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Maggie McKay (Host): Cuts and scrapes are one thing when it comes to wound care, but what about when you get a serious injury? It could require surgery. Today we're going to find out what wound care is and who needs it with Dr. Ryan Wood, medical Director at Eisenhower Wound care Clinic, certified wound specialist, physician and board-certified foot and ankle surgeon. I'm your host, Maggie McKay. Thanks for being here. Dr. Wood. Can't wait to hear all about this. I didn't even know that there were specialists in wound care. This is fascinating.

Dr Ryan Wood: Well, thanks Maggie. I appreciate, I'm excited to be here.

Maggie McKay (Host): So what is wound care? Just to start off with the basics.

Dr Ryan Wood: Well, I think it's good to start off kind of defining what a wound is. I actually get asked by patients, what's the difference between like a wound and an ulcer, because we can have two different types. A wound would be any kind of external problem. So if you get a cut or you scrape your knee or there's an abrasion or something like that, that would be something externally creating a sore. Whereas, an ulcer would be something internal. So if you have a metabolic issue and you develop a sore spontaneously, then that would be more what an ulcer is.

As I was a kid and growing up for me, any wound was just something that I needed to, let dry up and heal form a scab, and then it would go away. I remember watching a. Commercial of, I think it was a Neosporin commercial, and it showed a comparison of two wounds on a thumb, and the one that it applied Neosporin on showed that it healed quicker. I thought that was kind of weird because mine all just healed fine with the leaving the scab alone. But anyway, I've found that wounds are more than that, and when patients get wounds that don't heal, that's where we step in. So, so wound care is the process of treating wounds that are not on that healing process.

Maggie McKay (Host): And what types of conditions are treated at Eisenhower's Wound Care Center?

Dr Ryan Wood: So we treat all wounds, but we kind of define them in different categories and that helps us to figure out how to treat them. A lot of the wounds we get are traumatic, we live in a big golf community. Patients will get hit by a golf ball or run into a golf cart. Actually, one of the most vicious. things that we have as the dishwasher. So people put their dishwasher down and forget that the door's down and then run into it with their shin and develop a wound. And most of these wounds can heal fine, but it's when they're deeper or larger or there's something that either they become infected or things like that, then the wound it's not on that path to healing and that's where we need to make some changes.

Other types of wound would be related to blood flow. Either the arteries or the veins are bad. patients with diabetes that get wounds on their feet, we call those diabetic foot ulcers. Diabetes reeks havoc. The high blood sugar can ruin nerves and, arteries and make it difficult for wounds to heal. Patients that have burns, other surgical wounds, especially most procedures, we have patients that will have, skin cancers removed by specialized dermatologists. And those wounds sometimes are difficult to get healed and we help people with those. And those are kind of some of the more typical things we see.

And then there are atypical wounds. Things you probably have never even heard of. Things like Bioderma, gangrenosum, some of these words that sound kind of scary. There's bullous, pemphigoid, vasculopathy, gang green radiation. These are kind of the scary things that you've never heard of before. These are all stuff that we see, and so when patients don't heal wounds in the community, then they get referred to our center.

Maggie McKay (Host): So you mentioned, a lot of reasons. Any other reasons why wounds would not heal properly?

Dr Ryan Wood: I try to simplify it as much as I can for patients to understand. We like to educate our patients so that we all help in the healing process, but I usually use the VIP of wound care, so it's vascular. Infection and pressure, and those are kind of the main things that make wounds not heal. If there's a blood flow issue that has to be addressed and we use our colleagues, our vascular surgeons to help us to figure out how we can do better with blood flow. Infection is another reason why wounds won't heal and then pressure, if it's on the bottom of the foot, that's a tough place to get to heal.

Cause everybody still needs to get around the house and get to the bathroom. So how are we gonna do that when you're walking on top of a wound and then people that have underlying metabolic issues, or are taking medications that can cause, wounds. Those are all important things and we try to sort those out too.

Maggie McKay (Host): And I hear that Eisenhower has a hyperbaric oxygen chamber. When is that used and what's the purpose?

Dr Ryan Wood: So there are some wounds that are really difficult to heal, and just like it sounds, the hyperbaric oxygen chamber uses oxygen in a specific way in order to heal wounds. Hyperbarics is a unique, pretty interesting story. back in the days when they were, mining for coal, they had to develop these large tubes, metal tubes that men would crawl down in and try to harvest the, or mine, the coal from very deep areas. And they would pressurize these tubes so that they could get the sand and the water out of it so that they could harvest more easily.

And this is back in the 17th century and these were developing diseases. There was a mortality rate and these guys were getting sick and they didn't understand that by putting pressure in these tubes, that these guys, as they came back out they felt good when they were in there. But then when they would come out, they would start to develop these sicknesses. once they finally figured out that it was this decompression sickness, they developed these hyperbaric chambers where the men could go in and then slowly release the pressure.

And this wasn't until the 19th, 20th century when they started figuring out how important this was, and they started treating these decompression sicknesses. If you open up a pop can you hear that carbonation release that CO2 is releasing from the liquid. Well, just like in our bodies, if we take away some pressure, then those could release and in a decompression sickness, that nitrogen would be released into our joints. And that's why people would get, they call it the bends or cassons disease or other things like that.

In Hyperbarics, they can treat that by releasing the pressure slowly and in their treatments. They found that if they used oxygen in these. Compression chambers, they can increase the oxygen levels in the patient's bloodstream by up to 10 times. So patients that have wounds that are directly related to a lack of oxygen, these hyperbaric chambers can treat those wounds and heal wounds that we otherwise couldn't get healed. So it's really an incredible process.

And now they're quite simple, The chambers aren't made of steel. Now they're made of acrylic that you can see through. Patients that do hyperbaric treatments are often very comfortable. They'll take a nap while they're doing the treatment or watch some tv, we've made it a very safe process and a very comfortable process, and we have a couple of chambers here that we'll use for those types of wounds.

Maggie McKay (Host): That's amazing. Do most places have that option? A hyperbaric oxygen chamber?

Dr Ryan Wood: Wound centers have tried to get these because they're finding that these are so important for some of these non-healing wounds, but there's only a handful of places in the Valley that have these hyperbaric chambers, and we're one of them.

Maggie McKay (Host): Wow. What other special equipment does the Wound Care Center have at Eisenhower?

Dr Ryan Wood: So vascular testing is very important. So we have specialized vascular testing where we'll use an arterial doppler to listen to people's pulses. We also use what's called transcutaneous oxygen testing where we actually put patches on people's skin and detect how much oxygen is in the skin. And then we can determine if those patients are good candidates for hyperbarics. We'll use specialized synthetic grafts for patients. We call these skin substitutes, and these are made from different tissues. Every day I feel like there's a new fancy skin substitute, but they make them from modified fish skin, from the collagen, from sheep, from even Placenta tissue.

And they take this in the lab and they find those things that help stimulate growth. And then we can use these biologics. On the wounds. the other thing we can do is we can take biopsies of wounds. We can do, what do we call total contact casting, which is a way that we can take pressure off of wounds, especially for people who are always walking around if the wound is on the bottom of their foot. We have to find a way to protect those wounds, all the way to using wound vacuums. Sounds kind of crazy, but it's actually a very simple dressing.

We put like a foam or a sponge on the wound, and that's connected to a little device that creates, suction and then this helps get rid of any drainage and helps encourage tissue growth. Wound vacuums have really revolutionized wound care over the past 20, 30 years, and that's a valuable tool. we have lots of little tools and techniques that we can use to help with stubborn wounds.

Maggie McKay (Host): Does that little vacuum hurt?

Dr Ryan Wood: Typically, no. Some wounds have pain associated with it, and so we are, careful with those patients and sometimes it's important to get the wound healing a little before we start to use the wound vac or any dressing. But typically the wound vac, no, it doesn't hurt at all.

Maggie McKay (Host): That's great. Dr. Wood, who is the staff at Eisenhower Wound Care Center, who makes it up, for instance, are there specialists?

Dr Ryan Wood: Yes. I, we believe in a team approach, wound care, it's so helpful to get lots of people involved because wounds can be non-healing for any reason. we have a great nursing staff, and the nurses are the warriors. They're the ones who are on the ground, so they're the ones who put on the dressings. They're the ones who place the compression wraps on the patient. They administer the anesthetic and they educate patients. So our nurses are invaluable. I trust our nurses. They have a lot of experience with wound care.

We have hyperbaric supervisors. They're the ones who help the patients get into the chambers. they keep the patients safe and oversee everything. And then we have a medical staff that consists of, podiatrist surgeons, vascular surgeons, and then we work closely with infectious disease specialists, rheumatologists, plastic surgeons. And so everyone that comes to the center is going to see a physician and then have a plan created for them and depending what they need and what the reason the wound is there, we'll get them to the appropriate specialist.

The other nice thing is that after a patient, as we're looking forward to a patient getting healed, we can utilize physical therapists and occupational therapists as well as like a prosthetist or an orthotist to help us so that we can prevent these wounds from coming back. Whether that's helping a patient get some compression dressings, or even getting them like a new shoe or an insert in a shoe to help prevent the wounds from coming back.

Maggie McKay (Host): That's amazing. It sounds like the center has everything covered. If a patient is coming to the Eisenhower Wound Center, what can they expect?

Dr Ryan Wood: Well, first thing we know these are Troublesome wounds that we know that patients get frustrated with it. Some of these are painful. So we try to treat every patient with compassion. this is oftentimes kind of a frustrating point of their life where they've had wounds that have typically healed their entire life without a problem. Now they have this frustrating hole or sore that is giving them fits. So the compassion is one thing that we focus on here at the center. They'll get a workup thoroughly when they come in and we make it our top priority to establish a treatment plan based on why isn't this wound healing?

Because we usually don't get patients that have a simple cuts or scrapes. We get the patients that after the other doctors and the community has seen them and says, I don't know why your wound's not healing, we'll send you to the wound center. So that's our job. The other thing, If a patient has a painful wound, oftentimes we'll need to address this. So whether we're using topical anesthetic or even, just like a dentist to numb your tooth, sometimes we can numb up a wound area so that we can clean it, address it appropriately.

Then we'll plan with patients how to dress their wounds. We'll give them kind of a treatment. We can order dressing supplies for them. We can arrange for a nurse to go to their house to help them with dressings. It just depends on what the patient needs and how much care they're gonna need between visits. Usually we'll have the patient come back on a weekly basis, monitor the wound, take pictures, measurements, and we're making sure that we're on the right track. When I first started, in wound care, I got my feet wet going to a wound center and I found that it's so rewarding.

A lot of these patients, we take through a process and they come on a weekly basis with this frustrating issue that then we get on the right track, they see it start to heal. Pain goes away, things start to improve, and they're so happy and they're usually so appreciative that it's fun to take them through this process. And by the time we get 'em done, we're kind of high fiving. Everybody's excited and you kind of pop the cork and everybody's excited about, getting the wound healed.

Maggie McKay (Host): I bet it's rewarding. So for someone listening who says, I don't know when to go to a wound center, how would you advise them? Like, let's say somebody has maybe a medium wound, you know, not a scrape, but not something severe. Should they come in?

Dr Ryan Wood: We need a referral to see the patients here. Otherwise, we would be inundated with scrapes, but we often will get referrals from primary care doctors, urgent care doctors. Or if a patient just feels like this needs a little extra attention, then we encourage them to, talk about it with their primary doctor or urgent care to have a referral over here. I think most wounds, like we were saying at the beginning, are gonna heal without our special care. But if this wound stalls or if it looks like it's not healing like it should have been, then that's when we would expect a referral.

Maggie McKay (Host): Dr. Wood, it's been great to learn all about wound care. I learned so much, very informative. Thank you so much and all that Eisenhower offers, they have a lot of resources, so thank you so much for filling us in and for your time.

Dr Ryan Wood: You're welcome.

Maggie McKay (Host): Again, that's Dr. Ryan Wood Medical Director, Eisenhower Wound Care Clinic, certified wound specialist, physician and board certified foot and ankle surgeon. For more information, go to eisenhowerhealth.org/services/wound-care. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

Thanks for listening to Living Well with Eisenhower Health Healthcare as it should be. I'm Maggie McKay. Be well.