You don’t have to travel the world to be a healing hero. Every day, somewhere in the U.S. a health care worker helps heal a patient’s wounds.
Kara Couch, NP, CWS
I am Kara Couch, NP, CWS. I have been an NP for the past ten years and have worked in wound care the entire time. My NP training is in family practice. I was very fortunate to spend the first 6 years of my wound care life working in diabetic limb salvage with the amazing team at Georgetown University Hospital where I learned everything about wound care and built my foundation for my clinical practice. Currently, I work at Walter Reed National Military Medical Center, where I treat Wounded Warriors as well as patients with all other acute and chronic wounds. Over the past four years, I have been extremely humbled and blessed to work with these courageous veterans and active duty soldiers from the Army, Marines, Navy and Air Force. Our patients stay with us for many months so we develop incredible bonds with them as they recover from grievous injuries.
War wounds are unlike anything that is encountered in civilian practice. The extent of the trauma, which can lead to multiple limb amputations, usually necessitates repeated surgeries, skin grafting and sometimes sophisticated muscle flaps, in addition to their many other injuries. Many patients suffer from invasive fungal infections as well as multi-drug resistant infections that create wound challenges for our team as well as the surgeons. We work in a very collaborative environment to treat these highly complex patients. One aspect of war trauma that is not seen in the civilian population is heterotopic ossification (HO). It is found in approximately 65% of all of our amputees and 35-40% of those patients have it in moderate-severe amounts. HO creates unique challenges for the wound clinician because it cannot be resected effectively before it has matured for 6 months. It can cause significant pain and difficulty with prosthetic fitting. Skin breakdown is common. 20-25% of our patients require a technically difficult surgery to resect the HO. Nerves, arteries, veins can be wrapped into the HO and infection can occur. However, once the patients have their resections, typically, they do very well. For those who have mild-moderate HO, we can usually get them healed with local wound care and repeated socket modifications. I see my patients at least twice weekly for their wounds. Our outpatient amputee wound clinic is co-located with physical therapy, occupational therapy, orthopedics and prosthetics so we can work quickly to treat the wounds together as a team since the patients use us almost as an inpatient rehab setting. I consider myself to be extremely blessed to working with our nation's Heroes. I knew nothing of the war prior to my job at Walter Reed. Now I feel that I know almost too much. However, I know that my life has been forever changed for the better by knowing the resilience and unwavering bravery that I have witnessed as patient after patient walked slowly but steadily into their new normal life.
Michele (Shelly) R. Burdette-Taylor
PhD, MSN, RN-BC, CWCN, CFCN
Shelly Burdette-Taylor is a true “hero who heals”. She has devoted most of her over 35-year career as a wound, skin and foot care nurse specifically for chronic lower extremity disease to include neuropathy, lower extremity venous and arterial disease. Shelly is board certified in education, wound care, foot care, nurse case management and parish nursing. She completed her PhD at the University of San Diego, California focusing on traumatic limb loss in combat and related post-traumatic stress disorder. LTC Burdette-Taylor has been in the Army National Guard and US Army Reserves since 1986. She is certified as a Total Army Instructor and devotes much of her time teaching soldiers and nurses as a Nurse Case Manager for Wounded Warriors.
TayLORD Health, LLC is Dr. Burdette-Taylor’s education company that focuses on foot and wound care providing courses for the Wound Ostomy Continence Credentialing Board Certification utilizing the World Health Organization Wound Healing and Lymphedema Management Guidelines. Shelly’s team of US Nurses works closely with Honduran Nurses to elevate professionals with credentialing, knowledge, supplies/equipment and critical thinking skills specific to foot and wound care. She is a presently working on Grant Funding for support of this mission.
Diane Merkle APRN, CWOCN, PhD
Bridgeport Hospital Center for Wound Healing and Hyperbaric Medicine
Wound healing is a relatively new healthcare specialty. Over the past twenty-five years, I have enjoyed professional and personal growth as the science of wound healing has grown. It has been a great opportunity to provide a vital service to those who suffer from chronic wounds. The phenomenon of the healing and treatment of chronic wounds is still being explored and I look forward to an exciting future for wound care.
At our facility, we emphasize gentle treatment measures, and patient support. Our staff educates patients that “It takes a village to heal a wound”. Wound healing treatment for persons with leg wounds, diabetic foot wounds, surgical wounds and many others, commonly crosses multidisciplinary specialties. We are fortunate to have a staff that includes those from nursing, trauma / surgery, burn care, and podiatry. We also have excellent communication with our specialists in infectious disease, vascular, and orthopedics medicine. The team approach is rewarding for our professional team and provides strong patient outcomes. Overall, our community benefits from this important service.
I am currently in a hospital based, outpatient physical therapy clinic. The types of wounds that we see include the usual venous, arterial, diabetic foot ulcers and pressure sores, as well as atypical wounds. It is not unusual to see a range of complicated chronic wounds or acute surgical dehiscence. As a PT, I use energy based modalities to increase microcirculation and decrease bioburden. For example, these modalities include electrical stimulation, megahertz US, UVC, VAC, and pulsed lavage. My treatment sessions can also include sharp debridement and multi-layer compression if indicated for that specific patient. Our goals are patient focused and plan of care is discussed during the initial evaluation. Goals range from wound healing to percentage area reduction to wound bed prep for STSG or flaps. As a Physical Therapist, it is also important to assess a patient's functional limitation and try to progress them towards their prior level of functioning so the patient can be as independent as they used to be or would like to be now.