Advanced Wound Care: A Multidisciplinary Approach to Saving Life and Limb
When peripheral artery disease (PAD) reaches advanced stages, patients often develop wounds that won’t heal due to poor circulation. These wounds represent not just a medical challenge, but a life-altering condition that can lead to amputation if not properly treated. Finding the right wound care specialist can make all the difference between losing a limb and maintaining mobility and quality of life.
The Specialized World of Wound Care
Recently, I had the opportunity to speak with Dr. Reza Rohani, a surgeon with more than 30 years of experience and chair of the department of surgery at Good Samaritan Hospital, along with his nurse practitioner Ligia Abohande, at their Los Gatos Private Advanced Wound Care Clinic in California’s Bay Area.
Dr. Rohani explained his journey into specialized wound care: “I’m doing surgery, as you mentioned, 30 years, but recently I figured out there’s a big problem in wound care and they need more attention in this part. And then we found Ligia and she came to help us and we created this advanced wound clinic in our area.”
For Ligia, wound care has been her focus since the beginning of her nursing career. “Since I started to become a nurse, I did wound care. So I’ve been in the system for about eight years and all I did was wound care,” she shared. “I really liked wound care. We don’t just like the whole of the patient. We want to treat the patient as a whole.”
Understanding Different Types of Wounds
The conversation covered multiple types of non-healing wounds that patients may experience. While PAD-related wounds stem from blocked arteries limiting blood flow to the extremities, diabetic wounds often result from damaged capillaries that prevent proper blood flow to injury sites.
Venous wounds present another challenge entirely. As Dr. Rohani and Ligia explained, chronic venous insufficiency can lead to wounds on the lower leg and calf that are particularly difficult to heal without proper compression and circulation support.
What became clear during our discussion is that wound care isn’t one-size-fits-all. Each type requires a specialized approach and often multiple specialists working together.
The Art and Science of Wound Healing
“The wound healing is kind of the art,” Dr. Rohani noted, “because everybody’s different with a different problem, and we need to put together to be able to help that.”
This artful approach manifests in their multidisciplinary strategy. “We have a different group to helping us. We can refer to the vascular surgeon or the other group. Sometimes we can send for the hyperbaric oxygen to help for the wound care, different modality to help for the wound care,” Dr. Rohani explained.
Modern wound care has evolved significantly with advanced treatments like wound vacuums (wound VACs) and skin substitutes revolutionizing healing times.
“The wound VAC is a machine we can put over the top of the opening area and connected to the machine, they’re going to suck the wound for 24/7,” Dr. Rohani described. “That significantly improved the wound healing, accelerate the wound healing and also collect all of the moisture.”
The Advantage of Specialized Outpatient Care
One of the most interesting aspects of our conversation was learning about the advantages of specialized outpatient wound care versus hospital-based settings.
“If they need a big debridement and they need some kind of flaps, something like that, we can take the patient to the hospital to do that,” Dr. Rohani explained. “But we have a lot of options with the skin substitute and that’s going to help a lot recently for wound healing.”
Ligia added: “Here in the office, we’re able to, when it continues to heal, he is able to do partial closure until we’re able to close it out the way without having to take them again to surgery.”
This approach allows patients to maintain a more normal life while healing. As Dr. Rohani pointed out, “The wound healing needs time. It’s not going to be happening just in two, three days. That’s going to save the patient to stay in the hospital for a long period of time for the wound healing.”
Nutrition: The Overlooked Component of Wound Care
Something I’ve observed repeatedly in my work with PAD patients is how often nutrition gets overlooked in the healing process. The team at Los Gatos Private Advanced Wound Care Clinic emphasized this critical component.
“We always tend to forget that skin is the largest organ in the body. So if you don’t have good nutrition, no matter what type of treatment we do, those wounds are not going to heal,” Ligia explained.
Their approach includes monitoring weight, checking albumin and prealbumin levels, and providing specific nutritional recommendations. They recommend products like Juven that support wound healing through specialized nutrition.
The Philosophy of Limb Preservation
A question I’m passionate about concerns the philosophy of limb preservation versus amputation. Some healthcare providers suggest amputation as a quicker solution than months of wound care, but this ignores the lifelong impact of losing a limb.
When asked about their approach, Dr. Rohani was unequivocal: “We go to limb saving. We try to save as much as possible. And it’s very important to patient to save the part of the limb if we can. And we don’t want to go to the chopper first.”
Ligia added: “We will do first everything that needs to be done before even thinking that we need to remove a part of the body because maybe it might take a year, but it will heal. And at least they get to keep their leg rather than having an amputation.”
Of course, they acknowledged that sometimes amputation becomes necessary to save a patient’s life when infections become severe. But their priority is always preservation when possible.
Patient Education and Common Misconceptions
The team highlighted several misconceptions that patients often have about wound care.
“My experience regarding the wound care, people are thinking they shouldn’t take a shower, actually,” Dr. Rohani shared. “When I close the patient’s wound, after 48 hours, you can take a shower. If you have open wound, you can take a shower.”
Another common misunderstanding involves scabs. Ligia explained: “They think that a wound should create a scab. And when you have a scab, it means your wound is healed. But that’s not like that. The scab is just a wall that’s dead tissue pretty much. And underneath that wall, there is an open wound.”
Proper education includes teaching patients the signs of infection and setting realistic expectations about healing timelines.
Moving Forward: Exercise Options for Patients with Wounds
One of the challenges for PAD patients with wounds is maintaining cardiovascular health when walking becomes difficult. Since walking is the best medicine for growing collateral vessels, I asked the team for alternatives.
“If they cannot use the lower extremity, still they can use the upper extremity,” Dr. Rohani suggested. “Still upper body workout is possible.”
Ligia added that it’s important to determine whether a wound is venous or arterial, as this affects recommendations: “If it’s venous, we want to make sure that they wear compression stocking to bring that extra fluid from the legs back to the heart.”
At the Global PAD Association, we recommend toe yoga, foot alphabet exercises, and other movements that can be done even with wounds. As I often tell patients, “There’s no excuse not to move because you move it or lose it!”
The Future of Wound Care
When asked about their wish list for the future of wound care, Ligia highlighted insurance coverage: “I wish the insurance was a little bit more open-minded that if we are ordering something for the patient, it’s because they really need it.”
Dr. Rohani emphasized prevention: “We need to work on the prevention. If they have a vascular problem, before causing the ulcer, we should do some kind of the prevention to make sure it’s not going to happen or teach the patient and start the vascular study before causing the wound issues.”
This aligns perfectly with our mission at the Global PAD Association, where we advocate for early diagnosis and prevention through legislation like the ARC Act, which would democratize access to PAD testing for those at high risk.
Taking Action for Your Wound Care
If you or someone you love is dealing with non-healing wounds, especially related to poor circulation, diabetes, or venous insufficiency, seeking specialized care is crucial. For those in the Bay Area, Dr. Rohani and Ligia’s clinic offers multidisciplinary advanced wound care services. You can learn more at RezaRohaniMD.com.
For anyone concerned about poor circulation in the legs or PAD, call our Leg Saver Hotline at the Global PAD Association. We can connect you with resources, educational materials, and help you find appropriate care in your area.
Remember, early intervention is key to preventing wounds from developing in the first place. If you’re at risk for PAD – including those with diabetes, high blood pressure, high cholesterol, smokers, or adults over 60 – talk to your doctor about getting screened.
Disclaimer
The information provided in this article is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before following any recommendations or making changes to your treatment plan. This interview is not an endorsement of any specific practice or provider; it serves solely to share information about wound care options. Each patient’s situation is unique, and it’s important to research healthcare providers to find the best fit for your specific condition and needs.