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Photograph by Vicki Thompson

Healing Hand: Elizabeth Gillick, 92, began coming to the Wound Care Clinic at O'Conner Hospital two years ago for a foot injury that would not heal. Dr. Peter J. Schubart checks Gillick for obstructed blood vessels at the clinic's new facility across from O'Connor Hospital.

Expanded wound clinic among few to heal sores

By Mary Gottschalk

The word "wound" conjures up images of flesh torn by bullets, knives, bayonets or swords.

Although painful, these wounds usually heal relatively quickly and easily.

It is the wounds that don't heal that bring patients to the Wound Care Clinic at O'Connor Hospital, which recently moved into a new 13,000-square-foot facility.

These are wounds caused or aggravated by such medical conditions as diabetes, poor blood circulation, varicose veins, hypertension, heart disease or kidney failure. Contributing factors can include smoking, surgery, infections, and being bedridden or in a wheelchair.

A pressure sore is a typical wound seen at the clinic, caused when a person stays in one position for too long because they are bedridden or in a wheelchair. The pressure on the skin reduces the blood supply to that area and can cause tissue to die. The skin reddens and forms a blister, then an open sore follows.

Another typical wound is a diabetic foot ulcer. A shoe may rub a sore on a toe, which a diabetic may not immediately be aware of due to poor blood circulation and loss of sensation. The body's processes that fight infections are often slower in responding when a person has diabetes.

It was pressure sores that first sent Linda Walker to O'Connor's clinic a decade ago.

"I had sores on my heels, and I went to a doctor in Cupertino and they told me to go to Dr. Bruce Lerman, who was part of the Wound Care Clinic," recalls Walker, a 66-year-old Cupertino resident.

"I've had 31 sores so far, and they've helped me with every one," she says.

Currently Walker says she visits the clinic, directly across from O'Connor Hospital in the new Forest Medical Arts Building, once a week.

"I have several wounds on my feet. When they get better, I'll not go until the next one," Walker says.

Elizabeth Gillick, a 92-year-old former Rose Garden resident now living in Saratoga, started going to the clinic two years ago.

"About two years ago, I bumped my foot, and it was injured and wouldn't heal," she says.

"They took all kinds of tests and decided the circulation into the foot was poor, so they did an angioplasty to increase the blood supply.

"It never did quite heal, but they're very good about checking it and doing what has to be done. The toe is much better, and they're keeping a close watch on it."

Helping people such as Gillick and Walker to heal or keep their wounds from worsening is the focus of the Wound Care Center.

As a vascular surgeon, Dr. Peter Schubart, medical director of the clinic and one of the founders, says he would "spend a lot of time doing limb salvage in people with diabetes. People would come in with their toes turning black or holes in their feet or infections. These occur because they don't have enough blood supply.

"We'd fix the blood supply, but we had the issue of getting them healed up. It's exceedingly hard to do in an office. It's very inefficient."

Inspired by a wound care clinic set up by Dr. John Crew, also a vascular surgeon, at Seton Medical Center in Daly City, Schubart suggested starting one at O'Connor.

It is now, he says, the largest wound care clinic in Northern California.

"It took two years to set it up and get it open in February of 1992. We had one patient that first day, and it took us all day to take care of him. We've been growing ever since," he says.

In their new facility, the clinic has 20 exam rooms and a staff of 30, including 13 physicians and an equal number of nurses, deals with 8,000 patient visits annually, says Schubart.

Most other clinics, Schubart says, "have three or four rooms and are open just a few days a week. We're pretty much open full time.

"The hallmark of our clinic is that we're physician-run. There are a lot of storefront clinics with physical therapists or nurses that do dressing changes, but we're really a full-service outfit.

"We're multi-disciplinary. We have physicians with many specialties and we leverage their expertise. We're very collaborative, so from the get-go we're all working together as a team. The physicians are very free in getting opinions from other physicians and other specialists, and we rely heavily on the expertise of the nurses."

Additionally, Schubart says, "If a patient comes to us with a problem, we don't send them all over town. We bring everything to the clinic so if they need different kinds of physicians, we arrange it at the clinic. If they need cultures taken or blood drawn, we try and do everything in the clinic.

"We collaborate with a patient's primary care physician and we look at all issues, including transportation, how they get their dressings changed and any social or family issues involved."

The new clinic includes special Maxi Sky ceiling lifts for heavy patients, allowing nurses to safely maneuver patients weighing as much as 600 pounds into chairs, beds or onto scales without any manual lifting.

Photographs of serene scenery decorate the walls and everything is sparkling clean, as it must be to cure infections.

There is no single average length of treatment, although Schubart says, "our goal is to get things healed in eight to 12 weeks. Some are easy and healed in three weeks and some things take years.

"We've had wounds that have been present for 30 years. The patient has seen 50 doctors, and we'll take care of them.

"The typical person has had a wound for months, and many times it's for years.

"They are everybody's worst nightmare, and that's why we're set up to take care of difficult wounds that haven't healed."

Schubart says he and his staff are particularly focused on "limb salvage."

He says he's seen diabetic patients with kidney failure and gangrene in their foot who have been told their foot must be amputated.

"We can salvage their foot 95 percent of the time," he says.

When treating a new patient, Schubart says, "We figure out what's causing the wound. We can't always find out, but most of the time we can, and we can address the underlying problem.

"We do biopsies because a sore can be a skin cancer.

"If it's infection, we treat the infection. We have infectious disease specialists."

One tool that Schubart says has been helpful in treating wounds is Apilgraf, a skin-like product manufactured by Organogenesis Inc., which allows living cells to heal wounds faster.

Schubart says the clinic has been involved in medical trials of Apilgraf, which gained FDA approval in 1998, to treat pressure ulcers.

While Schubart and his colleagues use every tool and technique they can to heal wounds, Walker says what has helped her most is something that no company manufactures.

"For some reason, the love and care they give me seems to help," she says.

The O'Connor Hospital Wound Care Clinic is at 125 Ciro Ave., Suite 201, across from the hospital. For additional information, call 408.947.2804.