My Wound Healing Fellowship

by Stephan Barrientos, MD

I am truly honored to have served as the senior research fellow in the Winthrop Wound Center’s Mentoring Program. My experience was both educational and rewarding. During medical school, I had the opportunity to work with one of Dr. Harold Brem’s research associates, Dr. Marjana Tomic-Canic, doing mostly bench research. At that time, my focus was on understanding the pathophysiology of chronic wounds. When I had the opportunity to do a year of research during my general surgery residency program, I decided that the Winthrop Wound Care Mentoring Program offered an outstanding opportunity for me to bridge the translational research gap, enabling me to bring the insights of my previous bench research to the bedside of actual wound patients.

As a third-year general surgery resident, I saw firsthand the devastation that chronic wounds can inflict on patients. In my experience, wounds fail to heal mainly because of failures in the health care system. In particular, with chronic wound patients there is all too often a failure of standardized care, a lack of continuity of care, disagreement over the critical-to-quality factors that result in wounds failing to heal, a lack of knowledge of current treatment modalities, and poor documentation of many wound cases.

Solving these problems became the goal for my fellowship year. My primary research focus during that year was the development, validation and implementation of a clinical decision support tool for the Winthrop-University Hospital wound service. This informatics tool is an online system that provides clinical decision support to the wound care clinician. It recognizes over 100 parameters pertinent to wound healing, and sends out email and automated alerts to the clinicians when abnormal values are indicated. It then provides clinical treatment recommendations for the clinician to select from, based on published treatment protocols. The tool also provides educational support for patients through an interactive website and patient automated alerts designed to facilitate self-management goals. As the only clinical decision support tool developed to date for the treatment of chronic wounds, this system brings wound documentation to a new level. During my fellowship year we also worked on developing a randomized clinical trial to demonstrate our informatics tool’s effectiveness at improving healing success in pressure ulcers and diabetic foot ulcers.

As part of my fellowship, I also conducted other innovative research projects, including the use of fat-derived stem cells for the management of chronic wounds, the use of polymer technology delivery systems for growth factor administration, developing and updating treatment protocols for the management of diabetic foot ulcers and pressure ulcers, and exploring health care disparities in patients with chronic wounds.

While the Winthrop mentoring program is rigorous, the rewards are many. I was an author on over ten papers during my fellowship year, all of which went through the publication process and were submitted to the American College of Surgeons Surgical Forum. I also wrote a grant proposal dealing with our clinical decision support tool, gave lectures to such giants in the field of wound healing as Dr. Andrew Boulton, and acted as a research liaison between Winthrop and the University of Pennsylvania, Columbia University, and Mount Sinai—all institutions that are collaborating on our current research. As a senior fellow, I also had the privilege of teaching and overseeing the other fellows, residents and medical students in the Winthrop wound healing program.

Any general surgery resident who is able to devote time to research should seriously consider this opportunity. Wound healing and the management of chronic wounds is pertinent to all surgical subspecialties. Whether or not your future goal is to develop your own research program, the knowledge you will gain from this experience will be invaluable. In addition to generating publications and giving forum presentations, you will also hone your skills as a leader and develop lifelong relationships for the future. But perhaps the most rewarding feature of this program is that you will be providing the very best wound care for your patients.

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