Why Physiatry Matters in Wound Care: A Comprehensive, Medical Approach to Healing

By Dr. Juliet Gaisey, MD

Board-Certified Physical Medicine & Rehabilitation

Chronic and non-healing wounds – such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, and complex post-surgical wounds – are rarely caused by skin breakdown alone. They are most often the result of mobility impairment, pressure exposure, neurologic deficits, vascular disease, pain, and chronic medical conditions.

This article is written for home health agencies, skilled nursing facilities, assisted living communities, and referring providers seeking a more effective, medically integrated approach to wound care.

At Michigan Rehab Consultant, PC, wound care is led by a physiatrist (Physical Medicine & Rehabilitation physician) – a specialty uniquely trained to manage the medical and functional factors that determine whether a wound heals or recurs.

What Is a Physiatrist and Why Does It Matter for Wounds?

A physiatrist is a medical doctor specializing in function, mobility, pain, and recovery. In wound care, this perspective is critical.

Traditional wound care models often focus primarily on topical treatment and dressing selection. While essential, these interventions alone may fail if the underlying contributors to tissue breakdown are not addressed.

Physiatry-led wound care integrates:

• Medical management

• Mobility and functional assessment

• Pressure redistribution

• Pain control

• Coordination with nursing and therapy services

  
  

This whole-person approach aligns with evidence-based, multidisciplinary wound care principles and is associated with improved healing and fewer complications.

What Improves When a Physiatrist Leads Wound Care?

When physiatry is involved, wound care shifts from reactive treatment to proactive medical management. Benefits include:

• Improved wound healing through correction of pressure, positioning, and mobility factors

• Reduced recurrence of pressure injuries and ulcers

• Better pain control without compromising mobility or healing

• Lower risk of infection and hospitalization

• Preservation of function and independence during recovery

  
  

For facilities and home health agencies, this translates to better outcomes, safer care, and stronger interdisciplinary coordination.

How Physiatrists Address the Root Causes of Non-Healing Wounds

1. Pressure, Positioning, and Mobility Optimization

Physiatrists assess:

• Bed mobility and repositioning ability

• Wheelchair fit and seating systems

• Gait abnormalities and weight-bearing patterns

• Transfer techniques and caregiver support needs

  
  

Correcting pressure exposure is often the single most important factor in wound healing and prevention.

2. Medical Optimization for Healing

Wound healing depends heavily on systemic health. Physiatry-led wound care includes active management of:

• Diabetes and glycemic control

• Peripheral vascular disease

• Neuropathy and sensory loss

• Chronic kidney disease

• Anemia and nutritional deficits

• Pain that limits movement or repositioning

• Infection risk and inflammatory burden

  
  

Addressing these conditions is essential, particularly in medically complex or homebound patients.

3. Skilled Wound Assessment and Debridement

Physiatrists trained in wound care provide:

• Sharp and non-sharp debridement when indicated

• Ongoing wound measurement and documentation

• Tissue viability assessment

• Monitoring for infection or osteomyelitis

• Adjustment of treatment plans based on healing response

  
  

Consistent physician-level oversight improves safety, accuracy, and continuity of care.

4. Coordination With Home Health and Facility Teams

Effective wound care requires collaboration. Physiatrists coordinate closely with:

• Skilled nursing and home health agencies

• Physical and occupational therapy

• DME providers (offloading devices, specialty mattresses, seating systems)

• Primary care and specialty providers as needed

  
  

This reduces fragmentation and ensures consistent care across settings.

5. Healing the Wound While Preserving Function

Unlike wound-only care models, physiatry emphasizes:

• Maintaining mobility whenever safely possible

• Preventing deconditioning and functional decline

• Reducing fall risk

• Supporting independence and quality of life

  
  

Healing the wound should never come at the cost of losing function.

When to Refer to Physiatry-Led Wound Care

Refer when any of the following are present:

• Minimal wound improvement after 2-4 weeks

• Recurrent pressure injuries or ulcers

• Non-ambulatory or mobility-limited patients

• Pain or positioning limiting adherence to care plans

• Multiple chronic medical conditions affecting healing

• Homebound patients unable to attend outpatient wound clinics

• Concern for infection, decline, or frequent hospitalization

  
  

Early physiatry involvement can prevent prolonged wound courses and repeated complications.

Physiatry-Based Wound Care at Michigan Rehab Consultant, PC

Michigan Rehab Consultant, PC provides physician-led wound care with a rehabilitation-focused approach, particularly for patients who are medically complex or mobility-limited.

Our model emphasizes:

• Comprehensive medical oversight

• Functional and pressure-related risk reduction

• Skilled wound management

• Close coordination with home health and facility teams

• Care delivered directly in the home or facility when appropriate

Next Steps

To discuss whether physiatry-led wound care is appropriate for your patient or facility, contact Michigan Rehab Consultant, PC to arrange a consultation or referral review.

Home health agencies and facilities are welcome to request coordinated care support for complex or non-healing wounds.