APMA News - March/April 2020 - 26

SPECIAL WOUND CARE SECTION

Collaborative Care continued from page 24

APMA News: What about prevention? What are some of the promising developments that will help address wounds before they happen?
Dr. Ross: It's all about screening-bring them in every three months
for diabetic foot care and lower-extremity evaluation, and for
pretrophic ulcerations. If you screen, you may prevent about 85
percent of amputations. Prevention is about screening, and having
a relationship with our vascular surgery and cardiology colleagues is
essential, as well as internal medicine, infectious disease, even orthopedics. As Dr. Mills says, "no flow, no toe." Forge those relationships with your colleagues and say, "I'm a wound care specialist, I'm
a diabetic limb preservation specialist."
APMA News: Studies show care delivered by a podiatrist makes a
significant difference for patients who have suffered a diabetic ulceration. What do you believe is different about podiatry's approach?

How do you as a podiatrist approach wound care differently than
other specialists?
Dr. Ross: We know more about biomechanics and how the foot
functions and about gait and compensation. This is where my sports
medicine background and biomechanics background have a great
deal of impact on diabetic wounds. We can determine when there is
excessive forefoot pressure after a trans-metatarsal amputation and
whether a Tendo-Achilles lengthening is necessary. I know how to
create diabetic insoles or orthotics, and those are some of the areas
I think my expertise and background are utilized to help prevent an
ulcer or a recurrent ulcer.
But I think the multidisciplinary approach is so, so important. I
can't succeed by myself; we need to have different specialists working in concert, working together; you have to have that relationship
and communication. I'm constantly sharing these cases with our
vascular colleagues, and they're asking how good was the perfusion
after their intervention? We all have skin in the game.
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Wound Care in Podiatric Medical Training Programs
Wound care training as a part of the Podiatric
Medicine and Surgery Residency has been a
hot-button issue for the profession of late. The
MedStar Washington Hospital Center PMSR/
RRA in Washington, DC, directed by John
Steinberg, DPM, is renowned for its focus on
diabetic limb salvage and Charcot reconstruction surgeries. APMA News spoke with Colin
Mizuo, DPM, a 2019 graduate of the program, to
learn more about what he took away from his residency and how it
has changed his perspective.
APMA News: Tell us more about your experience in residency.
Dr. Mizuo: The thing that makes the MedStar program unique is
the integration of podiatry with plastics and the vascular department. Those three programs are intertwined, and podiatry has a
really good working relationship with both departments, which is
not the case everywhere. The insight I gained from that multidisciplinary approach has given me a very different perspective.
A lot of our patients with diabetes have a compromised vascular
system, and thanks to my work with the vascular surgeons, I learned
how important bloodflow is to a wound. From an industry standpoint, there are so many different treatments available, but none of
that matters without proper bloodflow. Opening up the vessels is
imperative to our success rate.
Plastics opened my eyes and changed the way we cover a wound.
Instead of throwing on grafts, we get fancy with wound closures.
What I took away from my residency is that we need strong fundamental knowledge of wound care and appropriate working relationships within our institutions. Wound care needs to be a multispecialty effort. Medicine has to be truly integrated so that we're
working with our counterparts in primary care and general medicine, vascular surgery, and plastics.
APMA News: There has been discussion within the profession about
the value of wound-care rotations within residency. What is your perspective based on the experience of a residency program with a heavy
focus on wound care?
26 APMA News March/April 2020

Dr. Mizuo: I think a wound-care rotation as part of training is
imperative. As a student, you get caught up in the trauma cases
and seeing a bone fractured in several places; you get caught up
in the elective reconstructive surgeries. Don't get me wrong; I love
doing that stuff. But we've made our stamp in the medical profession with wound care. It's lucrative for hospitals, and it's how we
make a difference in a lot of people's lives. It's really how we demonstrate our value to other medical professions. As long as diabetes is
on the rise, that's not going to change.
APMA News: You are currently serving in the US military-thank
you for your service! Your current practice is more focused on
sports medicine and trauma. Do you see yourself returning to
wound care in the future?
Dr. Mizuo: Yes, I'm treating healthy, young, active-duty military.
I love trauma and sports medicine, but I would be lying if I said
I didn't miss the diabetic limb salvage. I want to give people a
second chance.
I do think I will get back to it. Once I return to the civilian workforce, it would be a somewhat naïve expectation to not do some
diabetic limb salvage, unless I were in an exclusively orthopedic
practice.
My mom was a diabetic, so it really hits home for me that someone who gets a wound that gets infected does not automatically
need a below-knee amputation. We can do limb preservation and
leave them with a functional limb.
One of the many initial reasons I chose MedStar was that I
knew the faculty there would provide me not only with a comprehensive education to treat all kinds of pathology of the foot and
ankle, but provide me with the fundamental surgical principles
that I could take anywhere to cultivate a style that complements my
skill set. The deciding factor that defined my choice to attend
MedStar was the integrative approach I saw in diabetic limb salvage amongst multiple specialties, pioneered by experts in their respective fields. I think this approach needs to become standard in
the way we treat these patients, and I knew that I would leave residency with the best training in limb salvage.
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APMA News - March/April 2020

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