[The wound care center in surgery: an interdisciplinary concept for diagnostic and treatment of chronic wounds]

[Interdisciplinary centres in hospitals? A review of the literature]

The treatment of complex disease patterns demands knowledge, and hence the collaboration of many medical disciplines. Interdisciplinary approaches to treatment are thus superior to multidisciplinary ones in terms of quality and costs. To make use of those benefits, interdisciplinary centres have emerged at many hospitals. Our review of the literature has sought to answer two questions: 1) Is there any evidence for the relationship 'creation of a centre = creation of interdisciplinarity'? 2) How can interdisciplinarity be fostered in centres? Medical and economic publications were identified via key terms in PubMed, Web of Knowledge and WISO. Using their references, further publications were researched. Contributions that complied with predefined criteria were included. For 75 of the 78 publications interdisciplinarity is the means to achieve a centre's objectives in quality and cost. Almost all the positive results achieved in centres, e.g., an increase in number of cases, are attributed to the seemingly established interdisciplinarity, without any evidence to substantiate this interrelation (question 1). The recommendations for creating the requested lively interdisciplinarity are insufficient, since technical arrangements dominate and the importance of social and therewith behavioural aspects is often forgotten--the findings of the respective literature remain unappreciated (question 2). Moreover, pertinent research as well as qualitative longitudinal research designs activating the knowledge of physicians, social scientists and economists should be used to investigate the interdisciplinarity sought for in centres.

Evaluation of the quality of venous leg ulcer care given in a multidisciplinary specialist centre

OBJECTIVE

To determine the quality of venous leg ulcer care given in a multidisciplinary, specialist wound-healing centre and to identify problem areas that might affect it.

METHOD

The case records of 90 consecutive patients with venous leg ulcers, diagnosed and treated at the Copenhagen Wound Healing Centre, Denmark, were retrospectively audited by a Scandinavian cross-sectional and multidisciplinary expert panel. Quality of care was audited in each case using implicit criteria. The experts then formulated key recommendations for good clinical practice for patients with venous leg ulcers.

RESULTS

Quality of care was satisfactory in 74 patients (82%). The one-year healing rate was 77% (69/90), with a three-month recurrence rate of 12% (11/90). Identified problem areas included the lack of systematic assessment of patients' suitability for surgery; lack of systematic, duplex-verified diagnoses of venous aetiology; and the lack of systematic examination of distal arterial pressure. The recommendations include the need for venous diagnosis, differential diagnosis, compression therapy, surgery, systemic treatment, access to venous leg ulcer care and better communication.

CONCLUSION

The quality of venous leg ulcer care given in this multidisciplinary centre was satisfactory.

Skin Grafting of Venous Ulcers: A Review of its Current Role

As a therapeutic option, grafting of venous ulcers has not been very successfully received despite the different types of grafting methods. Currently, there are only a few controlled randomized trials offering clear guidance to clinicians. The development of artificially bioengineered skin constructs has led to a renewed interest in wound bed preparation, and preliminary successes suggest that the role of skin grafting could be studied in the current context.