Underscoring the need for interdisciplinary collaboration in treating high-risk patients with lower-extremity wounds, Robert Snyder, DPM, MBA, MSc, CWSP recalls a case he heard about involving a patient who was misdiagnosed with cellulitis and treated with antibiotics. The patient had chronic limb-threatening ischemia (CLTI) and a restenosis.
Shortly after becoming the Dean of the Barry University School of Podiatric Medicine, Dr. Snyder established a course on wound management and prevention. He says it was in response to his perception that while students had a solid textbook understanding of the fundamentals for treating lower extremity wounds, there was a “difficulty in putting it all together when assessing patients with wounds and the need for collaborating with other disciplines.”
After volunteering at a homeless shelter where she saw many people with lower extremity wounds, Khanh Phuong S. Tong decided to pursue a Doctor of Podiatric Medicine degree as well as a master’s degree in wound healing and tissue repair. She notes that she wanted to develop a better understanding of how to manage and prevent diabetic foot ulcers (DFUs), infections and related non-traumatic lower extremity amputations.
“Through my dual curriculums, I have learned about the importance of foot checks, glucose control, vascular function, and exercise in DFU management and amputation prevention but the interactions between podiatry, internal medicine, vascular surgery, physical therapy, and other disciplines that play a role in limb preservation were not discussed,” notes Ms. Tong, a fourth-year student at the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science.
With this in mind, Ms. Tong established a student chapter of the American Limb Preservation Society (ALPS) at the college. She says her goals for the ALPS student chapter include hosting panels or workshops with health-care providers who can share “their real-world interdisciplinary experiences and advice for limb salvage and amputation prevention.” Ms. Tong also sees the student chapter, currently comprised of 55 students, providing interdisciplinary activities and events for students to engage in early in their careers.
“My hope is the student chapter will motivate students to consult colleagues outside of their specialty early on and possibly encourage these future clinicians or surgeons to form interdisciplinary limb preservation teams,” adds Ms. Tong.
Developing interdisciplinary relationships is critical, according to Dr. Snyder, a Past President of the Association for the Advancement of Wound Care (AAWC) and the American Board for Wound Management.
While he maintains that podiatrists are “the best at treating the diabetic foot,” Dr. Snyder laments that many clinicians who are primarily working out of their offices are at a “significant disadvantage” when it comes to assessing and treating high-risk patients with wounds. Even when there is an appropriate referral to a vascular specialist for evaluation, the patient may be “waiting weeks for an appointment” with the vascular surgeon. This situation is particularly exacerbated in rural communities where the nearest vascular surgeon may be “hundreds of miles away,” points out Dr. Snyder, the Director of the Fellowship Program in Wound Healing and Clinical Research at the Barry University School of Podiatric Medicine.
Accordingly, he is a strong advocate of building a robust network of interdisciplinary alliances with colleagues one can quickly reach over the phone. Dr. Snyder says this network can greatly facilitate improved turnaround with referrals via the wound care without walls approach.
However, Dr. Snyder does concede that it may take some time to develop a level of trust between interdisciplinary colleagues. To that end, he foresees a shift from a multidisciplinary approach to more of a transdisciplinary approach that warrants a stronger knowledge and integration of what other disciplines bring to the table in the assessment and treatment of high-risk patients with wounds.
Ms. Tong suggests that ALPS can be a key resource for students in developing interdisciplinary relationships and improving their knowledge of the different aspects of limb preservation and amputation prevention.
“ALPS provides students with opportunities, early in their education, to learn about and work with organizations and programs that play a role in lower limb preservation,” notes Ms. Tong. “For instance, our ALPS student chapter hosted a virtual panel discussion with David Armstrong, DPM, MD, PhD, Bernadette Aulivola, MD, FACS, and Stephanie Woelfel, PT, DPT, CWS, FACCWS about the Toe, Flow, and Go model. The ALPS leadership offers a network of health-care professionals who can share their experiences and advice for working in or forming interdisciplinary limb preservation teams.”