Wound care begins with a comprehensive evaluation and development of an individualized care plan. Each patient receives a custom wound care regimen. The wound clinic at Stoughton Hospital services many kinds of conditions.
Listen in as Aaron Schwaab, MD discusses the wound clinic at Stoughton Hospital and what to expect as a patient.
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The Wound Clinic at Stoughton Hospital
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Learn more about Aaron Schwaab, MD
Aaron Schwaab, MD
Aaron Schwaab, MD is a general surgeon with Stoughton Hospital.Learn more about Aaron Schwaab, MD
Transcription:
The Wound Clinic at Stoughton Hospital
Melanie Cole (Host): Successful treatment of difficult wounds require assessment of the entire patient and not just the wound. The Wound Clinic at Stoughton Hospital services many kinds of conditions. My guest today is Dr. Aaron Schwaab. He’s a General Surgeon at Stoughton Hospital. Welcome to the show, Dr. Schwaab. When we think of wounds, people think of cutting themselves or nicking themselves and it becoming something that doesn’t heal quite as quickly, but wounds come in many shapes and sizes. Tell us what we’re talking about here.
Dr. Aaron Schwaab (Guest): Thank you, Melanie, it’s nice to be with you today. Yes, you’re very right. When it comes to wounds, there are multiple different causes for wounds. When we’re talking about a Wound Center like we have here at Stoughton, we’re dealing with what we call chronic wounds. Those wounds can be caused by pressure, by lack of blood flow, or what we call arterial wounds. They can be caused by trauma, so a traumatic wound. They can be caused by venous disease in the legs, so we call those venous stasis ulcers and diabetics also have a propensity to having chronic wounds. Those are some of the chronic conditions that we see that we have to treat at the Wound Center.
Melanie: So a chronic non-healing wound, when is it something that is chronic and non-healing? When do you look at a wound and say, “This one’s been going on awhile?” How long is awhile?
Dr. Schwaab: We define a chronic wound as a wound that you’ve had for two weeks that has not started to heal or a wound that you’ve had for over six weeks. Those are really the definitions that we use for a chronic wound.
Melanie: Diabetics, for example, they’re supposed to really give themselves a good foot check and a leg check on a regular basis. What would be the cause of wounds that they would get?
Dr. Schwaab: Diabetics are probably our most difficult population. The problem with diabetics is that they have neuropathy, peripheral neuropathy and basically, the nerves in their feet don’t work very well, and they can’t feel very well, so it’s very common for a diabetic to get a wound on their foot and they don’t even know they have it. The problem is, is that not only do their nerves not work, but they usually have poor blood flow, and so wounds don’t heal very well. I’ve seen patients who are diabetics who actually stepped on a tack or a nail, and they don’t even feel it, and that creates a wound, but in general, it’s a combination of poor blood flow and then not being able to tell that they actually have a wound. Because they’re prone to wounds, we recommend that they – at least every other day, or even every day, it’s a good idea for diabetics to look at their feet, look in between their toes and make sure that they’re not getting a wound there that they maybe don’t even know they have.
Melanie: So what would you like as the first line of defense for home treatment? People are often confused – leave the wound open and let it air heal, or keep it closed, keep it wet with Neosporin – what do you do with a wound?
Dr. Schwaab: Well, it’s kind of a myth that you want to leave the wounds open to the air. Actually, a wound requires a moist, contained environment for it to heal the quickest. Typically, for a wound that you might get at home, it’s going to heal quickest if you keep it covered with a bandage. Change that bandage as often as you see necessary depending on how much drainage the wound has and things like that. The topical antibiotics like Neosporin, I don’t think they necessarily hurt, but they’re not necessarily a big benefit to wounds. It’s mainly keeping it clean and keeping it protected and bandaged.
Melanie: And what about drainage? If there is yellow pus-like substance coming out, do we worry then, or is that a normal part of healing?
Dr. Schwaab: There’s many different kinds of drainage. There’s something we call serous drainage, which is more of the clear yellow drainage, that is really normal for any open wound. When you’re talking about pus or purulent drainage, that’s more of a foul-smelling, cloudy, brown, or white type of drainage and again, that usually is pretty obvious that that’s not supposed to be coming out of a wound. Also, you have to look at the appearance of the wound as far as the redness -- is there’s a lot of redness, swelling around a wound? That’s going to go along with more of an infected wound, so if you’re looking for signs of infection of a wound, you want to see spreading redness around the wound, and a more foul, cloudy, brown, or milky-type of drainage from a wound.
Melanie: If you see some of that -- the redness, or any of the symptoms you’re describing -- then it’s time to see a professional, yes?
Dr. Schwaab: Correct.
Melanie: So if someone notices some of these symptoms, do they go to Urgent Care? Is this an emergent situation? Could sepsis be something they’re worried about? Where do they go from there?
Dr. Schwaab: Yes, if you have a wound that is showing some of the signs of infection that we talked about, it’s best to see a healthcare provider. That could be your Primary Care Doctor, and that’s usually where I’d start, would be to call the Primary Care Doctor and see if they can see you. If they can’t, then an Urgent Care or Emergency Room is a good place to go because those doctors are there all the time and able to assess the wound and at least start the process of treatment with antibiotics, potentially change the kind of dressings that you’re doing, and then get you to the appropriate place like, for example, our Wound Center if it’s something that needs more professional care.
Melanie: So tell us about your Wound Center, what kind of conditions do you service and what do you do for people with chronic, non-healing wounds?
Dr. Schwaab: First of all, I’d like to say that we started this Wound Center because there seems to be a lack of that service in the Dane County area, so we thought that it would be a nice service to provide for the community. Basically, a place for patients to be seen and have someone with extensive wound background and experience be able to evaluate their wounds and then to provide ongoing care for the wounds is very important too. If we just see them and send them home and say, “You’ve on your own,” these wounds are not necessarily going to heal as well, so we provide ongoing care. The kind of wounds that we see are what we talked about in the very beginning, so we see diabetics with ulcers on their feet, we see patients with venous ulcers on their legs, we see traumatic wounds or post-surgical wounds. We really see the whole gamut of different etiologies for wounds in our clinic.
Melanie: What are some treatments that you might provide? What is different than what we do at home?
Dr. Schwaab: Very good question. What we can provide is number one, many wounds need to be debrided, or cleaned, or both. A wound isn’t going to heal and is more likely to get infected if there’s dead, or unhealthy tissue within a wound. Being a General Surgeon, if I see a wound that has any of this dead or necrotic tissue we call it, we’re going to clean that out of a wound at the initial visit, and that is going to allow the wound to start healing. We also have many different products that we have at our disposal, which are more advanced than just the typical band-aid. We have products that have antimicrobial, or antibacterial impregnated into the bandages themselves, which can help prevent the wound from getting infected. We also have products that have collagen, which is the basic building blocks for a wound to heal, in the dressing itself, which then dissolves into the wound and can help those wounds replenish the factors that they’re missing that require those wounds to heal.
We also can do tissue replacement, so we have certain kinds of cell cultures – it’s very complex, but we can add these back into a wound and provide new cells in a wound that can help it start to grow. The problem you have with some chronic wounds is the body seems to have forgotten that those wounds are even there, so it’s not unusual to see patients who’ve had wounds for six, seven months, or even years, that just are stagnant and not healing. You have to remind the body and reactivate the body’s knowledge of that wound so that the process can start over again as far as healing, so some of these products that we have and dressings that we have, add what the wound has been missing, and reactivate that wound, and get it along that healing process.
Melanie: Wrap it up for us Dr. Schwaab, with your best advice for people that notice that they have a wound and how long they should really keep a watch on it and keep it clean and covered before it’s time to go see a professional.
Dr. Schwaab: In general, I would say again that if you have a wound that does not seem to be healing at all in two weeks, or is still present after six weeks – most wounds should be healed after six weeks – you should seek professional care. You also have to realize that each patient is different, so diabetics really with any wound should probably see their health care provider immediately because especially on their feet, these wounds – in two weeks it might be too long to wait. Patients who are on steroids or on other immunosuppressive drugs should also have a lower threshold to see their doctors, but for a generally healthy, normal person, the two-week, six-week rule is a good rule.
Melanie: Thank you, so much, for being with us today, it’s really great information. You’re listening to Stoughton Hospital Health Talk, and for more information, you can go to StoughtonHospital.com, that’s StoughtonHospital.com, and right there you can find some of the information on the services that Stoughton Hospital offers in wound care. This is Melanie Cole. Thanks, so much, for listening.
The Wound Clinic at Stoughton Hospital
Melanie Cole (Host): Successful treatment of difficult wounds require assessment of the entire patient and not just the wound. The Wound Clinic at Stoughton Hospital services many kinds of conditions. My guest today is Dr. Aaron Schwaab. He’s a General Surgeon at Stoughton Hospital. Welcome to the show, Dr. Schwaab. When we think of wounds, people think of cutting themselves or nicking themselves and it becoming something that doesn’t heal quite as quickly, but wounds come in many shapes and sizes. Tell us what we’re talking about here.
Dr. Aaron Schwaab (Guest): Thank you, Melanie, it’s nice to be with you today. Yes, you’re very right. When it comes to wounds, there are multiple different causes for wounds. When we’re talking about a Wound Center like we have here at Stoughton, we’re dealing with what we call chronic wounds. Those wounds can be caused by pressure, by lack of blood flow, or what we call arterial wounds. They can be caused by trauma, so a traumatic wound. They can be caused by venous disease in the legs, so we call those venous stasis ulcers and diabetics also have a propensity to having chronic wounds. Those are some of the chronic conditions that we see that we have to treat at the Wound Center.
Melanie: So a chronic non-healing wound, when is it something that is chronic and non-healing? When do you look at a wound and say, “This one’s been going on awhile?” How long is awhile?
Dr. Schwaab: We define a chronic wound as a wound that you’ve had for two weeks that has not started to heal or a wound that you’ve had for over six weeks. Those are really the definitions that we use for a chronic wound.
Melanie: Diabetics, for example, they’re supposed to really give themselves a good foot check and a leg check on a regular basis. What would be the cause of wounds that they would get?
Dr. Schwaab: Diabetics are probably our most difficult population. The problem with diabetics is that they have neuropathy, peripheral neuropathy and basically, the nerves in their feet don’t work very well, and they can’t feel very well, so it’s very common for a diabetic to get a wound on their foot and they don’t even know they have it. The problem is, is that not only do their nerves not work, but they usually have poor blood flow, and so wounds don’t heal very well. I’ve seen patients who are diabetics who actually stepped on a tack or a nail, and they don’t even feel it, and that creates a wound, but in general, it’s a combination of poor blood flow and then not being able to tell that they actually have a wound. Because they’re prone to wounds, we recommend that they – at least every other day, or even every day, it’s a good idea for diabetics to look at their feet, look in between their toes and make sure that they’re not getting a wound there that they maybe don’t even know they have.
Melanie: So what would you like as the first line of defense for home treatment? People are often confused – leave the wound open and let it air heal, or keep it closed, keep it wet with Neosporin – what do you do with a wound?
Dr. Schwaab: Well, it’s kind of a myth that you want to leave the wounds open to the air. Actually, a wound requires a moist, contained environment for it to heal the quickest. Typically, for a wound that you might get at home, it’s going to heal quickest if you keep it covered with a bandage. Change that bandage as often as you see necessary depending on how much drainage the wound has and things like that. The topical antibiotics like Neosporin, I don’t think they necessarily hurt, but they’re not necessarily a big benefit to wounds. It’s mainly keeping it clean and keeping it protected and bandaged.
Melanie: And what about drainage? If there is yellow pus-like substance coming out, do we worry then, or is that a normal part of healing?
Dr. Schwaab: There’s many different kinds of drainage. There’s something we call serous drainage, which is more of the clear yellow drainage, that is really normal for any open wound. When you’re talking about pus or purulent drainage, that’s more of a foul-smelling, cloudy, brown, or white type of drainage and again, that usually is pretty obvious that that’s not supposed to be coming out of a wound. Also, you have to look at the appearance of the wound as far as the redness -- is there’s a lot of redness, swelling around a wound? That’s going to go along with more of an infected wound, so if you’re looking for signs of infection of a wound, you want to see spreading redness around the wound, and a more foul, cloudy, brown, or milky-type of drainage from a wound.
Melanie: If you see some of that -- the redness, or any of the symptoms you’re describing -- then it’s time to see a professional, yes?
Dr. Schwaab: Correct.
Melanie: So if someone notices some of these symptoms, do they go to Urgent Care? Is this an emergent situation? Could sepsis be something they’re worried about? Where do they go from there?
Dr. Schwaab: Yes, if you have a wound that is showing some of the signs of infection that we talked about, it’s best to see a healthcare provider. That could be your Primary Care Doctor, and that’s usually where I’d start, would be to call the Primary Care Doctor and see if they can see you. If they can’t, then an Urgent Care or Emergency Room is a good place to go because those doctors are there all the time and able to assess the wound and at least start the process of treatment with antibiotics, potentially change the kind of dressings that you’re doing, and then get you to the appropriate place like, for example, our Wound Center if it’s something that needs more professional care.
Melanie: So tell us about your Wound Center, what kind of conditions do you service and what do you do for people with chronic, non-healing wounds?
Dr. Schwaab: First of all, I’d like to say that we started this Wound Center because there seems to be a lack of that service in the Dane County area, so we thought that it would be a nice service to provide for the community. Basically, a place for patients to be seen and have someone with extensive wound background and experience be able to evaluate their wounds and then to provide ongoing care for the wounds is very important too. If we just see them and send them home and say, “You’ve on your own,” these wounds are not necessarily going to heal as well, so we provide ongoing care. The kind of wounds that we see are what we talked about in the very beginning, so we see diabetics with ulcers on their feet, we see patients with venous ulcers on their legs, we see traumatic wounds or post-surgical wounds. We really see the whole gamut of different etiologies for wounds in our clinic.
Melanie: What are some treatments that you might provide? What is different than what we do at home?
Dr. Schwaab: Very good question. What we can provide is number one, many wounds need to be debrided, or cleaned, or both. A wound isn’t going to heal and is more likely to get infected if there’s dead, or unhealthy tissue within a wound. Being a General Surgeon, if I see a wound that has any of this dead or necrotic tissue we call it, we’re going to clean that out of a wound at the initial visit, and that is going to allow the wound to start healing. We also have many different products that we have at our disposal, which are more advanced than just the typical band-aid. We have products that have antimicrobial, or antibacterial impregnated into the bandages themselves, which can help prevent the wound from getting infected. We also have products that have collagen, which is the basic building blocks for a wound to heal, in the dressing itself, which then dissolves into the wound and can help those wounds replenish the factors that they’re missing that require those wounds to heal.
We also can do tissue replacement, so we have certain kinds of cell cultures – it’s very complex, but we can add these back into a wound and provide new cells in a wound that can help it start to grow. The problem you have with some chronic wounds is the body seems to have forgotten that those wounds are even there, so it’s not unusual to see patients who’ve had wounds for six, seven months, or even years, that just are stagnant and not healing. You have to remind the body and reactivate the body’s knowledge of that wound so that the process can start over again as far as healing, so some of these products that we have and dressings that we have, add what the wound has been missing, and reactivate that wound, and get it along that healing process.
Melanie: Wrap it up for us Dr. Schwaab, with your best advice for people that notice that they have a wound and how long they should really keep a watch on it and keep it clean and covered before it’s time to go see a professional.
Dr. Schwaab: In general, I would say again that if you have a wound that does not seem to be healing at all in two weeks, or is still present after six weeks – most wounds should be healed after six weeks – you should seek professional care. You also have to realize that each patient is different, so diabetics really with any wound should probably see their health care provider immediately because especially on their feet, these wounds – in two weeks it might be too long to wait. Patients who are on steroids or on other immunosuppressive drugs should also have a lower threshold to see their doctors, but for a generally healthy, normal person, the two-week, six-week rule is a good rule.
Melanie: Thank you, so much, for being with us today, it’s really great information. You’re listening to Stoughton Hospital Health Talk, and for more information, you can go to StoughtonHospital.com, that’s StoughtonHospital.com, and right there you can find some of the information on the services that Stoughton Hospital offers in wound care. This is Melanie Cole. Thanks, so much, for listening.