Doctors, Scientists Team Up to Improve Wound Care

By Fred W. Baker III
American Forces Press Service

Aug. 25, 2009 - READER'S COMMENT:

Ronny R Dunn
Retired 1st Sgt.
Army Infantry
Aug. 26, 2009

Fred, I read your article regarding the fantastic work the medical professionals are researching.

Having been wounded by multiple fragmentation wounds myself I can attest to the fact that some wounds don't heal the same as the others. Even though they were from the same IED.

Having had my wounds cleaned daily the same way as all other soldiers and new bandages stuffed in the gaping holes.
The most terrifying times for me were when the nurses came in to change my bandages.

My god what excruciating pain. I always wondered why they didn't give me some sort of sedative or pain killer an hour before the procedure. I must tell you I more frightened of the nurses than the doctor. Surely in this day and age we have some sort of local numbing procedure to help alleviate this daily ritual of pain.

Besides the tormenting site of my buddies lying dead and other bad memories, I still have dreams of the nurses and their saline bottles, and those god awful tongs they used to pull the gauze out of the deep tissue.

WASHINGTON, Aug. 25, 2009 -- Army Spc. Adonnis Anderson said he knew the pain was coming.

After a bomb blew off much of his left forearm in Iraq in 2003, nurses came to his room daily to wash out his wounds. He described the treatment as two minutes of torture. They would swab the open wound as Anderson gritted his teeth and white-knuckle gripped the hospital bed railing.

"On a [pain] scale of 1 to 10, I'd give it a 15. It hurt really bad," Anderson said.

But the pain was a necessary evil. After being evacuated from the battlefield, Anderson's new fight was against dangerous infections that could destroy his chances of keeping his arm.

Anderson's story is not unique. Many soldiers evacuated from today's war zones suffer complex wounds from their injuries.

Bones are broken, and skin is burned or ripped by searing shrapnel. Mud, metal and fuel are fused into the wound. Harmful bacteria and other organisms are at work in the troops' bodies before they can be carried from the battlefield.

For the first time within the Defense Department, military doctors and scientists are working hand in hand to understand and improve the treatment of these complex wounds.

As part of an overarching, interservice combat wound initiative, scientists at the Armed Forces Institute of Pathology are researching the makeup of complex wounds to help doctors in military hospitals better individualize and chart a course of care.

Dubbed "translational research," this partnership breaks down traditional barriers between the scientists who study the medical intricacies of the wounds and the clinicians who provide the care for the wounded. Now, each supports the work of the other, basically taking the science from "the bench" to the "bedside."

At the core of their work, scientists and doctors hope to discover why some wounds heal and others resist treatment.

Army Col. (Dr.) Alexander Stojadinovic, a surgeon at Walter Reed Army Medical Center here, heads the combat wound initiative program. He said that while two wounds may look similar, they don't always react to treatment the same.

"We were perplexed. Why, when you close one [wound] it heals uneventfully, and when you close the other it has a complication that impairs healing? When by all criteria that we traditionally use you would have expected it to heal," Stojadinovic said.

Since early 2008, Stojadinovic has spearheaded efforts to merge the actions of military and private hospitals to address complex wound care.

He now has a staff of Army and Navy doctors that operates out of Walter Reed's Military Advanced Training Center. They deliver all of the needed specialists to the patients to collaborate on care.

"The nature of battlefield wounds today is complex. These are difficult medical problems that really challenge our creativity, our knowledge base and bring to bear teams," Stojadinovic said. "There's no single individual that can address all the problems that result from blast injuries."

When Stojadinovic decided to add a research arm to his program, he did not have to look far. The Armed Forces Institute of Pathology sits right in his back yard, situated on the same complex as Walter Reed.

About a year ago, Stojadinovic began talking with officials at the institute about research that can help doctors decide how to treat a wound and determine when it can be closed without further risk of infection. Many wounded troops are forced to endure several additional operations solely to remove infection. According to officials at the institute, the average soldier with complex wounds takes nine trips to the operating room.

Now, using troops enrolled in clinical trials at Walter Reed, doctors provide the scientists with wound fluids, blood and tissue that otherwise would be discarded. Scientists at the institute study the wound and provide feedback to the attending physicians. Scientists also study metal and other fragments that are taken from the wounds.

Depending on the study, scientists work to determine the number of bacteria in the sample, and characterize them genetically. The degree of bacterial contamination in a wound affects how it heals. Providing doctors with the number and type of bacteria allows them to avoid treatments that won't work and target treatments that will.

Officials also plan to use the data gathered in the studies to develop tools, such as a computer program, that will help doctors make faster, more tailored treatment decisions.

About 150 wounded troops are participating in clinical trials now. Their samples are stored in a repository at the institute of pathology. They are frozen and can be stored indefinitely.

This repository also can be to provide wound data for conflicts generations from now, said Dr. Mina Izadjoo, a microbiologist and the division chief of the wound biology and translational research at the institute.

Besides providing research for the clinical studies and maintaining the repository, Izadjoo's division also tests promising treatments that will advance wound care.

Already, a field deployable "dipstick" kit that can detect types of bacteria in a wound is being tested. This will allow doctors in the combat hospitals to identify which antibiotic to use first, she said.

"The bottom-line goal is [quickly] providing enough background information that leads to faster recovery of the wounded soldiers," she said.

(If you would like to comment on or have questions about this story, contact Fred Baker at fred.baker@osd.mil.)