When the first edition of Text and Atlas of Wound Diagnosis and Treatment was published, a physician friend said to me, “If I have a patient with a wound in my office, and I don’t know what it is, I do not have the time to go through this book and find it.” From that conversation, the idea originated for a pictorial reference that practicing clinicians could use to diagnose unusual wounds, and thus have a starting point for developing a plan of care, including appropriate referrals to other medical specialists.
The mission of this work, in addition to aiding diagnosis, is to stress that every wound is on a patient, and it is the patient who is being treated first and foremost. Yes, the wound requires attention directly, but concurrently, patient concerns, conditions, and circumstances must be specifically addressed as well. These include co-morbidities, nutrition, complete system review, functional status, and personal habits, as well as social, psychological, and economic factors. An inter-disciplinary approach to treating patients with wounds is often required for the best outcomes; thus the information included in this book is intended to be applicable and useful for all of the medical professions.
The principles of evidence-based wound care are discussed in the first chapter as a guide to caring for any patient with a wound, including the recommended supplies needed for care during the first encounter. However, “clean, cut, and cover” as a treatment model does not constitute evidence-based wound care and often adjunct therapies such as compression therapy, biophysical agents, advanced dressings, nutritional counseling, exercise, or hyperbaric oxygen therapy are recommended to advance healing, prevent infection, and achieve faster closure. Therefore, the sections on medical management and wound management are intended to suggest to the primary caregiver referrals that may be beneficial in achieving faster healing, thus helping to prevent the risk of complications, saving cost of care, and improving patient satisfaction.
My goal as a clinician was to treat a wound in such a way that the patient did not have to provide care between treatment sessions; the patient’s responsibility was to get on with life in as normal a way as possible. This was accomplished by performing appropriate debridement, using advanced dressings, and providing adequate patient education. Interestingly, much of this book was written during the COVID-19 pandemic of 2020. During this time, much of patient care was transitioned to telemedicine—i.e. teaching the patient or the caregiver how to manage the wound at home with less hands-on care by the clinician. This has allowed us to evaluate our previous methods and to compare them to a higher level of involvement of the patient and caregiver in the home setting. Time and research will hopefully reflect on the two different approaches and tell us which method produces the best outcomes. Regardless of how the patient and the wound are treated, an accurate diagnosis is the first very critical component of good care. To that end, we hope that you find the photographs and text beneficial in your practice.
The wounds covered in this book reflect the myriad of cases that we have seen in the combined thirty-plus years that we have practiced wound care. And each of you could add some from your own experiences, which we would welcome having you send to us so they can be included in the next edition. Students are often told that once they get into the clinic, the patients become their best teachers. We are incredibly grateful to all of those patients who have so graciously trusted us to provide their care and have taught us through their open honesty. God bless you as you work to care for His people who have chronic, non-healing, or atypical wounds; may you always be open to what those patients have to teach you.
Rose Hamm, DPT
Joseph Carey, MD