Anyone  finding barriers in wound care management with the uniinsured patient? What are you doing to improve this situation? eg Once a patient  has a healed ulcer, how can we assure the gain with this population once they go back into the community?

Can we also have three points of view:

1. Private practice

2. Private Hospital

3. Public Hospital

I agree completely.  Simply closing the challenging wound is only half of the battle.  Maintaining wound closure is another challenge entirely, but one that is no less important.  When dealing with those patients who present without insurance, an ounce of prevention is worth a pound of cure.  There are numerous articles published which delicate the consequences of lower extremity ulcerations, and there subsequent health care cost.  Abandoning these patients due to lack of appropriate health care coverage will only create a greater draw on a healthcare system which already stretched to the breaking point.  In these patients, the cost of appropriate preventative offloading and post-wound care management is far exceeded by the cost of the management of recurrent ulcerations.  Hospital administrators must be made to understand this, and develop hospital policy accordingly.

This image demonstrates a patient who presents with a chronic, pressure related UT grade 1A ulceration which requires appropriate wound management and offloading.  Additionally a Jones tenosuspension was performed to provide surgical offloading in this patient with a flexible, plantarflexed 1st ray.

This is truly a pressing issue and one that can be positively and absolutely addressed by an interdisciplinary  team approach.Whilst making  a difference is part of the clinical programs in all three settings (Private Practice, Private Hospital & Public Hospital), no meaningful outcomes can be achieved without a passion for saving limbs.

Considering the tremendous scope of the problem, it would stand to reason that we use the successful patients (ones that heal their wounds) thermselves to teach within thier community, much like "Train the Trainer". This training must be re-inforced at timely intervals to prepare more lay persons (or promotoras: Trained healthcare workers) This is especially true for the rural and underserved communities with limited access to care. This is a complimentary approach to aggresive wound healing as well as preventive care and is not an absolute independent solution.

We at Southern Arizona LImb Salvage Alliance (SALSA), have formed a Collaborative Healthcare Interdisciplinary Program (CHIPS-SALSA) initiative. As part of this program, we have secured a CDC grant in collaboration with Center for E-Health and Telemedicine, at University of Arizona to deliver educational curriculum via telemedicine. Stay tuned for more updates on this!