Day in the life with Alexander Garmaev
21/11/11 | Complex wounds, Service development and delivery
This issue features Dr Alexander Garmaev, a surgeon at Tavlada, a private wound care centre in Moscow, Russia.
Can you outline where you practice?
Our medical centre is an outpatient clinic that was set up three years ago and provides specialised medical treatment to patients with different wound problems in Moscow and the surrounding area.
The mission of the wound care centre is to deliver professional and cost-effective medical care to the community. Our medical staff works with each patient individually to treat his or her wound(s).
Can you explain the make-up of your team?
Our wound centre has one surgeon, a general practitioner, an endocrinologist, an ultrasound diagnostician, nurses and administrative assistants.
The surgeon, the endocrinologist and the general practitioner assess the patients and prescribe therapy and treatments. The surgeon performs any operations that are necessary (debridement, plastic surgery, etc), while the nursing staff assists patients in removing and reapplying wound dressings.
What types of wounds do you regularly see?
We often see a variety of acute and chronic wounds including pressure ulcers, diabetic foot ulcers, burns, and venous and arterial ulcers.
What are the main types of equipment, dressings and techniques that you use on a day-to-day basis?
In our clinic, we combine active surgical tactics with the principles of moist wound healing. If the patient's medical situation allows, we perform surgical debridement to remove necrotic tissue and slough as thoroughly as possible. If surgical debridement is impracticable, autolytic debridement by moist wound treatment may be used instead. For this purpose, we use modern wound dressings with different modes of action depending on the condition of the wound.
Advanced wound dressings are used routinely in the clinic. We often use gel-forming calcium alginate dressings, silver alginate wound pads, adhesive and non-adhesive hydroactive foam dressings, absorbent hydrocolloid dressings and transparent hydrogel dressings. We use a variety of compression materials such as bandages and stockings. We have also recently started using negative pressure wound therapy.
What is the most unusual wound you have seen recently and how did you manage it?
My most unusual patient was a one-year-old boy with epidermolysis bullosa (EB). EB is a rare and severe genetic connective tissue disease causing blisters on the skin and mucosal membranes.
We selected the necessary wound dressings for him, making the dressing process less painful, and significantly improving his quality of life. It was very rewarding to help ease this boy's suffering.
Do you feel your practice has any unique obstacles that hamper your work?
The main obstacles we face as wound care providers are the lack of modern supplies and equipment. We would also like to have a bigger operating room.
Another obstacle we are constantly dealing with is getting patients to complete their entire treatment programme. When they see that their wounds are partially recovered, sometimes they stop treatment, only to return later when their wounds inevitably deteriorate.
What equipment/resource/education would make the most difference to your everyday work?
We would like to have modern ultrasonic equipment to cleanse and debride wounds.
We are also planning to use negative pressure wound therapy more often as wounds heal faster and there is less scarring.