John Steinberg, DPM PRESENT Editor Assistant Professor, Department of Plastic Surgery Georgetown University School of Medicine Washington, DC

It's Not What You Put On the Wound...
It's What You Take OFF!

Introduction

I remember this statement echoing in the hallways of the University of Texas during my Fellowship many years ago, and I can safely report that it still holds true in many aspects of my practice today.  We would be in the midst of a grand rounds, conference, or a clinic patient presentation outside the exam room when the heated debate over treatment plans would take a major turn.  Often the discussion was focused on what new dressing, graft, gel, or goop would best improve the chances for wound healing in a particular patient scenario.  However, with the proper mentoring, the discussion would more appropriately change direction and the correct attention could now be directed at finding the actual etiology for the non healing wound and the need to apply good standard of care before looking elsewhere.  Additionally there would be references made to the literature and citations made that appropriately pointed out the fact that 80% of newly presenting diabetic foot ulcers would heal in 6 weeks with proper sharp debridement, pressure offloading, and the maintenance of a moist wound environment.

Now, I will readily admit that I enjoy keeping current with all the new technologies and gadgetry available to us in practice.  However, it's key that we keep focused on the big picture and Remember to treat the patient, rather than just the wound.  The principle quoted in the title of this editorial seeks to make a very simple point about wound care and practice.  We tend to get too caught up on debate over items; such as what topical is best and what dressing material provides the most optimal ratio of ions to the wound bed.  These debates are only worthwhile if one has already maximized the improvement you can achieve from the appropriate standard of care.

Conclusion

There are many areas of practice that this type of quotation can apply. Given the pressures we face in an evidence based world, we tend to get too caught up in the details and sometimes lose focus of the big picture.  I challenge you to take a step back and see things from a different perspective so that you can really make a judgement on what would be the best way forward for your patient and their concerns...

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