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The Wound Care Center -- Healing wounds, changing lives - 05/21/2008

Iris Slowkowski just wants to walk again. Last spring, it didn’t look like she ever would.

A circulation problem had disrupted blood flow to her right foot, causing gangrene.
“It was excruciating,” says Slowkowski, 63, of Southington. “I don’t know how I lived with that pain.”
A toe was amputated, and with other areas of her foot degrading, she was told the entire foot would likely have to come off.

Depressed at the prospect of life in a wheelchair, Slowkowski, who’s also dealt with diabetes and Muscular Dystrophy for over 20 years, went to a nursing care facility to recover from her toe amputation. There she met a nurse, Marie DiBenedetto, whom Slowkowski calls “my guardian angel.”

DiBenedetto had previously worked for The Wound Care Center® at The Hospital of Central Connecticut’s Bradley Memorial campus. She suggested Slowkowski visit the Center.

“I felt strongly that her foot could be saved,” says DiBenedetto, R.N., who has since returned to the Wound Care Center as clinical manager.
Leo Veleas, D.P.M., a podiatrist at the Center agreed, telling Slowkowski, “’We can heal this.’”
Eight months later, her foot is getting better.
“I can’t wait to get out of this chair,” she says.

When wounds won’t heal
For most of us, a little cut heals quickly, turning into a small scar in a week or two. But a lot occurs during that healing process, which begins within seconds of injury.

Whenever you get a cut, scrape or other injury involving the skin, blood vessels are torn and bleeding occurs. Special blood cells and proteins are immediately dispatched to plug the torn vessels and other, undamaged blood vessels leading to the wound constrict to reduce blood flow. Once bleeding is stopped, infection-fighting white blood cells enter the wound to destroy bacteria that might have entered with injury.
Over days or weeks, depending on wound severity, tissue repair and regeneration occur. Special cells produce collagen, a protein, that fills in the wound. Skin along the wound edges thickens and stretches, forming scar tissue that will strengthen, then gradually fade.

But many factors can derail that healing process, says Jennifer Clark, M.D., an infectious diseases specialist and Wound Care Center medical director. “Chronic wounds” are those that don’t improve significantly in four weeks or heal in eight.
The Center specializes in treating chronic wounds, and also treats patients with acute wounds (generally those resulting from trauma). The Center provides an outpatient clinic, care for hospitalized patients and outreach services for patients in area skilled-nursing facilities. The hospital contracts with Diversified Clinical Services /Wound Care Centers Inc to operate its Wound Care Center.

Following the Diversified model, patients are seen weekly by a physician-nurse team. Treatment may be medical or surgical, but always includes a “big picture” assessment of the patient. Physician referral is not required for treatment of chronic wounds – those that have not healed for at least four weeks.
Many patients have been living with the pain and disruption for much longer, says Holly Murray, R.N., a Center nurse."
“We’ll ask new patients, ‘How long have you had this?’ and they’ll say ‘12 years’ or ‘one year’ or ‘months and months,’” Murray says. “It’s really amazing how long people can live with a significant wound.”

Pain level often determines how quickly a person seeks treatment, Clark says. The problem is, some conditions can mask pain.Diabetes, the most common source of chronic wounds treated at the Center, can cause diabetic peripheral neuropathy, which most often damages leg and foot nerves. With reduced sensation, patients might injure themselves more easily and be less aware of wound severity. Additionally, high blood sugar can impair white blood cell function, making wounds susceptible to infection.

Rita Brett of Southington, who has diabetes, has twice had dog scratches on her legs get infected and turn into chronic wounds -- including one that went down to the muscle. Her first wounds several years ago took nine months to heal. She got the second wound last July.
“I went to the Emergency Department, then started at the Wound Care Center right away,” says Brett, 79. “They were all so nice there. I was healed by December.”

Diabetes can also cause peripheral vascular disease (also called peripheral artery disease), in which plaque buildup in the leg arteries restricts blood flow and impairs healing.
Other circulatory problems that commonly cause chronic wounds include venous stasis and arterial ulcers. These occur when fluid buildup in a limb makes it difficult for blood to get in to nourish cells and remove waste. Tissue becomes thin and inflamed and breaks open. Pressure ulcers (bed sores) can also turn into chronic wounds, particularly for people with other serious illnesses.

Treating chronic wounds
Like many Wound Care Center patients, Vernon R. Eldred, 73, of Meriden, has multiple health issues that make healing a challenge. Two years ago, he developed ulcers on his heels that, probably due to diabetes and vascular disease, turned into chronic wounds, says general surgeon Christian Ertl, M.D. Ertl and Veleas treated Eldred at the Center.

“When he came to us, he had gangrene so advanced his heel bone was exposed,” Ertl says. “We really weren’t sure we could save his feet.”

While they focus on wound healing, Center staff must deal with the patient’s overall health. They use a multidisciplinary approach, working closely with patients’ primary care physicians and specialists in podiatry, surgery, pain management, vascular care and other areas.

“We look at patients from a holistic standpoint. Do they need a diabetes or vascular assessment? Do they need a biopsy? Are they on medications that can interfere with wound healing? We need to address all the health issues that might be affecting wound healing,” Clark says.

Eldred’s treatment included weekly debridement, surgical removal of unhealthy tissue that can interfere with healing. The patient is awake but on pain medication for the procedure. Debridement can also be done with enzymatic treatments that dissolve unhealthy tissue over a couple weeks. Wounds won’t heal if they’re too dry or too moist, so the Center also uses treatments to maintain optimum moisture levels for healing.

While not appropriate for all patients, hyperbaric oxygen therapy can be effective for advanced diabetic wounds, wounds involving bone infection and those due to previous radiation therapy treatments.

Patients relax in a see-through chamber, which circulates 100 percent oxygen at two to three times atmospheric pressure (similar to what deep-sea divers experience). Pressurized oxygen has been shown to help heal wounds, preserve damaged tissues, control infection and increase blood vessel formation.
Patients are closely monitored during treatment, which takes 90 minutes to two hours. The number of treatments depends on the patient’s condition.

Other treatments might not directly involve the wound but support healing. Eldred underwent angioplasty -- a minimally invasive procedure to break up plaque in one of his leg arteries and restore blood flow. He returned to the Wound Care Center for after-care.

At home, he received care from a visiting nurse, his wife, Leona, and daughter, Elaine Graham, a certified nursing assistant. Eldred “graduated” from a year’s treatment at the Wound Care Center in February.
“I attribute the fact that Mr. Eldred did so well to the constant care he received from his family members, as well as from medical professionals,” Ertl says. “At first, I didn’t think we could save one leg, let alone both. We were so pleased when he was able to leave the Wound Care Center with both feet healed.”
“They’re wonderful,” Leona says of Center staff. “As we were leaving after his last appointment I said to Vern, ‘Well, you’re not walking out of here, but you’re going out with your feet.’”

Hope and healing
The Center has a 96 percent healing rate, with an average healing time of 28 days, says Kent LaPointe, Wound Care Center program director.

Center staff are proud of these results, but won’t take all the credit. Patients, they say, play a critical role in healing. Often they must make lifestyle changes to control blood sugar, reduce sodium intake, elevate the affected limb and ensure regular dressing changes.
“We try to set manageable goals for patients so they don’t get overwhelmed,” Clark says. “We won’t just say, ‘keep your leg elevated.’ We’ll say, ‘for one out of every three hours elevate your leg, while you’re watching TV or reading.’ You have to help people think about their day and how they’ll make wound care part of it.”

The patient’s role in recovery continues long after healing. Slowkowski is preparing for her next step: physical therapy.
“If it weren’t for my husband, Tony, and his constant support, love and caring I would not have made it this far,” Slowkowski says. “I still have a long way to go, but with my husband and family’s help and the care I’m getting from the Wound Care Center, I will walk again.”
After two years in a wheelchair, Eldred is in physical therapy to regain lost muscle tone, and should eventually be able to walk, Ertl says.

Eldred is calling upon the same determination that helped him heal to get him back on the two feet he almost lost.
“You gotta have the will power,” he says. “I will walk again.”

To reach the Wound Care Center:

Bradley Memorial campus and New Britain General campus satellite: (860) 378-1400
Physician referral not required