Fall 2005
Treating the Person, Not Just the Wound

All she did was bump into something while she was cleaning her Oxford home. No big deal—just a little cut on her leg, about half the size of a dime.

Except it didn't get better. It got worse. What started as a small wound became bigger, deeper and more painful. It closed up, then opened again. When it reached the size of a half-dollar, Karen Alfano went to her primary care physician to find out what was going on.

"I didn't realize it, but I had diabetes," she says. That diagnosis partly explained why her wound was stubborn. People with diabetes often have poor circulation in their legs and feet, which causes slow healing. For them, any cut, no matter how small, is a serious matter.

So Karen's physician sent her to a nearby wound center for treatment. That was in 2000—the beginning of a long, winding, uphill road for Karen.

Her wound still refused to heal, in spite of treatments— and the pain was becoming unbearable. That's when a family member suggested that she try the Wound Center at Bridgeport Hospital, which has since become the Wound Healing Center of Fairfield County, with Philip Fidler, MD, as Medical Director.

Dr. Fidler's philosophy: "Your body is built to heal. If it's not healing, something is wrong." His goal: to find out just what was wrong in Karen's body that was delaying healing.

In the Wound Healing Center, treatment of each patient and each wound begins with a careful evaluation to determine the best procedures and products. "No two wounds are alike and no two patients are alike," says Wound Healing Center surgeon William Butler, MD. "We take pride in treating the whole patient, not just the wound."

As it turned out, Karen's problems went beyond diabetes. In fact, it was a vicious circle of cause and effect (see diagram). The diabetes made her wound worse. Unable to exercise because of the wound and depressed by her poor health, Karen saw her weight soar. The excess weight made it difficult, if not impossible, to keep her diabetes under control. So around and around it went: her diabetes, her increasing weight and her stubborn wound each making the other problems worse.

Understanding these interlinked causes was the first step to treatment. Plus, the knowledge helped Karen and the Wound Healing Center to set some long-term goals. Among these goals was the possibility that Karen might be a candidate for bariatric surgery, sometimes called "stomach-stapling," to help her control her weight and regain control of her diabetes. But that lay in the future. First, her wound needed to be treated.

The treatment for a stubborn wound like Karen's is no stroll on the beach. It can be painful, it can take a long time and it always takes courage, determination and a willingness to follow directions meticulously. Karen was up for the challenge.

Her treatment in the Wound Healing Center included debridement. "This means removing dead tissue and revealing healthy tissue so the wound can begin to heal," explains Dr. Butler. "We also selected the antibacterial creams, ointments and dressings that would be best for Karen, to protect her wound, reduce the chances of infection and promote faster healing."

Under this comprehensive care, Karen's wound began to heal. Also, she says, "For the first time, someone finally addressed the pain issue." She was feeling better than she had in months, whenone day in 2003, she was involved in an automobile accident. "I was knocked into a ravine," Karen says. "My wound, which was almost healed, took a hard hit."

The results were devastating. "The whole circumference of my ankle opened up," Karen says. At that point she needed skin grafts. Bridgeport Hospital surgeons carefully took healthy skin from other areas of Karen's body and used it to cover her wound. And slowly, Karen's wound began to heal and stay healed.

With the help of weight-loss surgery and the encouragement of her Wound Healing Center team, Karen lost 117 pounds and is still going down. Today she follows a strict portion-control diet, exercises regularly and closely monitors her diabetes. Best of all, her wound has closed and has remained healed.

"Because we were able to recognize how her diabetes, her depression and her weight played a role in her total health, including her wound, we were able to help her body heal," says Dr. Fidler.

Karen's advice: "If you have a wound that won't heal, don't delay. The sooner you get it checked by the Wound Healing Center, the sooner your healing can begin."

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