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Sustained Leadership in Wound Care: A History of the Future

Salcido, Richard, “Sal”, MD, EdD

Advances in Skin & Wound Care: June 2018 - Volume 31 - Issue 6 - p 245
doi: 10.1097/01.ASW.0000533848.29073.66
DEPARTMENTS: EDITORIAL

Richard “Sal” Salcido, MD, EdD, is the Editor-in-Chief of Advances in Skin & Wound Care; the William Erdman Professor (Emeritus), Department of Physical Medicine and Rehabilitation; Senior Fellow, Institute on Aging; and Associate, Institute of Medicine and Bioengineering, at the University of Pennsylvania Health System, Philadelphia, Pennsylvania. He is also Professor and Founding Director, Physician Assistant Studies Program, Dominican University, River Forest, Illinois.

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Anniversaries are a time for reflection, celebration, solidarity, and providing a strong foundation for the future! The year 2018 marks the anniversary of several leading organizations in the wound care space, each providing a special brand of sustained leadership in their particular sector and foci. These include the 40th anniversary of the founding of the World Council of Enterostomal Therapists, a specialized wound care organization with a global interprofessional presence.1 This year also marks the 50th anniversary of the founding of the Wound, Ostomy and Continence Nurses Society, and the 30th anniversary of the National Pressure Ulcer Advisory Panel. Finally, this year also marks the 17th anniversary of our journal’s special partner, the American Professional Wound Care Association. The American Professional Wound Care Association was created to represent the various medical specialties involved in treating the many aspects of complex wounds.2

Each of these organizations shares a common thread: action- and results-oriented people who want to prevent and eliminate threats to the largest organ in the body—the integumentary system and subjacent tissues. As these organizations continue to push the boundaries of education and advancement to drive public policy, patient advocacy, and clinical discovery, the metaphoric wind under their sails will be advanced computerization.3

In recent history, these wound care organizations have seen computerization facilitate the delivery and documentation of wound care services, the education of wound care practitioners, and new research in the wound care universe. For example, researchers have now identified a new organ, the interstitium, which is implicated and involved in deep tissue or pressure injuries.4 More than two-thirds of the human body is water; most of that is intracellular. The remainder, about 20% of the fluid in the body, is “interstitial,” a Latin word combining “inter” and “sistere”—literally, “between the other places.”5 Previously, these spaces were not seen on normal pathology slides because histologic preparation caused them to become dehydrated and flat. Using new technology (microendoscopy), researchers can now visualize the interstitium in vivo in a 3-dimensional space.4

Using computer imaging (magnetic resonance imaging) of osteomyelitis at the calcaneal probe-to-bone interface, our group (led by Timothy M. Woods, PhD, and Jeff Niezgoda, MD) is exploring the use of advanced computing to provide a 3-dimensional reconstruction of deep tissue injury using an interface to our virtual program Anatomage (a computerized human cadaveric anatomy table).6 At this point, we are employing Anatomage as a teaching and research tool. Our inspiration for this project came from several spaces: (1) the National Pressure Ulcer Advisory Panel deep tissue injury projects5,7 and (2) previous animal model research related to evidence of free radical damage5,7,8 to the deep tissues, the interstitium, subcutaneous tissues, and the muscle-bone interface. This is technology all but unheard of just a few years ago.9

In a year of celebrating the past, I encourage wound care organizations to look to the future. The human–machine interface should empower these organizations that drive innovation to harness the confluence of energy, ideas, and leadership that allows us to move more powerfully and faster in the Second Machine Age.3 We possess more tools with more memory to reconstruct and image the pathologies that we could only hypothesize about in the past; what matters now is how we use them.

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References

1. Stelton S. The WCET at 40. Adv Skin Wound Care 2018;31:150–1.
2. American Professional Wound Care Association. Mission Statement. www.apwca.org/mission. Last accessed April 25, 2018.
3. Brynjolfsson E, McAfee A. The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies. New York, NY: WW Norton; 2014.
4. Benias PC, Wells RG, Sackey-Aboagye B, et al. Structure and distribution of an unrecognized interstitium in human tissues. Sci Rep 2018;8(1):4947.
5. National Pressure Ulcer Advisory Panel. Deep Tissue Injury. www.npuap.org/resources/white-papers. Last accessed April 27, 2018.
6. Anatomage Table. Muscles of the Foot. http://anatomagetable.com/Default?Category=1&Id=2072&Other=1&Name=Extensor%20Digitorum%20Longus. Last accessed April 25, 2018.
7. Salcido R. Uncritical transfer of terminology to establish causation: deep tissue injury. Adv Skin Wound Care 2014;27:104.
8. Salcido R, Popescu A, Ahn C. Animal models in pressure ulcer research. J Spinal Cord Med 2007;30:107–16.
9. Salcido R. Histopathology of pressure ulcers as a result of sequential computer-controlled pressure sessions in a fuzzy rat model. Adv Wound Care 1994;7(5):23–4.
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