Regular paper
A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds

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Abstract

The optimal way to improve prophylaxis and treatment of patients with problem wounds is to create an independent multidisciplinary wound-healing center that focuses on all types of problem wounds and has an outpatient clinic, as well as an inpatient ward. An integrated wound-healing department concept should be a standard in wound healing. A department structure containing both an outpatient clinic and inpatient ward, employing full-time personnel, allows the development of all features vital for optimal wound treatment. These are standardized treatment plans, access to relevant objective investigative methods and surgical approaches, a higher degree of continuity in treatment, increased patient satisfaction, greater potential for education and training, and improved possibilities for basic and clinical research in healing and care. The Copenhagen Wound Healing Center, Copenhagen, Denmark, and the University Center of Wound Healing, Odense, Denmark, are examples of this type of department. Initial results have demonstrated that these concept centers have resulted in improved rates of healing in patients with leg ulcers and have decreased the necessity for major amputations. The structure of the centers also offers greater opportunities for both basic and clinical research and provides expert education for all types of health care personnel. The centers were created in an attempt to establish an expert function in wound healing that would be fully integrated into the Danish national health care system. This model may, with individual modifications, be applicable for both industrialized and developing countries. In case it is impossible to realize the model in its entirety, alternative center concepts should be considered.

Section snippets

Wound types

Organization of a wound-healing center raises the question of how wide a range of wound types should be included in the ideal treatment concept. Currently, most centers or teams have been established in relation to a specialty department and specific types of wounds (eg, a diabetic foot ulcer clinic) [25], [26], [27]. Usually, treatment of certain types of wounds is relegated to specific medical specialties (eg, venous leg ulcers to dermatology, pressure ulcers to plastic surgery, and diabetic

Health care system status

For some years, it has been disputed whether wound healing and care should be considered a medical specialty like any other (eg, dermatology, internal medicine, and surgery subspecialties). The area of wound healing and care is, however, from the author's point of view, too multidisciplinary to be classified as a specialty. It is best thought of as a multidisciplinary expert area. However, in order for it to become and develop as an expert function, wound healing must first achieve status as an

Establishment of an interdisciplinary wound care organization

The Copenhagen Wound Healing Center (CWHC) and the University Center of Wound Healing (UCWH), established in 1996 and 2003, respectively, are clinical multidisciplinary departments treating all types of problem wounds. The CWHC is housed in the Bispebjerg University Hospital, and the UCWH in Odense University Hospital [11]. The wound-healing centers are part of the socialized health care system of Denmark. Under the socialized hospital system of Denmark, patients do not pay for diagnostic or

Multidisciplinary staff

Employees of the multidisciplinary wound-healing center are recruited from relevant specialties to form a multidisciplinary staff, where an individual member works full-time with problem wounds, regardless of specialty and previous education. Organization of personnel is based on the idea that an employee will follow his or her own patients during the entire treatment course, in order to enhance continuity of treatment. An example of a treatment course in a wound-healing center is shown in Fig.

Treatment facilities

Ideally, the multidisciplinary wound-healing center has both an outpatient clinic and an inpatient ward.

Treatment structure

Surgical treatment accounts for the major portion of treatment activity. Local treatment of wounds, especially debridement, requires surgical as well as wound experience. This has been demonstrated for diabetic wounds in particular, but all types of wounds need surgical evaluation and treatment before they are able to heal.

The surgical activity of CWHC has increased throughout the years of its existence. Major surgery under general anesthesia is performed in a central surgical theater, and

Integration of the expert function in the national health care organization

Full integration into the national health care organization is of vital importance for the future development of an expert function.

In Denmark, the expert function in wound healing and care has been called “clinical wound healing,” and a proposal for such a function has been submitted to the Danish National Board of Health [11]. The Danish health care system is divided into 14 regions, which have a separate economy in relation to health care expenses. Each of these regions has a standardized

Discussion

Different concepts for the treatment of problem wounds have been created during the last 10 to 20 years. Most models have been based on an outpatient clinic of a normal hospital department. These clinics usually function 1 to 2 days a week and focus on a specific type of problem wound, such as diabetic foot ulcer, venous leg ulcer, or pressure ulcer. This survey describes the specialized concept of a wound-healing center and organization of an expert function in a national health care system.

Conclusion

A specialized wound-healing center is needed to optimize the treatment of problem wounds. The proposed center concept consists of an independent multidisciplinary department function, which, when integrated into a national expert function, would be the ideal way to organize the wound-healing area in order to benefit patients as well as society. The importance of surgical treatment and bed facilities is emphasized. This model may, with minor modifications, be applicable for both industrialized

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