Primary Care, Urgent Care, ER clinicians, dermatologists, podiatrists and surgeons should refer patients to a wound-care specialist as soon as they notice that a wound is not healing as expected. Keep in mind that a scab is not a healthy, healing tissue.

Patients suffering from untreated wounds are 20 times more likely to end up in an emergency room or be admitted to a hospital. To help patients with wounds avoid emergency care, Wound Edge Clinic in Brooklyn offers advanced treatments and services for those with acute or chronic wounds. Early intervention significantly decreases the risk of downstream wound complications.

Our specialized wound care treatments restore the natural healing process by taking advantage of recent advances in wound care — whenever possible with in-office procedures. Our specially trained team, led by Dr. Roman Zinder, designs a plan of care that addresses both immediate symptoms and long-term wound care. We make sure that your patients get the assistance they need. Since we focus on patient care for open wounds, we’re perfectly suited to:

• Accurately diagnose any open wound
• Treat every wound appropriately with the latest medical methodologies, including negative pressure wound therapy and bio-engineered skin grafts

The Different Types and Etiologies of Wounds and Ulcers

An acute wound and a chronic ulcer refer to a break or damage to the skin’s surface. Acute wounds are often from sudden trauma or injury, such as cuts, tears, scrapes, lacerations, abrasions, avulsions and punctures or surgical incisions. Chronic ulcerations develop mostly due to underlying medical conditions, prolonged pressure, poor circulation, infection or immune dysfunction. These wounds include:

• Venous leg ulcers (VLUs). These wounds occur on the legs because of uncontrolled edema and fluid pooling on the surface of the skin due to compromised venous return. These ulcers very commonly start as blisters from uncontrolled lower extremity edema.
• Diabetic foot ulcers (DFUs). This skin damage on the foot occurs due to diabetic neuropathy and circulatory issues, as well as improper foot care and footwear.
• Pressure ulcers. Non-stop pressure, shearing or both over a bony area can lead to a break in the skin and ulceration, especially on the lower back, sacrum, heels, hips, buttocks, and ankles. These are caused when the pressure over the bony part restricts or compromises blood flow to the skin and subcutaneous tissue, often when a patient is bed- or wheelchair-bound.
• Arterial ulcers. Narrowing of the artery from peripheral arterial disease (PAD) can cause ischemia, which subsequently leads to ulceration in the ischemic area. These ulcers are most often seen on legs and feet, small but very painful.
• Radiation wounds, also known as cutaneous radiation injuries (CRIs). These are wounds arising in a previously irradiated area due to cancer treatment.

An open wound is a contaminated field by definition. Due to the spread and growth of microbes and pathogenic organisms around and in the wound, microbial burden interferes with the healing process. Infections remain a constant threat and may also damage tissues around the wound, causing painful inflammation. Our team takes all the necessary measures to treat open wounds to prevent unnecessary complications.

We treat every wound according to established standards of care, following what is known as the wound hygiene protocol.

Treating a chronic wound first requires an accurate diagnosis.  Once Dr. Zinder determines the cause and etiology of the wound, he takes steps to encourage the wound healing process by secondary intention by implementing the Key Principles of Wound Hygiene.  The steps in wound hygiene protocol include:

1. Assessing the wound. Dr. Zinder evaluates its location, size, depth and etiology. He notes the presence of necrotic tissue, undermining and/or tunneling. He assesses the amount and quality of an exudate, wound odor while evaluating the skin at the wound’s edges and surrounding the wound (the periwound).
2. Cleansing the wound. Dr. Zinder uses a gentle, antiseptic cleansing solution to remove debris, bacteria and biofilm.
3. Debriding the wound. Dr. Zinder removes necrotic tissue and biofilm, using sterile surgical instruments or enzymatic debridement agents.
4. Managing the wound’s biofilm. Dr. Zinder applies biofilm-disrupting solutions or dressings to break down the remaining biofilm and keep it from reforming.
5. Dressing the wound. Dr. Zinder chooses a specialized wound dressing that suits the wound type and provides the necessary support and protection.
6. Frequently evaluating and treating the wound. Dr. Zinder follows up with patients regularly, usually weekly, until the wound is healed.

Applying the right wound dressing — between specialized foams, hydrofibers, collagen matrices and many others — and using appropriate wound care products promotes the body’s natural healing process. It also encourages new tissue formation and speeds up healing and recovery. Depending on the condition, type and etiology of the wound, it can take from a couple of weeks to several months for the wound to properly heal, if it’s treated promptly and appropriately.

Negative Pressure Wound Therapy (NPWT) refers to a wound management system that applies a gentle but continuous or intermittent suction through foam placed in the wound. This therapy is also known as vacuum-assisted wound closure, “a VAC therapy”.  Many call it “a wound VAC,” or simply “the VAC.” It’s connected to a small electric vacuum pump for suction to promote faster wound healing by:

• Eliminating excess fluid
• Protecting the wound from germs
• Increasing blood supply to the wound site
• Fostering the growth of healthy tissue

The treatment involves applying a sealed dressing and a suction to create a vacuum or negative pressure environment in the wound. The treatment is a proven way to manage acute and chronic wounds. This procedure involves:

1. Packing the wound. Sterile open-cell foam is cut to size and packed into the clean, debrided wound. It filters slough and blood clots to prevent clogging the pump. 
2. Dressing the wound. The wound is covered with a polyurethane occlusive dressing to create an airtight seal.
3. Connecting the pump. A vacuum pump is connected to the dressing with a plastic hub and suction creates a negative pressure. The pump collects moisture and drainage from the wound into a special container locked on a device.
4. Programming the pump. The pump is programmed for suction strength and duration. Standard pressure is generally -125 mmHg, but can be adjusted to the patient’s comfort.

Patients may feel a slight pulling sensation for a few seconds when the suction starts, but it quickly subsides. Most patients tolerate it very well. We must change the dressing two-to-three times a week, depending on how much drainage the wound produces.

Negative pressure wound therapy may be used in conjunction with other treatments, including pain management and wound debridement and irrigation. During the procedure, Dr. Zinder evaluates the patient’s overall health while monitoring the wound. Because it is one of the few wound treatments that works 24/7, once initiated, the therapy continues at the patient’s home.  Dr. Zinder sends the patient home with instructions.

Wound VAC therapy applies continuous suction through a wound dressing via a small electrical pump to facilitate faster wound healing. This therapy may be used for a variety of wounds, since it’s suitable for many large, deep wounds, as well as those that drain excessively. It isn’t suitable for burn wounds or wounds with active infections.

Cellular, Acellular and Matrix-like Products (CAMPs)

Up until recently, these products were commonly referred to as Cellular and/or Tissue-based Products (CTPs), and less accurately as Bio-Engineered Skin Grafts, or simply “skin substitutes.” The newly adopted term CAMPs now describes this category of therapeutic wound-care products designed to promote healing and support tissue regeneration. Their purpose is to address the complex needs of chronic or difficult-to-heal wounds by creating a more favorable environment for tissue repair.

Cellular products: in wound care, these refer to viable or non-viable cells derived from sources such as blood, bone marrow, adipose tissue, or umbilical cord blood. Their goal is to support healing by introducing cells or cell components that can influence the repair process.

Acellular products: these are derived from human or animal tissues but do not contain living cells. They are processed to remove all cellular components while preserving the extracellular matrix (ECM) and its bioactive molecules, which help guide tissue regeneration.

Matrix-like products: a specialized type of acellular product, these materials mimic the body’s natural extracellular matrix (ECM). They are engineered to provide a biomimetic structure that closely resembles native tissue, helping create an optimal scaffold for wound healing.

What Are the Advantages of Using Bio-Engineered Skin Grafts?

The advantages of using bio-engineered skin grafts include:

• These skin grafts adhere quickly and firmly to any wound surface.
• Like normal skin, the graft material permits the transmission of water vapor.
• These skin grafts are rich in epidermal keratinocyte stem cells.
• The surface structure of the grafts promotes vigorous cell growth with high metabolic activity.
• These skin grafts stimulate a patient’s natural immune response, encouraging tissue regeneration.
• The outpatient procedure is performed in-office with no general anesthesia necessary.
• There’s no need for skin graft harvesting, eliminating complications and shortening recovery.
• The procedure causes less pain than other skin grafting techniques.
• The use of bio-engineered skin grafts reduces the overall cost of healing the wound.

For wounds that fail to heal themselves within a specific time period, Dr. Zinder may recommend a CAMP, if appropriate. Contact Wound Edge Clinic to refer a patient with problematic wounds.