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As a third-year medical student, I was assigned to a rotation on the vascular surgery service at Cook County Hospital in Chicago. I was not yet committed to family medicine as a career, and I started the rotation with an open mind about the field. As it turned out, it was not for me. I found the surgeries were not only endless but boring and repetitive. All blood vessels essentially looked alike from my end of the retractor, and I did not have the temperament to carefully tease out and ligate each little perforator.

Although I was not destined to be a vascular surgeon, vascular rounds were fascinating. We spent hours wrapping and unwrapping wounds, finding arterial pulses with Doppler ultrasonography, and measuring ankle-brachial indices. I mastered the ins and outs of wet-to-dry dressings, Dakin solution, and petrolatum gauze dressing (Xeroform), which were the three dressings that were available. The residents taught me to debride dead tissue, and they showed me the difference between erythematous infected tissue and beefy but healthy granulation tissue as well as the difference between necrotic slough and pus. I learned to incise, drain, pack, and dress. By the end of the rotation, I recognized wet and dry gangrene as soon as the dressings were off.

I picked up unexpected skills too. One of the vascular surgeons introduced himself and handed out business cards to every patient. “Patients have a right to know their surgeon’s name,” he told the residents, day after day. He was right, long before whiteboards and photographs of care team members became commonplace. I still hand out my business cards, with the family medicine residents’ names written on the back.

Other lessons from that long-ago rotation have not proven to be quite as enduring. As this edition of FP Essentials shows us, use of wet-to-dry dressings is no longer recommended. We have better options for antimicrobial dressings than Dakin solution, although Xeroform and other petrolatum-based dressings can still be found.

The care of patients with skin ulcers is complex but common enough that it is well within the scope of practice for many family physicians. This edition provides an understanding of how to approach patients with ulcers and other wounds. In Section One, the prevention and diagnosis of pressure, venous leg, and arterial ulcers are discussed. Section Two addresses wound management; Section Three discusses pharmacotherapy. In Section Four, surgical management of pressure, venous leg, and arterial ulcers and critical limb ischemia is reviewed.

As a medical student, my first exposure to wound care came from family physicians. One of my earliest clinical experiences was with a family physician who provided wound care at a student-run free clinic. The first Unna boot I applied was in a family medicine office. Many teachers and many experiences build family physicians, and our education continues long after we graduate from medical school. I hope this edition of FP Essentials helps you stay updated and helps you care for your patients.

Kate Rowland, MD, FAAFP, Associate Medical Editor
Associate Professor, Department of Family Medicine
Rush University, Chicago, Illinois

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