ORGANIZATION AND DEVELOPMENT OF A UNIVERSITY MULTIDISCIPLINARY WOUND CARE CLINIC

Background. A multidisciplinary wound care clinic was established to d iagnose and treat patients with nonhealing ulcers of the lower extremi ty. Methods. The clinic was organized under the direction of the depar tments of vascular surgery and dermatology with support by the departm ents of plastic surgery, hyperbaric medicine, orthopedic surgery, and podiatry, and a research nurse. Results. In the first 4 years and 3 mo nths, 683 patients were evaluated. One hundred seventy-one patients un derwent outpatient testing in the noninvasive vascular laboratory and 30 patients underwent angiography. Causes of the ulcers were venous st asis, 280 patients (41%); diabetic neuropathy, 182 patients (27%); art erial insufficiency, 119 patients (17%); rheumatologic disorders, 38 p atients (6%); trauma, 15 patients (2%); and in 49 patients (7%) a vari ety of other disorders. One hundred seventy-nine operations were perfo rmed including 86 operating room debridements, 48 amputations (43 toe, 4 below knee, 1 above knee), 23 arterial bypasses, 1 venous bypass, 1 4 skin grafts, 2 pedicle flaps, and 5 excisions of tumor. Fifty-six pa tients with cellulitis were admitted to the hospital for intravenous a ntibiotics and 12 patients were treated with hyperbaric oxygen therapy . One-hundred thirty-two patients were entered into randomized prospec tive trials of topical growth factors on Institutional Review Board ap proved protocols. Conclusion. We concluded that a multidisciplinary ap proach to wound care is beneficial to patients with chronic wounds and provides a mechanism for clinical investigation on the healing of pro blem wounds.