Management of Non-healing Wounds
Dr. Koller has been involved in the care of complex non-healing wounds since 1992 when he was a resident at Orlando Regional Medical Center. At that time, Dr. Koller was involved in basic science research looking into the causes for slow wound healing. Since then, Dr. Koller has had a keen interest in helping patients with complex, non-healing wounds.
Although the science behind wound healing continues, there is sufficient evidence and knowledge available to help doctors understand what it takes to get certain wounds to heal. Dr. Koller uses his basic science knowledge background in wound healing as well as his surgical skill and technique to help patients heal difficult wounds.
The basic principles which allow wounds to heal include a thorough history and physical examination by a Board certified surgeon who specializes in wound healing. Although there are non-surgeons who practice wound care, these physicians and nurses don’t typically have the surgical and basic science knowledge to fully understand the physiology of poor wound healing.
First, the arterial blood supply to the affected area must be sufficient to deliver oxygen to the tissues. If the non-healing wound is on the leg, often times the blood supply to that extremity is poor. This can occur from a general lack of circulation such as “hardening of the arteries” also known as atherosclerosis. Also, some diabetic patients have difficulties in wound healing because of microvascular circulation problems. This means that they may have adequate blood flow in the arteries but the circulation taking blood and oxygen down to the tissues is poor. Third, there can be a problem with venous blood flow. This is known as venostasis, and is a complicated problem that requires expertise and knowledge in both diagnosing and treating.
Aside from the physiologic conditions described above, factors such as cigarette smoking, high bacterial loads, and inadequate wound dressings can all contribute to poor wound healing. It requires knowledge and experience by a Board certified surgeon who specializes in wound management to get the most comprehensive care available.