Wound Care Clinics: Under the Domain of Plastic Surgery?
Andrea Lin1, Stephen Lu2
1Penn State College of Medicine, 2UPMC
Background: In the United States, wound care is a substantial industry, and dedicated wound care centers play a critical role in patient care and wound management. Such wound care centers typically involve a multidisciplinary team-based approach. Simultaneously, plastic surgeons are often considered experts in evaluation and management of wounds, particularly chronic and complex wounds. However, it is unclear the extent of direct involvement they have at wound care centers. In this study, we sought to evaluate the presence and involvement of plastic surgeons in wound care centers across Pennsylvania, the nation’s fifth largest state.
Methods: A comprehensive list of dedicated wound care clinics in Pennsylvania was obtained based on meeting criteria that dressing changes, debridement, antibiotics, and various treatments are available for acute and non-healing wounds (de Leon et al., 2016). This list was compiled by Milestone Healthcare Quality Unit as a developmental program under the Pennsylvania Department of Public Welfare and updated for 2022 (Milestone Centers, Inc., 2022). For each site, information was gathered via website listings, the location, number of providers, and the professional certification/specialization of each provider which included MD, DO, DPT, DPM, CRNP, PA, and PhD.
Results: Out of 81 wound care clinics, 59% (48/81) were hospital-based, 20% (16/81) were privately owned outside of hospital systems, and 21% (17/81) were non-profit with a total of 305 providers. After researching staff employed at each location, plastic surgeons only comprised of only 6% (18/305) providers employed at wound care centers. Specialties such as podiatry 26% (78/305), general surgery 20% (60/305), vascular surgery 11% (35/305), emergency medicine 8% (23/305), and other mid-level providers such as NP and PAs 12% (38/305) were more frequently employed rather than plastic surgery. 17/18 plastic surgeons were board certified by the American Board of Plastic Surgery.
Conclusions: Wound care is a field requiring collaboration between multiple specialties, with significant repercussions on healthcare costs and patient outcomes. Plastic surgery provides unique surgical services and abilities for healing of wounds and that they should be heavily involved at wound care centers. However, the data do not reflect significant involvement at a formal level. Further studies can investigate societal and financial causes of lack of engagement. While plastic surgeons may not desire much of their practice to be wound care management, it stands to reason some affiliation, at least for patient awareness and referral, may be warranted.
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