To the Editor,
Besides many other health related fields, Physical therapy is expected to grow with an average rate of 40% in 20171. New generation entering in the field of physiotherapy are experiencing revolutionary changes. Integumentary rehabilitation is one of undergoing radical changes as the research work is revealing the anonymities of complex manners of the wound healing, tissue reparation, deprivation and revival of tissues. Evidence-based practices bring innovation and new technologies helping in the wound healing, but it is an ignored field in Pakistan, where physiotherapists lack in knowledge of Integumentary rehabilitation. Rehabilitation teams are working for about five decades on the dynamic changes occurring in wound care concept2.
From 1960’s, evident changes have been observed in wound care practices with the finding of moist wound healing and modern dressings3. It has been discovered that re-epithelialization best occurs in moist environment of the wound bed, by ‘leap frogging’ that means the epithelial cells have to burrow down underneath the wound bed to find the moist environment if the wound is dry. Moreover, the debridement techniques were introduced to remove the dead necrotic tissues and for the revival of the cells around the wound bed. These debridement techniques include enzymatic agents through selective and non-selective chemical agents, autolytic through film dressings, mechanical by wet-dry dressings, furthermore whirlpool, irrigation and sharp surgical debridement techniques. The physical therapist along with the rehabilitation team selects the best method to remove dead necrotic tissue and getting the tissues ready for the regeneration. A lot of work has already been done by the Agency of Healthcare Research & Quality and they have released many guidelines for the medical practitioners.
Wound care is no longer the domain of nurses, it’s now been practice by the physicians, physical therapists, occupational therapist and podiatrists and many other healthcare related professionals. A comprehensive care given to the patient by multidisciplinary approach towards the variety of wounds in different healthcare settings, like outpatient departments, inpatients departments, long term care and even in home settings. Specialized centers for wound care have been established for wound care abroad. Specialized rehabilitation teams are conducting education courses, clinical symposia and specialized programs for the awareness for the clinicians for advanced knowledge to manage wounds in 21st century. American Academy of Wound Management (AAWM) and Wound Ostomy and Continence Nurses Society (WOCN) are the agencies who are offering certifications in wound care management. In future American Medical Association may approve the Wound Care as a special medical field.
All the progresses may sound implausible so far but it is clear that the wound care concepts are flying higher, giving better quality of life and advance options for the patients seeking help in healing process of their chronic and acute wounds. Innovative technologies that we can’t conceive right now are the future. Quantum leaps will occur between health care practitioners, patients and caregivers soon.
Dr. Muhammad Usman Khan
Ziauddin College of Physical Therapy
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 Hiag AJ, LeBrek DB. Measurement of change in rehabilitation team dynamics with the team assessment
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 Korting HC, Schollmann C, White RJ. Management of minor acute cutaneous wounds: importance of
wound healing in a moist environment. J Eur Acad Dermatol Venereol. 2011;25:130