"When I grow up, I want to be a wound care specialist."

That's not something you hear kids going around saying. Sure, kids want to be doctors or nurses. But wound care specialist? When you think about it, being a wound specialist is not a glamorous position, unlike being a neurosurgeon. The best quote that I ever heard from a colleague of mine was, "No one wants to do wound care; wound care isn't sexy." This may be true, but what is wound care then? To me it is ever changing, it is learning new things (most of which are not found in text books), and it is about helping patients heal both emotionally and physically from a chronic condition. Thinking about this concept is what led me to this topic of "Six Things Your Mother Never Told You about Wound Care" because there are many fascinating things that not everyone may know.

Six Things Your Mother Never Told You About Wound Care

1. Some wounds never heal. The World Health Organization (WHO) defines palliative care as an approach to improve the quality of life of patients and their families who are facing life-threatening illness.¹ How does this apply to wound care? Palliative wound care includes such things as controlling the wound environment, which can ultimately affect the quality of life. For example, fungating tumors can be quite pungent. Treating them with Dakin's or acetic acid soaks and topical 0.75% metronidazole gel can control the odor, ultimate improving the patient's quality of life.²

2. Nutrition plays a vital role in healing wounds. There is an old saying "you are what you eat." Well what if what you aren't eating is actually affecting your healing capabilities more? According to the Wound Healing Index (WHI), a tool for predicting wound healing, malnutrition was a statistically significant factor in healing all types of wounds.³ Many of our patients are nutritionally compromised, lacking in vitamin D, protein, zinc—the list goes on and on. Lesson: if you have a patient who has a wound that you are doing everything for, run a few labs. Start supplementing them with a multivitamin, vitamin D, and protein (depending on their kidney function). Also referring a patient with a chronic wound to a dietitian is a great idea.

3. It is OK to wash a wound with soap and water. "I can't get my wound wet," "I bought this fancy wound cleanser at the store," and "I have not taken a true shower in three months." I often hear patients say these phrases. There is this misconceived notion that you cannot wash a wound or get it wet with water. Studies have been performed that showed no difference in the infection rate of wounds irrigated with tap water or saline solution, making it a safe and cost-effective method to clean wounds.⁴ I often tell patients that if you do not have well water it is important to wash the entire area around the wound to help prevent the overgrowth of bacteria and normal flora that are found on your skin.

4. No fancy dressing can compensate for an untreated pathological condition. One would think this is pretty self-explanatory. However, time after time I see this aspect being over looked. Many times as specialists, we get fixated on the wound only and do not look at the overall patient. Patients with a hemoglobin A1C of 12 or an ABI of 0.6 are never going to heal their wounds, regardless of how fancy, expensive, or amazing the topical treatment is.

5. Sometimes you actually have to be a detective. Being a detective is my favorite part of this profession. You have to take a complete history and physical from the patient. For example, I had a patient once who was placing a vasoconstricting gel for her arthritis on her skin and then proceeded to use an aerosol menthol muscle relaxer to the same area, holding it in the same place and spraying for an extended period of time, which caused her frostbite. She had been to three other providers before seeing me. As a detective, you also need to realize if a wound is not healing on the normal trajectory, especially if it is a chronic wound, to do a biopsy. Marjolin, or squamous cell carcinoma, can arise from chronic wounds or old scars. One theory is that squamous cell cancer thrives on area of inflammation, and chronic wounds are often stuck in a chronic inflammatory state.⁵

6. The reaction you get when you tell someone you are a wound specialist. "You are a what? What is that, even?" I am asked this a lot when I tell people what I do for a living. Once I start explaining it to them, they generally have this look of disbelief on their face. I usually lead with "Well, if you do not have a chronic wound or a surgical complication, then you probably do not know my specialty exists." However, when you do need someone who has extensive advanced training in the treatment of wounds... you will be glad we do what we do.

Conclusion

In conclusion, wound care may not be the most recognized or glamorous specialty, but there are some pretty cool aspects about it. So, the next time someone asks you what you do for a living, say proudly "I help patients with wounds. Wounds that they may have had for years."

References

1. World Health Organization. National cancer control programmes: polices and managerial guidelines. Geneva, Switzerland: World Health Organization;2002.

2. Watanabe K, Shimo A, Tsugawa K, Tokuda Y, Yamauchi H, Miyai E, Takemura K, Ikoma A, Nakamura S. Safe and effective deodorization of malodorous fungating tumors using topical metronidazole 0.75% gel (GK567): a multicenter, open-label, phase III study. Support Cancer Care. 2016. 24:2583-2590.

3. Fife C. "People are starving- in your waiting room." Caroline Fife MD Blog. October 2018. https://carolinefifemd.com/2018/10/03/people-are-starving-in-your-waiti…

4. Sardina D. "Is your wound cleaning practice up to date?" Wound Care Advisor. 2018. https://woundcareadvisor.com/is-your-wound-cleansing-practice-up-to-dat…

5. Pekarek B, Buck S, Osher L. A comprehensive review on marjolin's ulcers: diagnosis and treatment. Journal of American College of Certified Wound Specialists. 2011. 3(3):60-64

6. Skin Cancer Foundation. Squamous cell carcinoma- causes and risk factors. 2018. https://www.skincancer.org/skin-cancer-information/squamous-cell-carcin…

About the Author

Emily Greenstein, APRN, CNP, CWON, FACCWS is a Certified Nurse Practitioner at Sanford Health in Fargo, ND. She received her BSN from Jamestown College and her MSN from Maryville University. She is certified as an Adult-Gerontology Nurse Practitioner through the American Academy of Nurse Practitioners. She has been certified in wound and ostomy care through the WOCNCB for the past 8 years. At Sanford she oversees the outpatient wound care program, serves as chair for the SVAT committee and is involved in many different research projects. She is an active member of the AAWC and currently serves as co-chair for the Research Task Force and Membership Committee. She is also a working member of the AAWC International Consolidated Diabetic Ulcer Guidelines Task Force. She has been involved with other wound organizations and currently serves as the Professional Practice Chair for the North Central Region Wound, Ostomy, and Continence Society. Emily has served as an expert reviewer for the WOCN Society and the Journal for WOCN. Her main career focus is on the advancement of wound care through evidence-based research.