The preface written by Joe McCulloch and Lu Kloth to the fourth edition of what is now most appropriately called Wound Healing: Evidence Based Management, has made my job remarkably easy. In their Preface to this edition, they have nicely highlighted the wonderful additions in content and authorship since the third edition was published in 2002. This text is truly an international masterpiece on a subject that has now drawn attention from multidisciplinary clinicians and students facing the need to demonstrate treatment efficacy for any traumatically or metabolically-induced pathology of the integument and underlying structures. Dr. McCulloch and Prof. Kloth have accomplished this goal through fine tuning of a process begun over 20 years ago. They have watched this field grow with diligence, and, in the process, have attracted a cadre of colleagues who recognize the value residing in their contributions to arguably the most comprehensive text on this subject. More importantly, the willingness of this diverse team of contributors to spend the time and resources to offer contemporary information is tempered by the realization that their efforts required comprehensive documentation to support many contentions made regarding treatment approaches and modality/technique utilization. Such a requirement forms the cornerstone of all texts comprising the Contemporary Perspectives in Rehabilitation series. Each text must provide information based on evidence while challenging the student or clinician through thought-provoking case histories or other unique vehicles. In that context, Dr. McCulloch and Prof. Kloth become the first to insert the notion of “pearls (of wisdom)” within chapters comprising this volume. Such pearls can be used to extract essential points of information, or, more comprehensively, to guide readers’ thinking as they absorb information within most chapters.
So why is all the attention to detail and the expansion of evidence-based information about the anatomy, pathology, and treatment of wounds so important? If we recognize that health-care insurers continue to seek ways to reduce reimbursement for rehabilitative efforts, virtually every aspect of patient care for which physical or occupational therapists might be engaged has become scrutinized more carefully. Our currency for communication in our efforts to engage these enterprises as we fight for our patients has now become “evidence.” In this regard, the facts are that the presence of a serious wound is most apparent to the naked eye, can evoke sympathy or empathy from even the least dispassionate decision maker, and brings to a level of conscientiousness the implications for failed treatment as measured by further medical costs as well as reduced quality of life. Such visibly obvious signs of immobility or disfigurement afford, in a most curious way, an opportunity to relate evidence for effective treatment approaches to obvious indicators of functional and aesthetic restoration. For example, such visible cues for impairment can draw the focus in a way often unattended by those who do not see the implications for functional imitation seen in the patient with a hemiparetic arm, a rigid gait, or with persistent low back pain. The contents of this book and utilization of information herein, whether impacting the patient with ulcerative lesions caused by uncontrolled diabetes, or subsequent to sustaining a serious burn, can potentially make the difference in the number of treatments provided to these patients and the concomitant but often unappreciated impact on health-related quality of life.
So, to all student or clinician users of the magnificent effort housed within these pages, we hope that your ability to extract the abundance of evidence reflected in each chapter will serve you and your patients well and help to reduce an emergent atrophy in rehabilitation care.
Steven L. Wolf, PhD, PT, FAPTA
Contemporary Perspectives in Rehabilitation Series