Consider Skin Hygiene and Care Beyond the Wound

Abstract

The wound care provider is often faced with challenges that extend beyond wound treatment. In any chronic wound treatment scenario, often dressing choice and wound bed preparation are the focus. Habitually, blinders are donned with disregard to the surrounding skin structures. It is important to consider all factors contiguous with the healing of a wound, as well as being cognizant of the patient’s surrounding skin integrity. Care of the periwound skin is mandated in successful treatment of any patient with a chronic wound. Regardless of the cause of wounds and potential secondary skin breakdown, diabetes, poor circulation, or other immunologic compromising states, treatment must always include an extensive evaluation of the patient’s general health. Placing the wound and skin condition in relation to the patient’s overall health helps the clinician to determine the best course toward reaching the ultimate goal of cure, closure, and or palliation. Early intervention reinforces the identification of the risk factors for developing ulcers and skin complications. Noting abnormal skin conditions immediately will hasten one’s success. Many of the physiological changes that occur in the creation of the chronic wound cascade are well known. As if our dressings, application and securing methods, wraps, offloading devices, stockings, and other means by which a wound is cared for were not enough to create potential risk for surrounding skin irritation, many pathologies coexist, adding to the potential for an at-risk environment. Patients with venous insufficiency or lymphedema, for example,