1. Salcido, Richard "Sal" MD

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A couple of months ago, I had the pleasure of getting together with a distinguished group of wound care practitioners to begin planning this year's Clinical Symposium on Advances in Skin & Wound Care. One of the topics we spent a lot of time talking about was emerging technologies in wound care. It was a lively exchange as we all enthusiastically shared our experiences with some of the new "gadgets" available to assess and treat our patients with wounds.


As I listened to my colleagues talk, I was struck by how fortunate we are to have experts in industry, academia, and clinical wound care working together to bring to market the latest and greatest technologies possible. The ultimate common pathway for wound care technology and clinical application is the point of service-in other words, the technology must be clinically applicable in the clinic, office, hospital, or long-term-care facility where we manage our patients. A successful technologic innovation is one that clinicians will use, third-party payers will reimburse, and patients will value for its positive contribution to their care.


New Product or New Package?

The introduction of new technologies-and with it, the promise of improved patient outcomes-is undoubtedly exciting. But I also have to wonder about its impact on older technologies. As new products become available and lead to more advanced treatments, are we-rightly or wrongly-following an "out with the old, in with the new" mindset? Are the older wound care products, modalities, and technologies we have relied on in managing our patients really no longer useful? Or are they victims of planned obsolescence?


That question begs another one: Are some of the modalities touted as "new" actually "new," or are they the same modalities repackaged? This is the "old wine in a new bottle" concept I discussed in my editorial in the November/December 2006 issue of Advances in Skin & Wound Care. A product we are using today may be improved or made different by newer manufacturing techniques, but the core product is the same.


The computer industry is the perfect example of this concept. In 1965, Gordon Moore, cofounder of the Intel Corporation, predicted that computer processor speeds would double every 18 months (known as Moore's Law). His prediction has proved true: We are seeing processor speeds jump at about that rate. In addition, ever-expanding memory capacity is a given these days. But other than that, nothing has changed recently in computer technology. So, the computer you buy today is basically the same as the one you bought 3 years ago, with a faster processor and more memory.


Look at it another way: Technology is obsolete the moment it is delivered to the customer-unless it is useful and is available at the appropriate price for an extended period of time (extended utility).


Changing the Course

It is common practice for bioengineering and manufacturing firms to adapt or apply existing technologies to existing clinical problems, including chronic wounds-meaning they actively search for ways to expand the clinical applications of their existing products.


This can be done very successfully. Consider the example of ultrasound, which has been around for 50 years and has now been adapted and refined for use in wound care at varying frequencies. By altering frequencies, ultrasound can image tissues or potentially evaluate impending tissue injury (deep tissue injury), and recently, it has even been used to debride wounds. Dentists now use ultrasound to clean plaque from teeth; why not use it to clean wounds too?


Although ultrasound and other technologies adapted for wound care have a place in patient management, I believe the process for getting to the technologies that would help us the most should be reversed. As wound care professionals, we should be at the forefront of developing answers to the clinical problems associated with chronic wounds. Because we know the issues involved in managing these patients, we should proactively assist industry in the development of ideas that lead to diagnostic, prevention, and treatment technologies tailored specifically to our patients' needs.


In addition, we must rigorously scrutinize the evidence for the use of older technologies that have been adapted to the treatment of wounds, as well as for the use of new technologies designed specifically for wounds. These technologies must demonstrate conclusive evidence that they are sustainable at the point of service and will benefit patient care.


As I mentioned at the outset, the genesis of this editorial was the discussion of emerging technologies at the planning meeting for the upcoming Clinical Symposium. The passion expressed by the planning panel members for this topic will be evident at conference sessions. Join us at the Clinical Symposium, October 11 to 14, 2007, at the Gaylord Opryland Resort & Convention Center, Nashville, TN, to learn more about emerging technologies in wound care.