New center tackles hard-to-heal wounds

Dr. Lynn Samuels talks with patient Frances Wallace who has suffered from a painful wound on her leg since the 1960s. Photo by Randy Litzinger.

By Marcia A. Chidester
Special to the Rappahannock News
The wound on Frances Wallace’s leg extends from just below her knee to below her ankle, and wraps halfway around her calf.

It is varying shades of angry purple, black and yellow.

It is also 42 years old.

It was 1968 when blood clots damaged the veins in Wallace’s legs. Then came a cut on her left ankle that would not heal. The cut became a sore the size of a quarter, then grew.

Wallace was in agony.

“I’ve laid in my bed and cried for hours,” she said.

Doctors in Illinois, where she lived at the time, tried skin grafts, but none of them lasted longer than a few weeks.

Then Wallace, 67, moved to Middleburg and, last year, saw a newsletter announcing the opening of the Wound Healing Center in Warrenton.

She became one of the center’s first patients.

Hard-to-heal wounds

The Wound Center — which is managed by Fauquier Health and National Healing, a partner in more than 100 wound-healing centers across the U.S. — cares for only the most chronic, difficult wounds, said director Robert Dart.

“Some people need some expertise, that extra bit to try to get these wounds to heal,” Dart said.

Hard-to-cure wounds have a variety of causes. Those such as Wallace’s are the result of bad circulation caused by interrupted blood flow in the veins. Others stem from such maladies as diabetes. Still others are caused by surgery or automobile accidents.

Some of the abrasions are chronic. For more than four decades, Wallace’s wound has healed, then reopened. It’s become infected twice.

Abrasions on pressure-point areas such as the back, heels, or the bottoms of feet, are especially slow to respond to treatment, said Lynn Samuel, one of the center’s six staff doctors.

“Pressure is the enemy to healing because it interferes with circulation,” Samuel said.

Dr. John McCue of Washington is one of eight doctors who staff the center. File photo.

“The Wound Center is really cutting edge,” said Rappahannock County physician John McCue, one of eight area doctors who staff the center on a rotating schedule. He smiles at his unintended pun, and goes on to say that the training provided by Fauquier and National Healing and the work — much of it surgical — that he and the others do at the center has also helped his general practice. “No question that I am able to better aid patients with old or ulcerated wounds in general. This has been a tremendous thing for all the doctors involved.”

Using technologies both state-of-the-art (a hyperbaric oxygen chamber, engineered skin for grafts) and ancient (“just good, old-fashioned cleaning of wounds and removal of dead or infected tissue — same as in Civil War days”), McCue said the center is often able to save patients’ limbs “which, even 10 years ago, they might have lost.”

Getting wound care

Some patients are referred to the center by their primary care physician. Others refer themselves.

First-time patients — whose average age is about 65 — undergo an evaluation complete with lab work, circulation study, clinical assessment and diagnosis, Dart said.

Each of the wound-center physicians, representing medical specialties such as infectious diseases, family practice, internal medicine and pathology, base treatment on techniques learned during specialized wound-care training, Dart said.

The center’s hyperbaric oxygen chamber increases oxygen in the blood, which encourages better blood flow and promotes healing.
Wound vacuums draw out infection and fluid, and keep the site clean so it can close, Samuel said.

Four-layer pressure wraps, such as the one Wallace wears, is another weapon in the wound arsenal.

While the center’s goal is to heal a wound within 16 weeks, sometimes the underlying causes, such as poor circulation, cannot be cured. Then, success is measured, not by complete healing, but by maintenance, Dart said.

If the problem is recurring foot or leg wounds, the center’s staff checks patients’ shoes for proper fit and makes sure their toenails are cut properly. They monitor sugar levels for diabetics and teach them to check their feet for injuries they might not otherwise feel due to the numbness caused by diabetic neuropathy, Samuel said.

Wallace wears compression stockings to encourage blood flow.

Throughout treatment, doctors follow wound progress by taking measurements and snapping pictures.

The model patient

Wallace is the ideal wound patient, Samuel said. She monitors her wound, cleans it, and prepares it for her weekly appointment at the center.

“She’s one of the few patients we ask to remove the wrap and clean the area before they come in,” Samuel said.

Because of her poor circulation, Wallace will likely be dealing with her wound for a long time, Samuel said.

But, Wallace isn’t letting it get her down.

“I can’t let this keep me from doing things,” she said. “I just push on through it, pain and all.”

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