Wound Aid

According to the National Institutes of Health, 6.5 million people in the US suffer from chronic wounds—and the agency expects that number to increase. With over 25 years of clinical experience, Bill Tettelbach, MD, has watched wound care grow from a relatively obscure pursuit to a true specialty, largely propelled by the escalating complications associated with rising diabetes rates.

“Anywhere from 10 to 13% of the population is currently affected by diabetes, with many more cases going undetected,” says Tettelbach, chief medical officer at both RestorixHealth, which manages over 260 wound-care clinics in the US, and OnSite Advanced Care, a mobile wound-care company based in Utah. “Each year, as many as 5% of these individuals will develop an ulcer.”

He notes that diabetic ulcers remaining unhealed for 30 days or more are at an increased risk of infection, and those infections can lead to even worse outcomes.

“If a patient with diabetes undergoes a non-traumatic lower-extremity major amputation, like a below-the-knee amputation, that patient’s five-year mortality rate increases to 50%. Studies show that the five-year mortality rate for patients with chronic diabetic foot ulcers alone can be as high as 30%, which is similar to the mortality rate of certain types of cancer.”

“Effective management is the key,” says Tettelbach, who completed his residency in 1998 at the University of Utah. In this conversation, he tells us about the technologies helping the field of wound care keep pace—and the challenges and opportunities ahead.

HOW HAS THE FIELD ADVANCED? WHAT ARE THE INNOVATIONS THAT HAVE PUSHED IT FORWARD?

Wound care is a relatively new field, and a lot of the advancements have been data-driven. The data published over the last couple of decades, for instance, have shown that the more one debrides a chronic wound—say surgically, with a scalpel—the quicker it heals. The innovation here is in the process: the data show that patients have better outcomes when surgical debridement is performed more routinely, say weekly or biweekly.

Also, new devices have been developed that can quantify the amount of biofilm in a wound bed and help direct more effective debridement. Por-table near-infrared technology can image a wound and give the treating clinician a better under-standing of how oxygenated the wound is, thus providing insights on what needs to be done next. On the prevention side, devices that employ thermal imaging and machine learning can help alert patients about their risk of developing a diabetic foot ulcer—suggesting, for instance, that they might need to put on an offloading boot or use crutches for a few days.

IN ADDITION TO YOUR WORK AT RESTORIX AND ONSITE, YOU WORK WITH LEADERS IN YOUR FIELD AS PRESIDENT OF THE AMERICAN PROFESSIONAL WOUND CARE ASSOCIATION. WHAT INDUSTRY-WIDE CHALLENGES DO YOU DISCUSS WITH YOUR PEERS?

One of the challenges we face is that hyperbaric medicine, which is used to treat certain hard-to-heal tissue injuries, is a recognized boarded specialty; wound care is not. As a result, the field of wound care is filled with clinicians from various specialties, such as general surgeons, podiatrists, internists, nurse practitioners, and infectious disease specialists. Yet none of these wound-care providers receive standardized training specifically focused on wound care.

Not having a dedicated taxonomy code or specialty code also gets in the way of funding and having hospitals see this as a true specialty that needs to be established and supported within their systems. Wound care is not a highly sought-after specialty, but the work is extremely important and relevant, whether or not it’s getting the headlines

THOSE ARE THE OBSTACLES THE FIELD FACES, BUT WHAT MAKES YOU OPTIMISTIC ABOUT ITS FUTURE?

Wound care as a specialty or service line is gaining momentum. As more and more hospitals launch these types of clinics in the outpatient setting, they will realize that this represents an unmet need. I believe the specialty of wound care will grow organically, and if we can get standardized training approved, I think it will gain substantially more momentum. I’m very optimistic that this field will grow: we know that when practiced appropriately and in the patients’ best interest, we can achieve the desired outcomes.

Wound care will improve the quality of life for these patients; it will extend life. At the same time, if we can manage these patients effectively and keep them out of the hospital, our approach will save money for the Medicare Trust Fund and the healthcare systems that treat these patients. It can mitigate a significant societal burden.