Which specialist for wound management?

[Eleoura]

Posting here for traffic. My neighbour (71) is asking me for help. She has a wound on her heel being dressed by district nurses for 5mths, but it isn't healing. She is a well controlled diabetic, previously active and still working. She now cannot drive, cannot work and sounds mismanaged. No tissue viability review, different nurses, different dressings and creams each week. No overall plan etc. GP fobs to foot clinic, private podiatrist said A&E due to an infection and A&E said her GP should manage.

She is happy to pay privately, but which consultant should she ask for? A surgeon for wound management, an endocrine/diabetes specialist or someone else?

If your local hospital has a diabetic foot clinic, that would be ideal. NHS podiatrists would accept referrals for this, but usually the DN would flag that up. Tissue viability nurses are experts at wounds, but again - the DN would have access to them. As far as consultants go - a vascular surgeon would help if poor circulation was causing delayed healing, an endocrinologist or diabetologist would help if high blood sugar levels were affecting healing.

Wound care tends not to be managed privately (I work in private healthcare and refer on all but the most basic of wounds).

@happylittlevegemites- thanks so much. Form what I can gather, despite 5mths of district nurses bandaging the wound, she hasn't seen a tissue viability nurse or have any further review! I'll give her the info though, thanks.

There should be a specialist TVN within the same organisation that the DNs are coming from so I would start there and request that her wound is reviewed by a TVN

Is it an ulcer?

A podiatrist should be your best port of call as they should know the best way forward, but as not I'd say private GP as I've found them best as sending patients to useful referrals

She needs a tissue viability nurse. District nurse should be able to refer. They have more weapons in their arsenal and are experts at wounds that fail to heal.

Diabetic foot clinic .... I run one. They are a multidisciplinary clinic with vascular , microbiology, podiatry , orthotics and a foot surgeon. Exactly the place for this.....

I had a very similar problem and after seven months of no healing, I tried some amazing dressings which allowed me to heal in about 3 weeks, the difference was unreal. I don't think I can put links but the dressings are called Biatain Silicone Ag dressings. They are really expensive (about £7 per dressing) but each one lasts for a week. You can get them on a website called medical dressings dot C0 dot uk. I saw a specialist dermatologist 3 times (private healthcare), had several scans and saw several nurses but no one was able to help me. I specifically made an account to recommend these as they were so good for me!

@Crazylegscrane21k- thanks for that. Certainly worth asking her DN if that dressing is any better than whatever they are currently using.

@Eleoura Yes definitely! I got the Biatain Silicone dressings for free on the nhs but I bought the Ag ones myself after doing a bit of research. However they may give her the Ag ones for free if she asks.

Next time DN's visit "I would like a referral to tissue viability please," rinse and repeat until she's seen by a TV nurse specialist. They have access to the wider multidisciplinary team where needed.

Next DN visit or a quick call to the GP and ask to be referred to the multi-disciplinary foot team at the local hospital. Something like 95% of hospitals have them, so I would be surprised if yours didn't!