When something is lost, it is always found in the last place searched …because once found, searching is no longer necessary. With diagnoses: once identified, looking further is unnecessary. Unless something rare can masquerade as many other things, causing a false find – a diagnosis that looks like one thing but is really something else.

So it is with Martorell’s Ulcer. It is so rare and atypical, it is frequently missed when it presents. One of the rarer lower extremity wounds, Martorell’s Ulcer is often unrecognized, leading to ineffective treatment and prolonged, intense pain for patients.

The wound associated with Martorell’s Ulcer is an ischemic lesion appearing on the lower leg and sometimes near the Achilles tendon. Historically, it was thought that women between the ages of 50-70 were more likely to develop Martorell’s Ulcer. However, current literature suggests the average age is 74 and there does not seem to be evidence that women any more than men are likely to develop them. A significant marker for Martorell’s Ulcer is the disproportionate level of pain as compared to the size of the wound; Martorell’s Ulcer causes extreme pain

In all cases, the patient will have severe, long standing, systemic and uncontrolled hypertension and nearly 60 percent will have diabetes. The Ulcers can be triggered by trauma, however, 50 percent will be spontaneous in formation. The wound will be of varying depth, have a necrotic base, bluish or purple edges, an irregular shape, and can be singular or present with satellite sites.

Before being treated by a wound specialist, a patient may see a general practitioner. The generalist will assess a patient presenting with a lesion and leg discoloration and ulceration. Being unfamiliar with Martorell’s Ulcer, the generalist may diagnose it as a more common venous wound.

Even wound care specialists may determine the evidence to be something other than Martorell’s Ulcer. Frequently, Pyoderma Gangrenosum is diagnosed first. While the symptoms of both Martorell’s Ulcer and Pyoderma Gangrenosum are similar, the treatments are very different. Proper treatment for Pyoderma Gangrenosum is contraindicated for Martorell’s Ulcer.

A proper diagnosis for Martorell’s Ulcer is possible only with a large specimen sample biopsy. The specimen must be large and cut to the fascia, and include healthy skin from the wound border into the necrotic area of the wound. The specimen must remain intact, imbedded for histological examination and be of longitudinal orientation. A punch biopsy is insufficient to diagnose Martorell’s Ulcer and if used, has been shown to wrongly diagnose it as Pyoderma Gangrenosum.

Once diagnosed with the biopsy, treatment calls for surgical removal of the necrotic skin followed immediately by a split skin graft. Post-surgery, negative pressure treatment has been shown to help. While pain management was crucial prior to diagnosis and surgery, patients report pain reduction very quickly after surgery. Long term management requires blood pressure and diabetes control, cessation of smoking, and compression to the area. Wound area bacteria can be managed with topical anti-microbials or systematic antibacterial agents.

When a patient presents with longstanding hypertension and diabetes along with a very painful necrotic wound on the lower leg or near the Achilles tendon, health care providers should consider Martorell’s Ulcer and include it as part of the differential diagnosis.

It is rare, can masquerade as many other things, and is frequently found last and only after looking at everything else.

For anyone who watched television in the 90s, the phrase “The More You Know” likely drums up memories of a bright yellow star shooting across the night sky, big purple letters, and celebrities offering helpful information about current social issues. A side-effect of our emphasis on knowledge is that when a patient enters your care, they come with the expectation that you will know “more,” if not “all” about the complaint. It can be tempting to jump into that persona, to go along with “seeming to know everything” at that moment, and fill in the gaps later. But what if admitting how little you know opened up a new window toward better wound care outcomes?

Physicians obtain their knowledge from many sources: medical school, clinical rotations, patient experiences, literature, and conferences.

Staying current is essential to providing patients with the care they deserve. But it takes time. And when new protocols or pharma solutions are presented, a physician will want to know more before changing known and successful programs. There is a risk that sticking for too long with what is known to be successful can cause us to miss something new, but it is essential to incorporate new learnings and challenge our comfort level with the care we provide.

In recently published trial results, I, along with my colleagues report on How Little We Know About Bacteria in Chronic Wounds, and the challenge to increase the accuracy by which bacteria is detected in wounds. By acknowledging we need to know more, we step outside the use of Clinical Signs and Symptoms (CSS) standards to detect infection in a wound and guide decisions regarding treatment.

There are many challenges with this approach, to use a three-step process to determine if the use of fluorescent light could help increase the accuracy of bacterial detection in chronic wounds. By starting with CSS, using fluorescent light technology and concluding with a biopsy to confirm the diagnosis, we were able to see the variance between what their professional opinion might have been on initial analysis and the reality of the wound.

In the first round of trials nearly 20 percent of the wounds that were originally determined not to be infected turned out to have significant amounts of bacteria present. Based on the photos from the fluorescent camera, many of the professionals participating in the trial were able to adjust treatment recommendations to better suit the patients’ needs and described feeling more confident they were making the right decisions.

The knowledge in the treatment room extends beyond what the physician knows. It is an illustration of the importance of a multi-disciplinary approach to wound care and treatment. It turns out, it is not The More YOU Know, it’s The More WE Know together.

###

Correction: In a recent article entitled "Madness Among Us" the article should have reported a recommendation to wait 4-6 days to perform wound closure, not to do the change of dressing. AAWC regrets the error.

It is hard to believe but 1 in 5 infants in the Neonatal Intensive Care Unit and pediatrics units will develop a pressure ulcer (PrU).  What is even more alarming, is that there are very limited studies of risk, prevention, and treatment in this patient population.

Neonates are not mini-children just as children are not little adults. Nonetheless, nearly all known risk assessment scales and PrU prevention plans for neonates are adapted from adult protocols. For both legal and ethical reasons, research in the pediatric and neonatal patient population is limited creating a lack of knowledge among one of the most vulnerable patient populations.

While there is evidence that pediatric skin is resilient and tends to heal quickly, the skin is also more fragile than that of an adult and immature systems can complicate wound care in pediatric patients.

As with the adult, a wound will cause increased risk for complications such as infection and water and electrolyte loss. However in the pediatric and neonatal population these risks are escalated due to their decreased surface area. In addition, the premature neonate’s skin is under developed which will reduce the skin’s barrier function, reduce their ability to regulate temperature, and increase their risk of water loss through the skin. In fact, absorption of seemingly benign topical medicines, lotions, creams or emollients can be dangerous in the neonate. The infant’s limited mobility and age appropriate mobilization patterns also present challenges to the prevention and management of wounds. Expression of discomfort and pain also complicate prevention, assessment and management of wounds in the neonatal and pediatric patient population.

When a neonate or pediatric patient develop a wound the treatment goals start with alleviating pain, reducing emotional distress, and minimizing scarring. To prevent additional trauma to the skin, dressings should be as small as possible to cover the wound and adhered using silicone or other gentle, non-skin stripping adhesives. In neonates, adhesives should be avoided altogether and replaced with loose or tubular bandages.

Pressure ulcers in hospitalized neonates and pediatric patients are significant and are frequently caused by immobility and medical devices necessary for their care. Of the various risk assessments used in adults, the Glamorgan Scale is reported to be the most readily adapted to infants and children.

The most common areas for pressure ulcers in this population occur on the heels, occipital region, and the sacrum/coccyx area. Medical device-related pressure ulcers can develop on the arm where blood pressure cuffs are applied or on fingers where pulse/oxygen meters are affixed. They may also develop in and around the nostril area from the prongs of oxygen tubes and masks.

Preventive efforts include padding prominent bony areas and rotating the patient to different positions or rotating the location of the medical devices. This population should receive a head-to-toe skin assessment on admission and again at 12 hour intervals with special attention to the sites where medical devices are in skin contact.

Pressure ulcers should be cleaned with room temperature sterile normal saline using a soft cloth or syringe. In the first two weeks after birth, no antiseptics or soaps should be used on the neonate. If emollients are necessary, careful evaluation is needed and must be applied sparingly to avoid systemic absorption – and avoided altogether in pre-term neonates.

Nutrition is key to healing of pressure ulcers, particularly among those with low birth rates or after neonate weight loss. Breast feeding can assist in promoting healing.

Infection risk is high in neonates necessitating close monitoring of the skin around the wound for subtle changes such as swelling or drainage, increased paleness around the wound or in the wound bed or increased redness around the wound. Healing is enhanced by using a moisture retentive dressing and close observation every 12-24 hours.

With little research to rely on, wound care providers treating neonatal and pediatric patients, have done well by adapting adult protocols. Forums for sharing experiences in this category can work to improve care for all those advancing wound care in young patients.

The Pediatric Wound Conference (ISPeW) will be held in Houston November 14-15. For further information visit ispew.org.

https://pedsinreview.aappublications.org/content/26/2/43

https://www.woundsource.com/patientcondition/pediatric-patients

https://advancedtissue.com/2015/05/how-to-treat-wounds-in-children/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985526/

https://www.dovepress.com/neonatal-pressure-ulcers-prevention-and-treatment-peer-reviewed-fulltext-article-RRN

It happened again. Of course, the IT in this context is a mass shooting -- two, in fact -- in fewer than 24 hours last week. The horror of El Paso was swiftly replaced with the tragedy of Dayton. Any town, USA.

Who bears blame and responsibility, and whatever the politics, a fix is an issue for everyone. However, the physical wounds that result are the direct responsibility of wound care professionals.

Unless in a war zone, civilian injuries resulting from gunshots have been linked largely to handguns or rifles. It is estimated that of the 67,000 people injured from gunshot injuries each year, approximately 32,000 will die. Legislation in 2004 lifting a ban on civilian ownership of assault weapons now enables consumers to obtain them.

And since the ban on assault rifles was lifted, there has been an increase in the number of mass shootings in which assault rifles were used.

Injuries inflicted by assault rifles are very different than those received from handguns or other non-assault style weapons. Patients presenting with non-assault style wounds typically have a wound with a defined entrance and exit. There is bleeding from the laceration and there may be fragments in the wound. Provided no vital organs have been hit and provided the patient has not lost too much blood prior to being treated, there is a good chance the patient can survive.

Assault rifle victims often present to an Emergency Department with injuries so severe recovery is not likely. The damage done is beyond repair.

Bullets from assault weapons tend to shred organs as a result of the high velocity at which they leave the weapon. The speed creates more energy as it passes through the body. The injuries result from tissue moving away from the bullet as it passes and then settling – a process known as cavitation. It leaves the tissue damaged or dead, and the cavitation impacts tissue and organs several inches from the bullet path. It is like a pebble tossed in a lake and the resulting eddies or concentric rings moving outward from the point of where the pebble entered the water, followed by the water becoming still again. The result may be injuries to organs not touched directly by a bullet but injured by the eddies created by the bullet path. The entry wound may be small, not unlike that of traditional guns. However, exit wounds from assault weapons tend to be large. Some bullets are designed to expand and fragment on impact and the exit can be as much as 12 inches in diameter.

Even if an assault weapon victim arrives to an Emergency Department alive, the tissue and organ damage may be beyond repair. Those who survive and receive life-saving surgery face long recoveries and require unique and ongoing wound care.

Long term treatment of victims of assault weapons parallels war wound care. Post- surgery, there are many concerns for survival. For wound care, the concern is for infection. Infection can result from residual dead and contaminated tissue or from foreign body material remaining in the wound. If that occurs, additional surgery may be necessary to remove it.

Leaving a wound open for healing may be indicated. Doing so allows for unrestricted swelling, exudation of serum from tissue, avoidance of an anaerobic environment, and to assure there is no residual dead and contaminated tissue.

Open wounds still require dressing. Dry and loose gauze may be indicated for wounds over tendons or with exposed bones. The gauze may be kept moist with saline. Cavities should not be packed but the dressings should be able to absorb blood and serum from the wound. The dressings should not contain petroleum jelly but antibiotic ointment may be used. All dressings should be non-constrictive, never tight, and there should be no adhesive encircling a limb. Doing so increases the risk of constriction. Plaster of Paris (POP) may be used for large wounds and for injuries near joints. If used, POP should not encircle the wound but serve as a support and remain split to the skin so the wound remains open.

As the wound heals, it is recommended not to examine it until 4-6 days after surgery. When changing dressings, do so to the outer dressing, leaving intact that in direct contact with the wound. This reduces the chance of cross-infection, avoids disturbing the wound healing process, avoids causing added pain to a patient, and reduces the amount of time and resources expended by a wound care provider.

Measuring progress includes monitoring for fever, examining for redness or tenderness around the area of the wound, odor from the dressing, and visually determining whether the dressing remains clean.

When the recommended time has passed for the wound to begin healing, look to see whether the wound is clean and red – both indicators of granulation as new tissue is formed. Note whether the deepest dressing is dry and hard indicating exudation. Gauze should remove easily with gentle pressure. These are indicators of improvement and healing.

If the patient has a fever, the dressing is wet with little bleeding and if the wound appears wet and shiny, shows pus, and skin erythema, the wound is not healing and different interventions are needed.

The physical wounds are only part of the damage done by assault weapons in shootings, mass or otherwise. The mental trauma from surviving either from physical wounds or guilt that others did not survive can be almost as difficult to heal. As part of a collaborative treatment team, wound care providers and all members of the treatment team must tend to the mental healing of the patient too. As the visible wounds heal, the invisible ones need equal but different attention.

Wound care providers and trauma teams can go to work together after a mass casualty from assault weapons, and their exquisite skills can result in almost miraculous outcomes. But these are skills no health care provider wants to be called upon to deliver. Until there is multi-platform change, health and wound care providers stand ready to put the pieces back together. 

For additional information, see (co-authored by AAWC’s Ruth Bryant, PhD, MS, RN, CWOCN) Nelson V. et al, Traumatic Wounds: Bullets, Blasts, and Vehicle Crashed. In Bryant, R. Nix, D. Coeditors: Acute and Chronic Wounds: Current Management Concepts, 5th Edition. St. Louis, Mosby/Elsevier January 2016

 

https://reference.medscape.com/slideshow/gunshot-wounds-6008960#19

https://www.scientificamerican.com/article/data-confirm-semiautomatic-rifles-linked-to-more-deaths-injuries/

https://tcf.org/content/commentary/the-assault-weapons-ban-did-it-curtail-mass-shootings/?session=1

https://www.outsidethebeltway.com/the-difference-between-ar-15-and-normal-gunshot-wounds/

https://www.nytimes.com/2018/03/04/health/parkland-shooting-victims-ar15.html

https://www.icrc.org/en/doc/assets/files/other/icrc_002_0570.pdf

Gauze and Chicken Divan have some commonalities: both are easy, quick, inexpensive, and have French connections-- which somehow makes both seem perhaps better than they really are. But both Chicken Divan and gauze may be too easy and as such, create an unwillingness to try something new.

It was the Ancient Egyptians and Greeks who first used woven fabric as bandages for wounds thousands of years ago. However, the continued use of gauze is far more based on tradition than on its functionality. Ancient Egyptians were familiar with the classic signs of infection; however, it was not until the nineteenth century work of Louis Pasteur and Robert Koch that the link was made between infection and specific pathogenic microbes. Then, it wasn’t until the 1978 work of JW Costerton that the biofilm paradigm was discovered, named, and defined by this pioneer.  Ongoing research is now showing that effective treatment of a chronic wound requires aggressive treatment of biofilm.

The French connection comes from the French word “gaze” which means gauze and is linked to the concept of gazing through a gauze veil. It is this lattice work which allows bacteria to penetrate up to 60 layers of gauze. Further the gauze itself is a breeding ground for bacteria, allowing maturation of biofilm within access of host nutrition but above and separated from action of host immunity. Bacteria can be up to 1000 times more tolerant to antimicrobial treatment than planktonic/free floating microorganisms. The recalcitrance of biofilm cannot be effectively addressed by a simple gauze sponge therefore more advanced modalities must be added to routine treatment options. 

When it comes to topical wound and post op incisional management, gauze is used far too often. It is no longer considered the standard of care as a primary wound dressing. So why does it remain the go-to, top drawer tool for wound care providers? A simple answer is that wound care is not taught routinely in medical and nursing schools. Therefore, many providers are not aware that the science and practice has advanced to more sophisticated wound dressings which treat patients more effectively. There are times when gauze is exactly the right option. However, It can also be labor intensive, require ongoing monitoring and frequent change, can be painful to remove, can leave pieces behind in the wound, and increases the bacteria and bioburden in the wound area.

There are thousands of other options available and there are multiple options for each stage of wound healing. Some kill bacteria-causing infection and include antimicrobial agents. Others have electronic sensors that can indicate changes in the wound as it heals. Some are skin substitutes, others are regenerative material. These can decrease healing time, be cost effective, and improve a patient’s quality of life.

The current challenge is in selecting from among these myriad options. The acronyms NERDS & STONEES help with that determination. NERDS for Non-Healing, Exudate, Red Friable Tissue, Debris/Discoloration, and Smell; STONEES for Size Increasing, Temperature Elevation, OS (probe to bone), New Breakdown, Erythema/Edema, Exudate, and Smell. Is it topical? Or is systemic treatment necessary? Each wound requires careful assessment to determine proper care.

Like medicine and wound care, treatment options evolve and improve. Gauze, like Chicken Divan, is likely to remain an option in the arsenal of wound care. But like other recipes, it is no longer the only choice and wound care must continue to provide the highest level of evidence-based care to patients.

Soon after his appendectomy, the eight year old’s mother was anxious for him to stand up tall and walk. He resisted, convinced his stitches would open and his insides would come out. When she lost patience with his hunched posture, he cried in fear while gradually standing ramrod straight. And his stitches gave way.

While nothing spilled out, the boy was traumatized not only from the appendectomy but from the reopening of the wound. Still an inpatient, new sutures were placed quickly.

Known as dehiscence[1], the reopening of surgical wounds is not uncommon. The boy’s fear of insides falling out, known as evisceration[2], is very serious and can be avoided with immediate treatment of dehiscence.

There are many options to close wounds, surgical or any other types. Catgut[3], manufactured from animal intestines has largely been replaced by synthetic materials which provide strength and yet are readily absorbed by the human body. But sutures are no longer the only option for closing a wound or incision. Other options include adhesive strips, staples and glue. Which option is used depends mostly on the type of wound requiring closure.

Sutures[4] are used to sew a wound closed. Dissolvable sutures are often used for internal wound closure. Non-dissolvable suture material must be removed by a medical professional. Sutures are used for deep incisions or wounds, can be done quickly, and are among the lesser expensive options for wound closure.

Staples[5], by look, feel and administration are exactly what one would find in an office supply store. Except those used with wound closure are larger, thicker, sterile, and applied using a medical device. Staples are especially strong and may be used in areas likely to move, such as abdominal incisions. Staples must be removed by a medical provider and done so in a timely manner so that new tissue growth does not grow around the staples causing further injury.

Surgical glue[6] may be used for small incisions that don’t require a lot of hold strength. Unlike other methods, the glue will dissolve and wear off over time, and does not need a medical person to remove it.

Adhesive strips[7] act like a tape to pull a wound closed. Areas where a wound is not in a high stress part of the body can use adhesive strips to close the wound. Caution is essential as individuals may be allergic to the adhesive on the strips.

Regardless of the method used to close a wound or incision, wound care is crucial for proper healing, to avoid infection, and to minimize scarring. Closed wounds establish a clean environment for healing internally and externally; open ones are a gateway for bacteria. Bandages must be changed regularly in a clean environment using clean tools and techniques. Beyond the bandages is the essential need to eat properly to fuel healing. Otherwise, healing can be delayed and there is greater potential for infection.[8]

The eight year old boy’s incision healed nicely with no infection and minimal scaring, and he recovered from both the surgery and the trauma of the reopened wound. His mother, however, is still working through the guilt.

Historian Thomas Carlyle is credited with developing what is known as “The Great Man Theory” when he said great leaders are born and not made. Having lived in the mid 1800’s he can be forgiven for not calling it The Great Man/Woman Theory. It suggests that certain traits or qualities are better suited to leadership, these are innate characteristics present at birth, and leadership will allude those lacking the genetics.

Legendary Green Bay Packers Coach Vince Lombardi had a different view of leadership. There on the frozen tundra, he claimed leaders are made, not born. That they are made by hard effort which is the price to be paid for achieving anything worthwhile.

And like any point of view, the truth is probably somewhere in the middle. It is leaders made and leaders born that the AAWC seeks with nominations for its slate of future directors.

“The AAWC board of directors are those charged with leading the organization in fulfillment of its mission,” said Victoria Elliott, R.Ph., MBA, CAE, and AAWC Chief Executive Officer. “Each board post reflects the composition of our membership and essentially provides each member with a voice and conduit to the organizational leadership.”

The AAWC Board of Directors includes president, president-elect, immediate past president, secretary, treasurer, and directors-at-large including positions for consumer, nursing, podiatry and physical therapy, research, international, and industry. A complete list of the current board of directors can be found at https://aawconline.memberclicks.net/board-of-directors .

The open positions for 2020 are secretary and these directors-at-large: industry, two nurse positions (each 2-year terms), two physical therapist positions (one 2-year term and one 1-year term), two physician positions (one 2-year term  and 1-year term), podiatric physician and research.

With the late 2018 transition to an independent status, the AAWC executive committee postponed elections till 2019. Incumbents are Tomas Serena MD, FACS, President, Ruth A. Bryant, PhD, MS, RN, CWOCN, President Elect, Gregory Bohn MD, UHM/ABPM, MAPWCA, FACHM, Immediate Past President, Kara Couch MS, CRNP, CWCN-AP, Secretary, and Tim Paine, PT, Treasurer.

“This decision enabled the AAWC to remain stable and member-focused during a transition year,” said Tomas Serena MD, FACS, AAWC president. “Each member of the board and the executive committee has been unwavering in support and commitment to AAWC with the needs of members as the primary focus.”

Short and long term goals have been established and are linked to membership input gleaned from a survey conducted last fall. The focus is on education and expansion of learning opportunities for membership, followed by two other pillars of public policy and research.

Ruth A. Bryant, PhD, MS, RN, CWOCN is president-elect and will assume the presidency in 2020. “We have a spectacularly strong organization,” she said. “Members have defined our future and have demonstrated keen insight in selection of solid leadership. With the call for nominations, we are excited to welcome new leaders to the board.”

A willingness to be nominated and then to serve presents opportunity and reward well-beyond wound care responsibilities. It is a chance to step outside a zone of comfort, face new kinds of challenges, and develop skills which may be dormant during the day-to-day. Further, these positions offer a chance to expand a professional network, change the industry, and try new things.

Nominations for candidates will be distributed to membership on July 11^th and will be accepted through July 28^th. Candidates must be AAWC members for no less than one year as of July 10, 2019.

Whether you were you born with or you developed the leadership skills necessary to help AAWC recognize its mission, consider how you or someone you know can take a larger role in impacting your profession in wound care.

When a patient presents with a wound, it is not surprising that the first field of focus is the wound itself. Assessing the wound indicates to the wound care professional what the wound condition is, whether it is chronic or the result of a recent injury, related to surgery, if infected and at what level, possible co-morbidities, and much more. The second field of focus is the computer screen to chart the course of treatment so the wound healing can begin.

All this can be achieved without ever looking beyond the wound or the chart. But limiting the focus and not including the patient’s complete condition is a mistake that can significantly delay wound healing. The injury from a wound goes far beyond the wound’s perimeter.

A study of outpatients in wound care clinics found 81 percent [1] of its patients tested positive for depression. Further, it found depression common in patients with wounds, especially those with wounds lasting more than 90 days[2].

“The visibility of the wound creates a negative self-image because much of our self-image is based on external appearance and is a reminder to the patient that they may no longer look like most other people, “said Tim Paine, physical therapist with Litchfield Hills Orthopedic Associates, Torrington, CT.

Chronic wounds are stressful for a patient. As a long term condition requiring ongoing care and medical attention, these individuals are often removed from their life’s routine, limited in mobility, and isolated from family and friends. It can result in depression and stress, especially in older individuals. [3]

“Healing a chronic wound takes a long time, and requires constant attention to help the healing process, and it is very common for the patient to become emotionally and physically fatigued, which often results in depression and loss of motivation. This in turn prolongs the healing process. This cycle of emotional fatigue, physical fatigue and change in self-image results in a cycle of slowed healing and loss of motivation,” Paine added.

Surgical wounds are likely representative of a co-morbidity meaning the patient is concerned not only with the healing of wounds at a surgical site but also the primary cause and disorder for which the surgery was indicated.[4]

The most common site for slower healing wounds are on the feet and lower legs.[5] Studies indicate patients with lower extremity wounds when combined with stress are 25 percent slower to heal than those patients in a healthy mental state.[6]

Pain associated with wounds can be severe, if left unmanaged. As healing begins, pain and itching can cause sleeplessness impacting emotions, energy and motivation – including motivation to heal.[7]

Mental health is among the leading causes of disability around the world [8],with depression and stress highly prevalent in those with wounds. And once a patient’s wound is considered healed, it is estimated that 12 percent [9] of those patients will have some sort of psychological impact from the experience.

It is long recognized that collaborative care improves wound healing when it includes nutrition, physical therapy, and other specialties.[10] Integrating mental and emotional health assessments in the initial stages of wound care and treatment has been shown to decrease healing time.[11] While mental and emotional health conditions are harder to detect, early intervention can help a wound care patient begin to adjust to potential long term life changes, work through acceptance and avoid withdrawal which may lead to deepening depression.[12]

Mental and emotional health may be overlooked as part of the collaborative care model. As wound care professionals, there is an opportunity to be aware and alert to potential injury beyond the site of the wound. Watch for hard to detect symptoms of emotional and mental suffering, and add to the care team appropriate care givers to treat the patient’s mind while the wound heals.

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The AAWC’s regional WIS meetings are well known by members and others in the wound care world as the Wound Infection Summits. However, the WIS acronym could just as easily stand for Where Information Starts. It is at the WIS meetings where key learnings, new findings, and bold treatment plans are shared and become the renewed start in advancing wound care.

The next WIS is August 16-17^th in Detroit. The two day meeting is overflowing with programs designed to engage those in attendance to individually and collectively advance wound care. Through a series of lectures, panels, and interactive discussions, those attending will learn about:

• bacteria and biofilms,
• special needs of those with wounds resulting from IV drug use,
• use of oxygen in hyperbaric chambers for wound care and therapy,
• impact of nutrition in wound care and treatment, and
• the application of advances in research on biofilms, topical antiseptics, swab cultures and planktonic bacteria to clinical practice.

Meeting attendees are encouraged to submit case studies for use in the “Making the Diagnosis” session where participants will engage with a multi-disciplinary panel to examine case-based differential diagnoses, identify gaps in assessment and discuss diagnosis and the complexity of wound infections.

“The AAWC is able to attract some of the most well-known names in wound care’” said Victoria Elliott, R.Ph., MBA, CAE, and AAWC Chief Executive Officer. “As the foremost recognized multidisciplinary organization in wound care, we find there is great interest in becoming part of the WIS faculty."

The speakers and panel leaders include nurses, doctors, physical therapists and other professionals in various categories of wound care. Among them are Thomas E. Serena MD, Garth James PhD, Claudiu Georgescu MD, Barbara Pieper MD, Jennifer Gaddy MD, Jennifer Hurlow, Greg Bohn MD, Lindsay Kalan PhD, Randy Wolcott MD, Frank Aviles PT, Karen Bauer DNP, Kara Couch CRNP, Jeff Shook DPM, and Munier Nazzal MD.

“The varied professions of the faculty represent the AAWC’s professional membership roster,” said Ms. Elliott. “Further, it is reflective of the collaborative disciplines brought together in teams to treat patients with wounds.”

Among the most anticipated event of the August WIS is a segment entitled “The Patient Experience.” Those in attendance will hear from a patient who has experienced a chronic wound that became even more complicated by infection. Facing the specter of amputation, the individual will share a story of personal bravery, bold treatment plans, a willingness to consider new therapies, comprehensive and collaborative care, and ultimately, the happy new beginning.

“This is an exciting addition for the AAWC Summits,” said Ms. Elliott. “To hear about the personal and successful journey of an individual who has benefited from the help of wound care professionals is a defining moment for those on the front lines of patient care. This story is the personification of how we advance wound care.”

Registration is open for this Wound Infection Summit, and the one to follow in Kansas City. Additional details about the program, the schedule of events, and the travel and lodging information can be found at www.aawcsummits.com

Continuing education credit is available for nurses and physicians through Amedco, LLC. AAWC.  This activity has been submitted to the Board of Texas Physical Therapy for approval of credits.

As the largest member based multi-disciplinary organization dedicated to the prevention and management of patients with and at risk for wounds, it is THE AAWC’S responsibility to draw attention to issues that IMPACT clinical practice and PATIENT CARE.  One such recent topic concerns terms used to describe skin breakdown that appears to coincide with impending death: the Kennedy Terminal Ulcer (KTU), acute skin failure, Skin Changes At Life’s End (SCALE) and Trombley-Brennan terminal tissue (TB-TTI).  First proposed and described in 1983, the KTU was introduced as a subset of pressure ulcers that a patient may develop as they were nearing death.  These were characterized by shape (pear, butterfly or horseshoe), edges (irregular), and color (red, yellow or black).  The KTU may initially be an abrasion, black or darkened area that then rapidly deteriorates into a Stage II, III or IV or unstageable pressure ulcer.  This concept has sparked much interest and debate, including validity of the concept, further descriptions of the event, and case reports.  In a recent scoping review of the concept, Latimer et al (2019) identified a need for further research to deepen understanding of the phenomenon which could then inform practice.  Similarly, Ayello et al (2019) reported a review of literature on the concepts pertaining to pressure ulcers in patients at end of life.  In this report the authors acknowledge that there exists a gap in Understanding of the pathophysiology of changes that occur in the skin as a patient is dying. 

Opinions abound on the merit and validity of KTU, SCALE and TB-TTI and skin failure.  These opinions and debates are beneficial to the discussion because they add perspective and challenge us in the way we think about these conditions in terms of biologic plausibility, defining characteristics, AMONG OTHERS. 

Thus far, the level of evidence that exists to substantiate or refine these phenomenon and terms is largely composed of expert opinion, case reports, and descriptive studies.  This is to be expected with new concepts (and yes 30 years for a relatively rare event, is still legitimately considered a “new” concept).  As the body of descriptive evidence grows, more sophisticated methods of research can be designed and conducted to validate and refine the terminology and thus move the science to a more objectively identified condition. 

However, there is also an expressed desire to agree on definitions and terms concerning skin failure and skin changes at end of life (Ayello et al, 2019).   Recently, an editorial by Schank (2019) hypothesized there may be a plan or steps being put into place to eliminate the terms such as KTU or SCALE.   The state of the existing science concerning the KTU or end of life skin changes phenomenon need a more objective and rigorous scientific process through which to advance what is known before terms can be dismissed or consolidated.

Traditionally the strategy that has been employed to advance policy concerning pressure ulcers has been the use of consensus conferences sometimes in a fully transparent process, sometimes not so much. This is a valid and appropriate methodology for rare conditions when the decision-making participants in the audience are experts with that rare event. Another scholarly approach is to use a process known as a concept analysis to compile what is known about a new condition or phenomenon and, through the rigor of the analysis, explore the utility, practicality, precision and appropriateness of that term.

It behooves all of us to be aware of the issues surrounding ulcers that may masquerade as pressure: the KTU, SCALE, TB-TTI and skin failure. The articles cited in this blog provide a succinct history of the evolution of these terms.  As the multidisciplinary membership of healthcare professionals interested in wound care, attention to these terms and these phenomena is critical so that we are prepared to engage and influence patient care, public policy and professional practice in a responsible, scholarly process that is informed by science, not opinion.

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References:

1. Understanding the Kennedy Terminal Ulcer. http://kennedyterminalulcer.com/  Last accessed 6/15/19.
2. Latimer S, Shaw J, Hunt T, Mackrell K, & Gillespie BM (2019). Kennedy Terminal Ulcers: A scoping review. J Hospital and Palliative Nursing. doi: 10.1097/NJH.000 000 000 000 0563.
3. Ayello EA, Levine JM, Langemo D., Kennedy-Evans KL, Brennan MR., & Sibbald RG (2019).  Reexamining the literature on terminal ulcers, SCALE, skin failure, and unavoidable pressure injuries. Advances in Skin & Wound Care 32(3): 109-121.  www.woundcarjournal.com
4. Schank JE (2019). Special Report: Terminating the Kennedy Terminal Ulcer? Wound Management & Prevention (formerly Ostomy-Wound Management); 65(4). ISSN 2640-5245  http://www.o-wm.com/article/terminating-kennedy-terminal-ulcer

There is a difference between having a certificate and being certified. Having a certificate means that an individual has completed required courses of learning in a particular area. Being certified means that an individual has the specific knowledge and skills required to perform successfully in a particular role. Certification in health care originated from the specialty organizations in the field, with the purpose of conferring upon their members public recognition of having met these criteria of knowledge and required skills. Certifications of value have historically been those that are supported or endorsed by the specialty organization in the field.

In the healthcare field, being certified and maintaining certification is more often than not an essential requirement to remaining in a job. Standards of care evolve based on research findings and practical experience, and keeping current on best in class practices makes a difference in patient outcomes. Maintaining certification provides independent verification of certain levels of expertise and on the job capabilities.

In wound care, there are numerous certifications which can be earned, and members of the AAWC represent virtually all of them. Once earned, certifications are valid for varying periods of time and may last up to a decade before re-certification is required.

While some employers pay for an employee to maintain certification, it is increasingly a cost line axed by tightening budgets leaving an individual to cover the costs independently. Until now, there has been no alternative to the high cost of maintaining certifications.

The American Board of Wound Healing has recently offered a special opportunity to AAWC membership to grandfather existing certifications at no cost. Modeled after other American Board of Medical Specialties organizations, the ABWH is an example of a professional society that supports and endorses a certification in wound care. Further, ABWH does not charge annual maintenance fees to its certificate holders.
 
“This opportunity offers a significant savings to the AAWC membership,” said Victoria Elliott, R.Ph., MBA, CAE and Chief Executive Officer, AAWC. “We are grateful to ABWH for recognizing the depth of capabilities of our membership and its willingness to support the certification process in this way.”

Savings to the AAWC membership will vary according to the certifications held. For those with multiple certifications, the accumulating costs are significant. For example, an individual with a certificate valid for 10 years paying an annual maintenance fee of $150 will pay $1,500 for the duration of the certification. At expiration, additional fees are required to complete reexaminations to maintain certification and once renewal is earned, the maintenance fees continue unabated.

With the offer from ABWH, through November 2019 all AAWC members may apply for a conferment of their existing certification(s) to the equivalent ABWH certification. On completion of a satisfactory review by the ABWH Board, the comparable certification(s) will be issued. The ABWH does not charge an annual maintenance fee. Successful applicants must maintain AAWC membership for the duration of the certification period. Re-certification requirements as outlined with each exam category will apply.

“ABWH recognizes the high degree of expertise represented by the AAWC membership,” said Greg Bohn, MD and President, American Board of Wound Healing. “We are pleased to make this offer to them.”

The process for AAWC members to take advantage of this opportunity is as follows. An applicant would identify the appropriate category for certification and submit the required documentation as indicated in the application. In addition, the Applicant would provide ABWH with:

• Current certification, including dates of expiration
• Documentation of current AAWC membership
• A complete application with required information supporting the certification requested

After review and confirmation by ABWH leadership, comparable certification will be issued. A copy of the certificate can be provided on request and for a small fee. ABWH will advise the AAWC about which members have become certified and the expiration date of the certification. To qualify for certification conferment, applicants must maintain continuous membership in AAWC and comply with re-certification requirements as outlined with each exam category. 

More information can be obtained by visiting https://abwh.net/recertification/.

A simple search of professional medical and healthcare organizations reveals thousands of options for medical professionals. Without looking at the remainder of the alphabet, there are hundreds beginning with the letter A: American this, Academy that, Association of – it is an almost endless list and presents myriad choices for those in the medical and healthcare communities.

Professional organizations are the members’ sources for industry trends, legislative updates, connections of clinical practices with advancing research, and peer-to-peer relationships, among other benefits. But membership alone is not sufficient. Studies on member value show membership becomes meaningful only when individuals feel engaged and attached with the organization.

Being active and informed, developing relationships with other professionals while advancing the organization’s mission, is the difference between being a member of something versus being a part of something. The Association for the Advancement of Wound Care offers many opportunities to enhance membership and make it matter.

“We are what our members make us,” said Victoria Elliott, R.Ph., MBA, CAE, & AAWC Chief Executive Officer. “It is through member engagement and participation that the AAWC drives its vision to advance wound care worldwide. We rely on the volunteers to support the three strategic pillars of Education, Policy and Research.”

The AAWC has a class of 150 volunteers engaged throughout the year on many important issues and programs that membership at large has defined as key to their profession. Volunteers are the ones who serve as conference planners and speakers, facilitators, moderators and program reviewers. Content creators develop newsletter articles, blogs, social media posts and other content for various communications platforms. Those involved in policy matters develop letters and position papers, write platform materials, and visit with elected state and federal officials. In the area of awards and scholarships, volunteers work to define appropriate honors, review submissions and requests, and select recipients.

Recent achievements of AAWC volunteers include successful focused-topic regional summits, and advancing policy considerations in Washington, D.C. by giving voice to the need for increased prevention of pressure ulcers for our nation’s veterans. Educational programs have improved with expanded and participatory Journal Clubs featuring AAWC volunteer faculty, linking new research findings from the lab with the practice in clinical settings.

Volunteers report having a greater sense of community in the wound care profession and a deeper connection with their peers across all disciplines of care. “I was unsure whether I really had anything to contribute,” said one volunteer. “I was new to the AAWC and fairly new in my job, and was intimidated by the experience of others. But by becoming involved in a committee for one of the Summits, I was able to build my skills and develop a greater sense of confidence.”

There are currently a variety of education, content creation and committee volunteer positions available to members. For more information, go to https://aawconline.memberclicks.net/volunteer-opportunities.

“This is how to make membership matter,” said Victoria Elliott. “Get involved, make a difference for yourself, for others and for the AAWC.”

There are thousands of medical professional conferences each year around the world. The cost to host and attend professional conferences continues to increase while organizations are decreasing budgets allocated for attending. Then there is a notion that the internet and social media platforms make conference information and contacts available without ever leaving the office.

Historically, success is evidenced when meetings draw crowds, sponsors and exhibitors quantify a positive return on their investment, and the content is graded as informative by attendees. But success can also breed complacency with the temptation to re-bake the same successful recipe year after year. That is a mistake.

In 2019, the AAWC began offering regional education summits. The model offers science-based deep dives into specific topics crucial to advancing wound care. At the same time, the model is responsive to reduced budgets and enables members to travel shorter distances. On the other hand, the content of each summit draws global expertise to bring best in class research and care direct to those involved in the day-to-day ministrations of wound care. The increased intimacy of the regional meetings improves face-to-face interaction and connection so it is possible to actually meet with all those on a target list.

For example, the AAWC continues to host one annual Pressure Ulcer Summit (PrU) drawing attendees from across the globe. This topic is one of daily challenge to wound care providers and staying in front of current research is crucial. The Summit is designed to be collaborative, evidence-based, interactive, scientific, open and cutting edge. One attendee reported it to be, “a learning bonanza.” Ninety-eight (98%) percent of attendees said they were satisfied or highly satisfied with the multi-disciplinary approach to wound care and 94% said the PrU Summit exceeded their expectations.

In 2019 the AAWC will be host to multiple Wound Infection Summits (WIS, pronounced WISE) and the feedback about those held to date underscore the content and operational model are highly successful. With 94% reporting WIS to be scientifically sound and 92% reporting it helpful in practice and treatment strategies. One attendee said it was, “concise, relatable, and comprehensible.” Another described it as “exciting, collaborative, cutting-edge information.”

Conversely, AAWC members report different experiences with a recent national conference. One found the agenda to be virtually identical to offerings of prior years with the same topics for the educational tracks and even some repeat speakers. One said she will have a hard time selling through to her employer a compelling reason to attend again.

As the AAWC’s national and global presence expands, its influence for advancing wound care makes the AAWC’s leadership coveted partners at meetings hosted by others. This year, the AAWC has been invited to develop multidisciplinary wound care educational tracks for several prominent national meetings including DFCon, focusing on diabetic foot wounds, Desert Foot focusing on limb salvage, and the C3 Summit focused on collaboration among cardiovascular disciplines necessary to successfully manage complex coronary, carotid, and peripheral arterial disease. As an international partner to the European Wound Management Association (EWMA), the AAWC will participate in their global Summit in June.

While AAWC is likely to host national meetings in the future, it will do so with an eye toward assuring attendees find it fresh, scientific, medically practical, collaborative and interactive. However, for 2019 the bold move to shake up its conference model has proven smart. The following is the schedule for the remaining 2019 AAWC conferences. We hope to see you there.

AAWC Regional Wound Infection Summit

Detroit	Kansas City
August 16-17, 2019 Detroit, Michigan	October 5-6, 2019 Kansas City, MO

AAWC Regional Lower Extremity Summit
November 1-2, 2019
Sacramento, CA

Also look for AAWC Featured Tracks at these meetings:
Special AAWC Member Rates will apply!

***Log in to the Members Only section of the AAWC website to obtain Member Discount Codes***

Complex Cardiovascular Catheter Therapeutics: Advanced Endovascular and Coronary Intervention Global Summit (C3)
June 23-26, Orlando, FL
AAWC Members save 15% on registration!
http://www.c3conference.net/Main/Conference-Registration

DFCon – Diabetic Foot Global Conference
October 17-19, Los Angeles, CA
AAWC Members save 15% on registration!
http://dfcon.com/

Desert Foot
December 4-7, Phoenix, AZ
AAWC Members pay only $99!
https://www.desertfoot.org/

There is knowledge in numbers – even small ones and the AAWC is making sure that wound care clinicians from facilities large and small can take part in AAWC’s valuable programming.

Most AAWC members work in institutional or clinic settings of varying sizes. Regardless of size and budget, it is important that all the wound care clinicians have access to education and resources needed to provide the best in class patient care. That is why the AAWC has established a Group Membership option. The two-tiered program enables either up to four or up to eight employees from one facility to engage with member activities and receive member benefits such as the newsletter, Journal Club and member rates on AAWC Regional Summits. As a group membership, it is interchangeable among employees. If an employee were to leave that facility, another can be added at no additional charge for the duration of that membership year.

“The knowledge transfer accruing from AAWC membership is unique, valuable in routine wound care practice, and essential to advancing wound care worldwide,” said Victoria Elliott, AAWC Chief Executive Officer. “A group membership option allowing for individual interchange means that anyone from that institution or clinic can participate in a program and bring the knowledge back to be shared among colleagues. Otherwise, if the one member was unavailable for a program, the facility might miss out on the knowledge shared.”

The costs for the group membership are $480 for up to four employees and $959 for up to eight employees. Those facilities with more than eight can receive a discounted membership of $95 for each additional member, a $20 savings over individual AAWC membership. The membership for all individuals in the group option would begin and then renew at the same time.

To learn more about a group facility membership option, please contact Lyn Donze, [email protected] or visit https://aawconline.memberclicks.net/about-membership.

When Florence Nightingale began nursing patients in the mid 1800’s, she was joined by a team of fewer than 40 women all of whom she had trained herself. Credited with establishing the nursing profession, the seed she planted has grown exponentially across many specialty care areas. Today it is estimated that there are about 29 million nurses across the globe, with nearly four million in the US alone.

International Nurses Week from May 6-12^th is dedicated to honoring those men and women who put their patients first with International Nurses Day May 12^th, Florence Nightingale’s birthday.

Nurses are caregivers, scientists, technical specialists, ministers and healers who work with their heads, hands and hearts – and they do it 24/7/365. They are special people with skills extending far beyond bedpans and blood pressure cuffs. In the course of a shift, a nurse is responsible for administering medications and managing IVs as well as observing and monitoring patients’ conditions, maintaining electronic and traditional records, and communicating with doctors, patients and patients’ families. They are the first line in the fight for healing and total health.

Wound care nurses bring specific skills to the bedside. They are responsible to assess and evaluate a patient’s complete condition and then assess and evaluate acute and chronic wounds, obtain cultures, evaluate how other presenting illnesses impact the wound. They initiate the care to manage the wound, coordinate with other caregivers, and educate and counsel the patients and their families on wound care and self-management of the wound.

Florence Nightingale’s initial nursing assignment along with her team was to provide wound care to British soldiers injured in combat during the Crimean War. She described it as the most challenging of her life. Working in horrific conditions, she treated wounds while working to improving sanitary conditions, food and nutritional needs, and establishing a library to stimulate intellect.  

It is the model of modern day nursing to treat the whole patient with nurses ministering to the mind, body and spirit of patients and their loved ones. The nursing profession continues to evolve as all nurses, including those in wound care, work to advance and improve patient care. AAWC salutes all nurses for their selfless service to their patients.

In the May 2019 Journal Club webinar, Kara Couch, MS, CRNP, CWCN-AP, Director of Inpatient Wound Care at the George Washington Hospital, will examine the Hypertensive Ischemic Leg Ulcer, also known as Martorell’s ulcer.  This is an atypical lower extremity ulcer that is likely underdiagnosed as some of its clinical features closely mimic other atypicals such as calciphylaxis and pyoderma gangrenosum.  Couch will review the pathophysiology of the Martorell's ulcer, discuss its prevalence and explain the appropriate workup and treatment options.

One of the distinguishing characteristics of Martorell’s is excruciating pain. Using a recent patient case, Ms. Couch will be joined by her patient to give both the provider and patient perspective in managing this rapidly progressive and extremely painful ulcer. In this particular case, the patient also has an unusual co-morbid condition called Liddle’s syndrome which will also be discussed.

AAWC’s monthly Journal Club is free to members. The next journal club is May 8 from 1:00 to 2:00 p.m. Eastern. CLICK HERE to sign up today!

As Jennifer Hurlow, GNP, CWOCN, highlighted in the February Journal Club Presentation “Diabetic Foot Infection: A Critical Complication,” the science is there, but clinical practice – often – is not. Evidence suggests that approaches to treatment for chronic wounds that incorporate biofilm research, like Biofilm Based Wound Care (BWCC) can lead to significant increases in the efficacy of treatment of chronic wounds, but most traditional diagnosis and treatment methodologies overlook the importance of biofilm in wound healing. So how can YOU help make the transition and bring more of these evidence-based practices into the wound care community?

Read Up. For a start, AAWC members can review the recorded webinar and hear about some of this research from Jennifer, first hand, by logging into AAWConline.org. Or, the article was originally published by the International Wound Journal and you can access the full text there with a subscription.  Equip yourself with a thorough understanding of the research so you and your teams can better use it to inform your practice.

Join the Conversation at the upcoming Wound Infection Summit Atlanta. Jennifer and several other researchers and clinicians with BWCC expertise will be sharing their insights, practices and tactical approaches as a part of the program. Not only that, the summit includes additional conversation on gaps between scientific research and clinical practice, helping share practices and new ideas across disciplines. Learn more and register today for the WIS Atlanta!

Reach out. Who are the fellow healthcare professionals you interact with regularly in your community that you “only wish more fully understood and appreciated the great information that is available”? Invite them to membership and engagement with the AAWC. The more diverse healthcare providers are included in this multi-disciplinary wound care community, the better the results… if you’re not already a member, join today and invite those you work with to join!

On Wednesday, March 13, the Association for the Advancement of Wound Care (AAWC) President-elect Ruth Bryant, PhD, RN, CWOCN, met with a number of House and Senate offices on Capitol Hill to educate lawmakers on the need for increased prevention of pressure ulcers for our nation’s veterans. Dr. Bryant was joined by Martin Burns, CEO of Bruin Biometrics, and representatives from Arnold & Porter specializing in health care policy.

Congress is now developing the appropriations bills that will fund the federal government’s departments and programs in the 2020 fiscal year. BBI and AAWC met with House and Senate offices to discuss the need for increased funding for research on pressure ulcer prevention at the Veterans Hospital Administration (VHA), particularly with high risk populations such as veterans with spinal cord injuries, and BBI’s interest in developing a pilot program for the VHA using SEM Scanner technology*. Veterans treated in Veterans Health Administration (VHA) hospitals are 52% more likely to develop a pressure ulcer than patients in civilian hospitals. It costs the VHA between $20,900 and $151,700 to treat each individual pressure ulcer, totaling an estimated $1.3 to $3.6 billion in costs annually. Dr. Bryant discussed the importance of finding new approaches that could allow the VHA to save resources and ensure the highest quality of care for veterans.

The group met with the staff of the following members of Congress:

•    Rep. Sanford Bishop (D-GA)
•    Rep. Doug Collins (R-GA)
•    Rep. Tom Emmer (R-MN)
•    Rep. Chellie Pingree (D-ME)
•    Rep. Martha Roby (R-AL)
•    Rep. Rob Woodall (R-GA)
•    Sen. Susan Collins (R-ME)
•    Sen. Dianne Feinstein (D-CA)
•    Sen. Marco Rubio (R-FL)

The group also discussed the unique challenges facing the VHA in addressing pressure ulcers with staff members of the House and Senate Appropriations Committees, which are tasked with crafting the legislation that is ultimately approved by Congress. The day was highlighted by a meeting with Representative Debbie Wasserman Schultz (D-FL), who serves as Chairwoman of the House Appropriations Committee’s Subcommittee on Military Construction, Veterans’ Affairs, and Related Agencies, which oversees the Department of Veterans Affairs. Rep. Wasserman Schultz has been supportive of efforts to combat the threat of pressure ulcers in the past, and expressed interest in BBI’s pilot program proposal.

Throughout the day, Dr. Bryant provided valuable insight into the challenges of identifying and treating pressure ulcers, and the harm they cause to patients. Her perspective as an expert on the subject provided valuable information for Congressional staff, who have been concerned about higher pressure ulcer rates at the VA. Dr. Bryant’s efforts ensured that Congressional leaders are aware of new developments in the science and technology to alleviate the burden of pressure ulcers, setting a strong base for progress on this issue down the road. The AAWC is committed to continuing to work with Congress to improve the identification and care of patients with pressure ulcers and to improve prevention strategies for those at risk.


* Bruin Biometrics (BBI) is a medical device company that has developed innovative technology called the “SEM Scanner,” for early detection and prevention of pressure ulcers. The hand-held, portable wound assessment device can alert caregivers and providers to increased risk 5 days (median) before ulceration or visual signs of skin damage. The SEM Scanner, currently deployed across the UK and Canada, has seen success in reducing facility-acquired pressure ulcers (FAPUs). The SEM Scanner has been used in Europe since 2014 to prevent pressure ulcers, with up to 100% reductions in PU incidents across all care settings. In December of this past year, the U.S. Food and Drug Administration granted marketing authorization for the SEM Scanner, as an adjunct to the standard of care when assessing patients in the U.S. who are at increased risk for pressure ulcers. BBI is interested in partnering with the VA to pilot the technology.

AAWC walks a careful line toward assuring balance for members. Policies have long been in place to prevent organizational endorsements of any businesses or corporations or products associated with wound care. Additional policies assure the AAWC leadership does not benefit financially from relationships with wound care businesses. The AAWC expects and offers transparency, and holds both leadership and membership accountable.

And yet at all Summits, there is an exhibition hall of sponsors members and summit attendees are asked to visit. The sponsors are there because they have been invited by the AAWC or they have asked and paid the AAWC to participate. It may seem a violation of the organization’s very tenets. But it isn’t and here is why.

On the front lines of wound care in clinical settings across the country and around the world, members need the very best tools available to successfully treat patients under care. It is not possible for individuals or even individual institutions to remain on the cutting edge of all things new in wound care. Having developers and manufacturers of tools, treatments, practices, and devices willing to participate in a Summit helps advance wound care. It enables care providers to do what they do best, confident in the knowledge they have what is new and best.

Removing vendors as sponsors and exhibitors would limit the potential of providing best in class care for patients in need of healing. These opportunities for engagement one-on-one with those most familiar with innovative healing tools are crucial to advance wound care. AAWC Summit attendees and all members can trust that policies prevent inappropriate relationships and can use the time to learn how the newest options can help in the clinic.

At a White House dinner for Nobel Prize recipients, President Kennedy said, “I think this is the most extraordinary collection of talent, of human knowledge, that has ever been gathered at the White House - with the possible exception of when Thomas Jefferson dined alone.”
A more than appropriate reference to President Jefferson, a man who was a statesman, a visionary, an inventor, an educator, a lawyer, a farmer – and many other things.

And on April 26-27th at the AAWC Wound Infection Summit, the same concept is likely to apply. On those days in Atlanta, some of the brightest minds and advanced care givers in wound care will gather to share expertise on a range of topics as vast as Mr. Jefferson’s accomplishments.
It is there when attendees will learn about the cost of wound care, the gaps in research and practice, how to bring research to the bedside, various approaches to wound care, how radiology is used in wound care, the impact of topical treatments on wounds, and the necessity of a systemic approach to wound treatment, among many other topics.

Like the Nobel recipients listening to Mr. Kennedy, the Summit attendees will hear from those most connected with advancing these matters in a practical environment. Registration is open at WoundInfectionSummit.com. Don’t miss your chance to join the best thinkers and practitioners in wound care.

In coming weeks, the AAWC will share speaker highlights and new research findings of the Wound Infection Summit – Atlanta. Stay tuned!