The American College of Wound Healing and Tissue Repair (ACWHTR) is a 501(c)(3) nonprofit organization based in Chicago, Illinois committed to advancing the field of wound care through education, research, and advocacy. The College fosters the training of medical professionals through the sharing of a physician-based, clinical fellowship curriculum developed in conjunction with the University of Illinois Hospital and Health Sciences System and allied healthcare colleges and programs. The ultimate goal of the organization is to designate wound care as a board-certified medical specialty.
"To improve public health by leading the growth of a new integrated field of medicine and surgery dedicated to the practice of modern wound healing and tissue repair."
"All patients with wounds, regardless of etiology or duration, will have access to the appropriate evidence-based care and treatment to optimize their outcomes across all clinical sites of care."
The incidence of non-healing cutaneous wounds is 5 to 7 million per year in the United States. It is estimated that this clinical volume results in over a 20 billion dollar cost to the healthcare system. Wound healing is a complex process that involves a coordinated integration of numerous clinical and biochemical pathways. The replacement of injured or damaged tissue can be compromised by multiple factors including but not limited to: obesity, diabetes, smoking, vascular disease, infection, renal failure, cancer, and malnutrition. A classic example of a non-healing wound is a diabetic foot ulceration. With decreased sensation and frequently concomitantperipheral vascular disease, chronic ulcers can easily form in this ever growing population. With an estimated 366 million diabetic patients by 2030, we can expect an increasing number of patients with chronic non-healing wounds in the future. With an aging society, it is also expected that there will be an increase in the number of surgical wounds, venous leg ulcerations, and traumatic wounds that will be at risk for non-healing. Further complicating the situation is the lack of formal education for physicians, nurses, therapists, and all ancillary health care providers on the science and treatment of non-healing wounds. A paper by Patel and Granick in the Annals of Plastic Surgery in 2007 reported that a total of only 9.2 hours of formal didactic training related to wound healing was found in the average four year medical school curriculum.
These factors all support the need to establish a formal wound care specialty. Although wound care has been practiced for hundreds of years, it has only been during the past 45 years that the age of modern wound care has flourished. British researcher George D. Winter's 1962 seminal paper in Nature on moist healing catalyzed a radical shift from the passive gauze therapy that was promoted at the time. However, the fear of promoting wound infections through the use of occlusive dressings delayed the emergence of commercially available wound products (dressings) until the late 1970s. Hydrocolloid dressings were released in 1982, and nurses became early adopters of the treatment. Physical therapists (PTs) provided a slightly different approach to wound healing through the use of energy-based modalities such as ultrasound, electrical stimulation, ultraviolet light, compression therapy, and manual lymphedema treatments. Virtually all wound care products and technologies lacked substantive evidence of efficacy from well-designed, carefully conducted randomized clinical trials, with many products developed under 510K regulatory status that allowed marketing without rigorous evidence or clinical trials. The first recombinant growth factor (Becaplermin) for chronic wounds along with bioengineered tissues (Apligraf, Dermagraft) brought biotechnology to the field of wound care and stimulated physician interest in the field. Modern wound care centers were established and provided a disease focused, central location for the diagnosis and management of complex wound care patients.
As the field of wound care matures, there is a critical need for rigorous training, research, evidence development, and advocacy to improve outcomes of patients with non-healing wounds. As mentioned, presently physicians receive only limited formal education concerning the diagnosis and treatment of wounds in either their pre or post graduate medical education. Many physicians, depending on residency training, will not receive any further information about wound care throughout their career. When a wound care center opens in a hospital, members of the existing medical staff are invited to participate and often receive less than one week of didactic training before working in the center. While this training is a considerable improvement in the current conditions, it is still considerably less rigorous than participating in a formal residency and fellowship-based medical education. The path to specialization will need to not only provide for formal fellowship training at the graduate medical education level of accredited university centers but will also need to address the needs of those physicians currently practicing in the field who could benefit from the didactic content and are mid-career and cannot take a year off to pursue formal training. In addition, education for patients must not be underestimated or left off the agenda. Not only are patient-centered outcomes finally achieving their place in guideline development, but the voice of the patient at all levels of the education, research, and advocacy process must be incorporated.
In 2004, the first physician-based, clinical fellowship in the United States was started at Advocate Christ Hospital, a teaching hospital affiliated with the University of Illinois at Chicago. This 700-bed, level one trauma center provided both an inpatient and outpatient setting for wound care focused, medical education delivered through direct patient experience. The program was self-funded, the faculty unpaid, and although there was a formal didactic content, clinical rotations were inconsistent and a more formal infrastructure was needed. As a result of this initial program, the graduating fellow was hired by the program director and subsequently a more structured curriculum was developed. The program matured and the curriculum was continuously refined over the next several years; however, no additional fellows were enrolled in the program for several years. The initial fellow along with the program director were brought to the University of Illinois in 2008 to formally begin the program within the graduate medical education structure of the nation's largest university medical school, namely, the University of Illinois at Chicago.
A group of key opinion leaders in wound healing from both clinical, research, and industry met in December 2009 to discuss the creation of a wound care specialty. Participants at that meeting included: William J. Ennis, DO, MBA; William Li, MD, The Angiogenesis Foundation; Dale Lupu, PhD, American Association Hospice and Palliative Medicine; Robert Kirsner, MD, PhD, University of Miami; Jeff Davidson, PhD, Vanderbilt University; Vickie Driver, DPM, MS, Boston University; Kelman Cohen, MD, Co-Founder Wound Healing Society; and William Marston, MD, University of North Carolina.
There was agreement that a specialty was needed and several overall guiding principles emerged. The new organization should serve as the credible physician voice for wound healing and tissue repair. The primary objective of the organization is to create a medical subspecialty in wound healing and tissue repair through creating fellowship programs, examinations, and certification processes. The college will use the guidelines as listed by the American Board of Medical Specialties (ABMS) to maximize acceptance and credibility. Through achieving this goal the college will also 1) generate awareness of the problem of non-healing wounds and help foster research and advance the development of new technologies, 2) promote access to effective and appropriate therapies for all patients, and 3) assist in the development of health policy as it relates to the field. These goals and objectives will be reached through the creation of an annual meeting, membership for physicians, educational offerings, journals, involvement in health policy development, and the creation of multiple university-based wound care fellowship programs.
The University of Illinois Hospital and Health Sciences System became the first academic sponsor for the fellowship concept and created a section of Wound Healing and Tissue Repair within the division of Vascular Surgery in January 2008. Dr. William Ennis was appointed as Chief of the Section. The first fellow was accepted in July 2008. Malgorzata Plummer, MD, completed the program on August 1, 2009, and is now an Assistant Professor of Clinical Surgery at the University of Illinois Hospital and Health Sciences System. A second fellow, Igor Altman, DO, MBA, has graduated and is also now on faculty at the University of Illinois Hospital and Health Sciences System as an Assistant Professor of Clinical Surgery. The third fellow, Dr. Devn Frandsen, DO, will be finishing in 2014. The program is a 12 month rotating program and allows the fellow to participate in the care of patients with non-healing wounds of any etiology, anatomical location, or site of care across the continuum of care. Hospital-based wound clinics, inpatient rounding and consultation, research, and sub-acute wound care are all included in the educational program for the wound care fellow.
The first annual meeting for the American College of Wound Healing and Tissue Repair was held at the University of Illinois at Chicago on August 4-6, 2011 at the UIC Forum. Over 400 attendees participated in this inaugural meeting which was well received by clinicians, researchers, and industry participants. A fellowship planning group included attendees from University of Illinois, University of North Carolina, Georgetown University, Boston University, University of Pittsburgh, Hackensack University, U.S. Army, Baylor College of Medicine, Washington University, Harvard University, and Bispebjerg University Hospital (Denmark).
The second annual meeting took place in Chicago on July 26-28, 2012 at the Swissotel Chicago with over 350 attendees. The college also hosted a Fellowship Curriculum meeting and a Patient Centered Outcomes in Wound Healing Summit where a multidisciplinary group of clinicians, patients, and researchers met to discuss how to better align and incorporate patient's goals into wound care. The White Paper that was generated from this meeting is available for download on this website. The third annual meeting was at the Fairmont in Chicago on December 6-7, 2013. The winter setting was a big success and the 4th meeting will be held at the Hilton Chicago on December 4-6, 2014. This year, a pre-conference on stem cells and regenerative medicine will kick off the meeting. This exciting new program is sponsored by the University of Illinois Stem Cell and Regenerative Medicine Program headed by one of our board members, Dr. Amelia Bartholomew, MD, Professor of Surgery at UIC.