, with a little exercise he can already contribute in reducing the risk of decubitus ulcers. Another area is varicose veins. They should be treated early, since they can lead to leg ulcers after a few years. Varicose veins are a very common disease affecting many people.

Since diabetics are among an important high-risk group, we have to well inform them on subjects like neuropathy, eyesight and renal problems. These patients should also know for instance that their feet are at risk and that maybe special shoes with a soft foot bed are needed. Very many, usually simple measures can be taken preemptively. But when we don’t start therapy until wounds already exist, it will get difficult, takes a long time and is also expensive.


Photo: Dressing material Which treatment goals have to be pursued once patients are already suffering from a chronic wound?

Eder: The first priority is to perform a cause study. We have to find out why the wound developed, whether it’s due to varicose veins, disturbed blood flow or diabetes. However, as long as the diabetes patient is not aware of the pressure problem, the wound can still be treated, but it will not heal. If the wound already exists, it should not be solely treated with local wound dressings. This is the wrong approach, because we don’t want to nurse the wound, but treat it instead. We have to eliminate the cause. Is there a so-called “gold standard therapy“ that has proven effective over the past few years?

Eder: Unfortunately there is no such gold standard therapy. We have created only very few scientific foundations and can therefore not very much refer to so-called evidence-based medicine, the basis of empirically proven effectiveness, in the area of local wound care. However, there is a gold standard for any type of causes and their treatment.

Great importance is particularly attached to randomized clinical trials. Even if we are not able to produce many of these studies, by now we can clearly assert that moist wound healing is part of the standard. If we let the wound dry up, for example we apply a dry compress and band-aids, the wound heals considerably slower. But if we keep it moist, the environment has a markedly favorable effect on the cells. However, for moist wound healing we need material that creates this type of environment.

Another standard is for the nursing staff to keep the wound clean. The dressing should provide external protection, so that no more bacteria can enter. In addition the bacterial level in the wound should be kept low with appropriate dressing material. This is the first point where experts are starting to differ. There are only few consolidated findings.

Among experts we focus far too little on the basics. The most effective solution is to detect the wound cause and to get rid of it; afterwards the wound heals almost on its own. What medical developments can we expect in the near future?

Eder: It is already sufficient for good wound treatment to carefully examine the wound and to analyze the causes. During the initial examination, the general practitioner should give some thought to why the patient has this wound in the first place. Is a blood vessel disease, obstructive arterial disease, a pressure issue or diabetic neuropathy responsible for this? If we further distribute this knowledge, we will be able to solve about 80 percent of chronic wound problems very quickly.

The interview was conducted by Diana Posth and translated by Elena O'Meara.



Chairman: Dr. Stephan Eder, Managing Director of the Deutschen Instituts für Wundheilung (DIW)

Program (in German): Wednesday, 17.11.2011 until Friday, 18.11.2011 from 11:00 until 16:00 and Saturday, 19.11.2011 from 11:00 until 13:00.
Venue at the MEDICA: Hall 6, Booth G20

- Find out more about the program!


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