Last November, Newport Hospital opened a wound care center to provide a local treatment facility for Aquidneck Island residents with diabetes and other conditions leading to non-healing wounds. Before that, patients had to travel to Providence or Wakefield.
The Vanderbilt Wound Care Program is led by Dr. Thomas Fantes and clinical manager Kelly Brothers, both of whom are certified in wound care. Fantes answered questions about the new center and the growing need for wound care services.
PBN: How great a need is there for wound care on Aquidneck Island?
FANTES: Based on statistics from the Centers for Disease Control, before starting the program we estimated that we would take care of about 130 patients the first year. After 10 weeks, we have treated 41 patients, so we are ahead of our expectation, which tells us there is definitely a need here in the Newport area. About 80 percent of our patients are from Aquidneck Island and the remainder from the surrounding communities.
To date we have seen mostly venous stasis ulcers (in nearly 40 percent of our patients), which occur most often in older patients. These ulcers are the result of a breakdown of the skin from chronic leg swelling caused by leaky veins. Older veins often can’t hold water, so fluid seeps out into the surrounding tissue of the lower legs, causing chronic swelling. This interferes with blood supply to the skin, and eventually the skin breaks down.
PBN: What are the main causes of non-healing wounds, and how long have most patients who come to you had such a wound?
FANTES: In addition to venous statis ulcers, our most common wounds are diabetic ulcers and pressure ulcers. We see patients who have been dealing with their wounds for several weeks without progress. Most often the patients are referred to us by their primary care physicians, but we also see patients who contact us on their own.
PBN: What kind of impact does a non-healing wound have on patients’ lives and overall health?
FANTES: Chronic wounds impact patients in several ways. Some wounds can be painful. Others create such drainage that the area is always wet. Odor is often a problem. Wounds are prone to infection, can lead to hospitalization for treatment of infection, and can even become life threatening. Above all, chronic wounds limit peoples’ ability to carry on their normal activities. This creates a downward spiral in which inactivity progressively impairs other functions, such as muscle strength, breathing capacity, cardiac reserve, and emotional well-being. The chronic wound is often the issue that tips the patient and family into being overwhelmed, and their health care, even their daily life, begins to unravel.
PBN: What does a wound care center do to help heal them, and how is that different from what a patient alone, or a primary care doctor, might do?
FANTES: A wound center is often the only setting that can focus on chronic wound care. Chronic wound patients all have associated serious health issues that demand the attention of their health providers in almost any other health care setting. Diabetes, high blood pressure, heart disease, breathing difficulties, stroke complications, paralysis, pain syndromes, depression – all tend to demand the attention of the office or emergency provider at almost any given visit. A wound center can focus on wounds alone, and as a result is the only setting that can reliably focus the time, obtain the supplies, devote a space, and develop the expertise to care for wounds. Most things a wound center does could in theory be done in other settings. In practice, that is almost impossible.
PBN: How does it help to have such a facility closer to home for patients?
FANTES: The proximity of a wound center to the patient is key to successful wound care. By its nature, chronic wound care almost always requires regular visits over weeks to months of time. Again, the reality of care is that compliance is only possible if getting to the site of care is practical. Before the wound center at Newport Hospital opened, the closest wound center was more than a 45-minute drive away, in unfamiliar neighborhoods with access challenges that could defeat patients and their families. Keep in mind that most wound patients have mobility issues, and most need a care giver for transport. An annoying travel for an able person becomes an impossible trip for the patient with impaired mobility. A local wound center can be the difference in whether care gets provided at all.
