60-second interview with Peter Vowden13th February 2013
Peter Vowden, Consultant Vascular Surgeon, Bradford Royal Infirmary
Q. How long have you worked as a vascular surgeon?
A. 22 years as a consultant surgeon in Bradford
Q. How did you develop an interest in wound care?
A. It was a natural progression from my interest in limb salvage surgery and diabetic foot management. Kathryn and I started a wound care research unit in 1992 and I have maintained an active interest both in wound care research and clinical wound management ever since.
Q. In your opinion, has the incidence of vascular disease increased?
A. Yes, this is a natural consequence of both an aging population and an increasing incidence of diabetes. The increase has however been partially offset by improved management of cardiovascular disease.
Q. Do you feel that clinicians make the link between vascular stages and wound healing?
A. No, symptoms of vascular disease can be vague and may be difficult to recognise in patients with diabetes. Healthcare professionals are also not confident about assessing patients for vascular disease and many seem to struggle with Doppler ABPI assessment. Similarly too many patients with recurrent venous leg ulcers are not referred for vascular assessment and possible treatment of their superficial venous disease.
Q. Do all untreated vascular disease patients go on to get a wound? How many patients get referred to you who with more preventative care, could have avoided disease progression?
A. Prevention strategies should be in place for all patients with diabetes – foot clinic review. Patients deemed at risk of pressure ulceration – pressure relief aids and offloading and those patients with venous disease – surgery/hosiery. In addition all patients with cardiovascular disease need to receive healthy living advice (diet, non-smoking, exercise) as well as lipid and blood pressure management. Too often we simply focus on the wound and forget to integrate all aspects of care.
Q. With Vascular Disease Awareness week, the Activa LegHealth campaign, Leg Clubs opening throughout the country, what do you feel is the scale of the problem in the UK?
A. The message is slowly getting across that we need an integrated strategy with a functional multidisciplinary and multi-professional team supporting patients with wounds. Hopefully commissioning and AQP will provide the necessary drivers for change and allow us to establish good local care strategies to support patients
Q. Do you believe that there is not enough synergy throughout the country between vascular and tissue viability teams, and with more combined working healing rates could be improved? Or are they better placed working in isolation without diluting each other’s expertise?
A. No, it is vitally important that we stop healthcare professionals working in isolation. Patients need to be able to access the best person to give them care and that includes everything from prevention to diagnosis and treatment.
Q. Is everyone, especially the public, as aware as they should be of the risks of vascular disease and its impact on wound care?
A. No, patients frequently fail to see the link between their other symptoms and the non-healing wound on their leg.
Q. What should the wound care generalist look out for when visiting patients in the community?
A. Most wounds actually heal quickly however some have a very prolonged healing time. Everyone should do their best to identify wounds that may not heal in a timely manner and ensure that they are referred to the appropriate specialist. One important aspect of care is to make sure the diagnosis is correct as this drives all the treatment decisions.
Q. In your opinion, what is the best way to prevent disease progression, or is this not actually possible with current resources?
A. Yes it is possible if we recognise the disease! Patients with venous disease need the underlying cause of their ulceration treated. Patients with arterial disease need a good cardiovascular prevention strategy. Careful foot care and good diabetic control need to be in place for patients with diabetes. These are all things which are recognised in existing guidelines yet are not always followed by healthcare professionals.
Q. What area of care needs updating?
A. We need to get better at understanding costs – to often we focus on the cost of one dressing and not the cost of managing a patient’s wound and healing it.
Q. What annoys you most in wound care?
A. Delayed referrals.
Q. If you had the opportunity to change one thing in today’s health service, what would it be?
A. Care boundaries – we need to ensure that patients get the correct care and that that care is correctly co-ordinated. Too often there are big gaps in care between systems and this produces conflict and confusion for individual patients.