Wound Care - Eden Smith, MD

Ask a Doctor
Eden Smith, MD
Wound Care

Q: I’ve had a wound for almost a year. Why won’t it heal?
A: There are many reasons why wounds won’t heal. One of the primary reasons is inadequate blood supply. Swelling in the tissue can also prevent healing. Infection is another problem for non-healing wounds. For patients with neuropathy – loss of sensation – repeated trauma or pressure will prevent wounds from healing. Without the sensation of pain, patients won’t realize a wound is developing or growing worse.
Some medications can impair healing. Corticosteroids, certain chemotherapy agents, and even some anti-inflammatory drugs can slow wound healing. Wounds caused by prior radiation therapy may need special treatment to heal. There are also some inherited conditions that lead to non-healing wounds but these are quite uncommon. And simply as we get older, we don’t heal as well. After the age of 60 or 65, we may need to take greater care for our wounds to fully heal.

Q: Why does diabetes cause foot ulcers?
A: The biggest reason for diabetic foot ulcers is that the patients often have neuropathy. They don’t feel pain and can be totally unaware of the wound developing on the bottom of the foot. Once the wound develops, infection can set in. Very often they also have diminished blood supply and a weakened immune response. Unfortunately they have all strikes against them and these wounds can lead to amputation. However, with treatment, foot ulcers can heal.

Q: What is off-loading and how long is it required to heal an ulcer?
A: Off-loading simply means taking pressure off of the affected area; that can be done with a cast, custom orthotics, or the use of a walker or crutches. The time to heal depends on the severity of the wound and other issues the patient may have. The wound can heal as quickly as three to four weeks with off-loading, along with other treatments.

Q: What conditions can complicate the healing process and how does specialized wound care help?
A: Diabetes, venous disease, and arterial problems such as peripheral arterial disease (PAD) are a few conditions that can complicate the healing process. At the Wound Care Center, our first step is to ensure the patient has proper circulation. This may require surgery to repair arteries and return sufficient blood flow to the wound. Procedures to deal with damaged veins may also be required. Next, we have special dressings that are typically only available in the wound center; some fight infection and others stimulate healing. We also use bio-engineered wound care products often thought of as human skin substitutes. Actual human skin cells present in the product help the patient’s tissue to grow and heal. To control drainage we use a Wound Vac, a device that gently pulls fluid away from the wound and stimulates healing. For some wounds, we recommend hyperbaric oxygen therapy.

Q: What is a hyperbaric oxygen chamber and how does it help wounds?
A: The hyperbaric oxygen chamber is a device commonly associated with deep sea diving – a chamber used to decompress divers with decompression sickness or “the bends.” The hyperbaric oxygen chamber delivers 100% oxygen under pressure. For most wound care patients we bring the chamber to a pressure of two atmospheres, the equivalent of a deep sea diver at a depth of 33 feet. This delivers 10 to 20 times the normal amount of oxygen to the body. The increase in oxygen delivered to the tissues stimulates the development of new blood vessels, provides a positive effect on white blood cells to help fight infection, enhances the effect of antibiotics, helps reduce swelling, and stimulates healing by increasing the production of collagen and growth factors in tissues. We have found the oxygen chamber to be especially beneficial for patients with osteomyelitis, a chronic bone infection. A recent study showed that hyperbaric oxygen treatment prevented 1 in 4 amputations that resulted from chronic, non-healing wounds in diabetics.

Q: Are antibiotics a part of treatment at the Wound Care Center?
A: Antibiotics are used as appropriate when there is infection. Frequently we do use antibiotics as a part of treatment but not for every patient.

Q: How long will it take my wound to heal?
A: Wounds come in many levels of severity. Depending on the severity of the wound, treatment at the wound center can heal wounds in two to three weeks while other wounds may take several months of treatment before they heal. I have seen patients who have had a chronic, untreated wound for years. With the right treatment, I’ve seen those wounds heal. In fact, last year 93 percent of our patients had a healed wound in 14 weeks or less.

Bio:
Eden Smith, MD, is Board Certified by the American Board of Surgery. He completed medical school and residency in general surgery at Loma Linda University and has been practicing for nearly 40 years. Dr. Smith has been in Sonora for almost 20 years. When the Center for Wound Care opened in late 2009, Dr. Smith moved his primary focus to wound care but works one day a week in private practice performing minor surgeries and endoscopies.