Best Practices in Wound Care for Dermatology Nursing

Reviewed by Tara Call Triplett, RN, WCC, CHFN

Wound care is a necessary part of dermatology nursing, requiring a deep understanding of skin biology, wound healing processes, and the most effective treatments for certain types of wounds.

Whether dealing with chronic ulcers, surgical wounds, or traumatic injuries, a dermatology nurse is key in ensuring optimal healing and preventing complications. Let’s explore best practices for wound care in dermatology nursing, covering wound assessment, treatment modalities, patient education, and the importance of a multidisciplinary approach.

Understanding the basics of wound healing

To provide effective wound care, the first step is understanding the wound healing process. Wound healing occurs in the following four overlapping stages:

Hemostasis: Immediately after an injury, blood vessels constrict, and platelets aggregate to form a clot, stopping the bleeding.
Inflammation: This phase involves the recruitment of immune cells to the wound site, which helps to fight infection and clear debris. Redness, heat, and swelling characterize this stage.
Proliferation: During this phase, new tissue forms as fibroblasts produce collagen, and epithelial cells migrate across the wound surface. Granulation tissue fills the wound, and angiogenesis occurs to restore blood supply.
Remodeling: This final stage involves the maturation of the newly formed tissue, with collagen being reorganized to increase tensile strength. Scar tissue forms as the wound closes.

Understanding these phases can help a dermatology nurse tailor their wound care strategies to the specific stage of healing, optimizing outcomes for patients.

Wound assessment: The cornerstone of effective care

Accurate wound assessment is fundamental to wound care. It allows nurses to identify the wound type, assess the severity, and monitor progress over time. Steps of wound assessment include understanding the following factors:

Wound type: Identifying the wound type is crucial for selecting the appropriate treatment. Common types include pressure injuries, venous ulcers, arterial ulcers, diabetic foot ulcers, traumatic wounds, and surgical wounds.
Wound location and size: Measuring the wound's length, width, and depth provides baseline data to track healing progress. Nurses should document the wound's location and the presence of any areas of tunneling and/or undermining.
Wound bed appearance: The wound bed's condition offers insights into the wound's health. Nurses should assess for granulation tissue, slough, or eschar, as these indicate the health of the wound bed and the need for specific interventions.
Exudate: The amount, color, and consistency of wound exudate provide clues about the wound's status. For example, a high volume of purulent exudate may indicate infection, while a small amount of serous exudate is considered normal.
Odor: Unusual odors can signify infection or necrotic tissue, prompting further investigation and potential changes in treatment. Assess for wound odor after dressings have been disposed of and the wound cleansed.
Periwound skin: The condition of the skin surrounding the wound is also important. Maceration, erythema, or induration can signal issues such as excessive moisture, infection, or trauma from dressings.

By conducting a thorough and systematic wound assessment, a dermatology nurse can help develop a comprehensive care plan that addresses the wound's specific needs.

Evidence-based wound treatment strategies

Evidence-based wound care strategies are essential to achieving optimal outcomes. Treatment modalities should be tailored to the wound's characteristics and the patient's overall health status. Here are some key wound care interventions:

Cleansing: Proper wound cleansing is crucial to prevent infection and promote healing. Normal saline is the most common solution for wound cleansing due to its isotonic nature and ability to avoid further tissue damage. Other acceptable wound cleansers include surfactant wound washes and mild soap and water. For wounds with high bioburden, non-cytotoxic antimicrobial cleansers and acetic acid can be helpful.

Debridement: Removing dead or non-viable tissue is essential to promote healing. Various debridement methods include:

Autolytic debridement: This method uses the body's enzymes and moisture to break down necrotic tissue, often facilitated by moisture-retentive dressings like hydrogels or hydrocolloids.
Enzymatic debridement: Proteolytic enzymes are applied to the wound to dissolve dead tissue selectively. This method is useful for patients who cannot tolerate surgical debridement.
Surgical debridement: This involves the physical removal of necrotic tissue by a medical professional. It is often necessary for extensive wounds or those with significant necrosis.
Mechanical debridement: Uses physical methods such as wet-to-dry dressings or irrigation to remove dead tissue. While effective, it can be painful and may damage healthy tissue.

Moisture balance: Maintaining an optimal moisture level in the wound bed is critical. Too much moisture can lead to maceration, while too little can cause desiccation and impede healing. Modern wound dressings, such as hydrogels, foams, and alginates, help manage moisture effectively.

Infection control: Infection prevention and control are paramount in wound care. Signs of infection include increased pain, redness, warmth, swelling, and purulent exudate. Topical antibiotics, such as silver-based dressings, may be used for localized infections, while systemic antibiotics are necessary for infections that are more severe.

Dressings: Choosing the right dressing is vital to protect the wound, manage exudate, and promote healing. The selection depends on the wound type, exudate level, and the presence of infection. Common dressing types include:

Hydrogels: Provide moisture to dry wounds and are useful for autolytic debridement.
Foams: Absorb moderate to heavy exudate while maintaining a moist environment.
Alginates: Highly absorbent dressings made from seaweed, ideal for wounds with heavy exudate.
Hydrocolloids: Create a gel-like substance when in contact with wound exudate, helping to maintain moisture and protect against infection.

Advanced therapies: In some cases, advanced therapies may be necessary to promote healing, including:

Negative pressure wound therapy (NPWT): This treatment uses a vacuum system to remove exudate, reduce edema, and promote granulation tissue formation. It is particularly effective for large or complex wounds.
Growth factors and bioengineered skin substitutes: These products can be applied to chronic wounds that are not responding to conventional therapies, helping to stimulate tissue growth and accelerate healing.

Pain management: Wound-related pain can significantly impact a patient's overall quality of life and impede healing. Nurses should assess pain levels regularly and provide appropriate analgesia, whether through systemic medications or topical agents like lidocaine.

Patient education and empowerment

Patient education is necessary for successful wound treatment and management in dermatology nursing. Empowering patients with knowledge about their condition and treatment fosters adherence to the care plan and improves outcomes. Here are some factors of patient education to consider:

Wound care at home: Patients should be taught how to care for their wounds at home, including how to cleanse the wound, apply dressings, and recognize signs of infection. Providing written instructions and demonstrating techniques can enhance understanding.

Nutrition and hydration: Proper nutrition is vital for wound healing, as protein, vitamins, and minerals play essential roles in tissue repair. Nurses should educate patients about the importance of a balanced diet rich in protein, vitamins A and C, zinc, and adequate hydration to support healing.

Managing comorbidities: Many patients with chronic wounds have underlying conditions such as diabetes, venous insufficiency, or peripheral artery disease. Educating patients about managing these conditions, including blood sugar control or wearing compression stockings, can prevent wound recurrence and promote healing.

Lifestyle modifications: Encouraging patients to practice healthy lifestyle habits, such as smoking cessation, physical activity, and proper skin care, can significantly improve wound healing and overall health.

Follow-up care: Patients should understand the importance of consistent follow-up appointments to assess wound progress and tailor treatments as needed. Nurses should also provide information on when to seek medical attention if complications arise, such as increased pain, redness, or fever.

The role of a multidisciplinary approach

Wound care is often complex and requires collaboration among various healthcare professionals. A multidisciplinary approach ensures comprehensive care and addresses all aspects of wound management. Some members of the multidisciplinary team in wound care include:

Dermatologists: Specialists in skin health who can provide expert guidance on wound etiology, treatment options, and advanced therapies.
Wound care nurses and other specialists: Nurses or physicians with specialized training in wound care who can offer expertise in assessment, debridement, and treatment planning.
Nutritionists or dietitians: Experts who can assess a patient’s nutritional status and develop a plan to optimize their diet for wound healing.
Physical therapists: Assist with mobility issues, particularly in patients with pressure ulcers or diabetic foot ulcers, by recommending appropriate exercises and positioning strategies.
Social workers: Help address psychosocial issues, such as access to care, financial concerns, or support systems, which can impact a patient’s ability to adhere to the wound care plan.
Infectious disease specialists: Provide guidance on managing complex infections, particularly in cases of antibiotic-resistant bacteria or chronic wounds with biofilm formation.
Surgeons: In cases requiring surgical intervention, such as skin grafts, flap procedures, or extensive debridement, surgeons play a critical role in wound management.

Staying updated with wound care advancements

The field of wound care is constantly changing, with new research, innovations, and wound care products emerging regularly. A dermatology nurse must stay informed about the latest advancements to provide the best possible care.

Participating in wound care courses, workshops, and conferences allows these nurses to learn about the latest evidence-based practices and emerging treatments. In addition, joining organizations such as the Wound, Ostomy and Continence Nurses Society (WOCN) or the American Professional Wound Care Association (APWCA) provides access to resources, networking opportunities, and the latest research in wound care.

Reading wound care journals and staying current with research publications can also help a dermatology nurse incorporate the latest evidence into their practice. But in the end, engaging in discussions with colleagues, sharing experiences, and seeking advice from wound care specialists is what truly fosters a culture of continuous learning and improvement.