United Wound Healing

10/28/2025

💎 Pamela Pearls: Wound Hygiene – Step 2
Debride Early, Often, and with Purpose

✨ Integral Debridement is the 2024 advancement in wound care — blending complementary methods for safer, faster, and more complete healing.

🩺 Debridement isn’t a one-time event — it’s an ongoing therapy that drives healing forward.

🔬 Learn how Active, Maintenance, and Biofilm-Targeted debridement work together to keep wounds progressing.

10/27/2025

🔬 Integral Debridement — A 2024 Advancement

✨ The new consensus introduces Integral Debridement — the intentional combination of complementary methods on the same wound to achieve optimal healing.

💧 For example:
   •   Autolytic or osmotic methods may soften devitalized tissue before sharp or mechanical debridement.
   •   Surfactant cleansing or HOCl irrigation can amplify the removal of residual biofilm.

💡 This patient-centered, step-up/step-down strategy tailors technique selection to wound characteristics, clinician skill, and setting—promoting safer, more effective, and continuous wound bed preparation.

⸻

📚 Key Concepts
   •   🔁 Debridement is an ongoing therapy—not a one-time event.
   •   🧠 The 2024 International Debridement Consensus outlines three core purposes:
1️⃣ Active (Initial) Debridement: Removes necrotic or infected tissue to convert a chronic wound into an acute healing state.
2️⃣ Maintenance Debridement: Repetitive removal of slough and biofilm to sustain healing opportunities.
3️⃣ Biofilm-Targeted Debridement: Combines mechanical/sharp methods with surfactant cleansing and antimicrobial dressings to disrupt and delay biofilm reformation.

📈 Frequent debridement (weekly or more) can double healing rates 🩹 (Wolcott et al., 2010; Nowak et al., 2022).

🪓 Conservative Sharp Debridement (CSD) bridges mechanical and surgical levels—removing non-viable tissue to the point of non-bleeding viable tissue.
(Providers, RNs, and PTs should perform CSD within their licensure and competency.)

🌱 Maintenance Debridement

Performed purposefully and integrally—it maintains a biofilm-free environment and drives granulation tissue formation.

📖 Resource:
Mayer DO, Tettelbach WH, Ciprandi G, et al. Best practice for wound debridement: an international consensus.
J Wound Care. 2024;33(6 Suppl C):S1–S29. doi:10.12968/jowc.2024.33.Sup6.S1

10/22/2025

✨ We’re Growing & Hiring! ✨

United Wound Healing is expanding rapidly as we continue our rich history of providing compassionate, specialized wound and skin care across communities. With new partnerships, advanced training programs, and an ever-growing team of providers, we’re proud to be making a real difference in patients’ lives. 💙

We’re looking for dedicated clinicians and support staff who are ready to and be part of something bigger. If you have a passion for patient care and want to grow in a supportive, innovative environment, we’d love to meet you.

🔹 Learn more about our open positions at https://www.unitedwoundhealing.com/about/careers/

🔹 Join a team that’s redefining wound care

🔹 Make an impact, every single day

10/21/2025

As mentioned in last week’s education, there are 4 components of care for Wound Hygiene:
Cleanse
Debride
Refashion wound edges (often needed and neglected)
Dress for antibiofilm/antimicrobial protection.

🧐Today’s Focus: Evidence-based wound cleansing for bacterial/biofilm control.
Key Concepts:

Cleansing is the first act of wound hygiene and is the removal of surface debris, exudate, and contaminants that harbor bacteria and biofilm (Weir & Swanson, 2019; Murphy et al., 2020).

Effective cleansing requires intentional technique:
Volume: 50–100 mL/cm² of wound area. I.e. Use adequate fluid for cleaning.

Pressure: 4–15 PSI (pounds per square inch) for meaningful debris loosening/removal without driving bacteria deeper.

Mechanical cleansing with gauze or monofilament pad.
Examples of currently used safe antiseptic agents:
PHMB (polyhexamethylene biguanide)

Examples of trade names: Prontosan, Kerlix AMD, and more
Octenidine Dihydrochloride (OCT) Examples of trade names: Octenisept, Octetincare, and more
HOCL (hypochlorous acid) Examples of trade names: Vashe, Microcyn, Puracyn, and more.

🩺
Clinical takeaway: “Clean it Like you MEAN It!!! (Weir, 2019).” The goal is microbial disruption, not gentle rinsing.

Resources:
1. Nair HKR et al (2023) International Consensus Document: Use of wound antiseptics in practice. Wounds International. Available online at www.woundsinternational. com
2. Mayer DO, Tettelbach WH, Ciprandi G, Downie F, Hampton J, Hodgson H, Lazaro-Martinez JL, Probst A, Schultz G, Stürmer EK. Best practice for wound debridement: International consensus document. J Wound Care. 2024;33(Suppl 6C):S1–S29.
3. Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, Vega de Ceniga M, Weir D, Wolcott R. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. International consensus document. J Wound Care. 2020;29(Suppl 3b):S1–S28.

Brought to you by:
Pamela Scarborough,PT,DPT,CWS,FAAWC

10/17/2025

🆓 Register NOW!

Our webinar Staging Pressure Ulcers/Injuries and Coding Tips from MDS goes live October 23
at 12 PM PST.
Learn staging best practices
Understand CMS “present on admission”
Avoid F686 triggers and costly tags
Don’t miss this practical education for RNs, wound nurses, providers, and MDS coordinators.
Register today:
https://zoom.us/webinar/register/8617582140623/WN_Umbist2STLSfNXThLKx5Q

10/16/2025

Please give a worm welcome to the newest member of our team, Lauren Mayer PA-C,
Skin & Wound Care Provider! Lauren will be healing, preventing, protecting & educating in Oregon! You can learn more about this exceptional healer here: https://www.unitedwoundhealing.com/specialist/lauren-mayer-pa-c/

10/13/2025

Wound cleansing and debridement are part of the overall wound hygiene process to create a functional wound healing environment. Over the next six weeks, we’ll focus on wound cleansing, hygiene, and debridement interventions across credentials. (Integrating 2024 Debridement Consensus, JWC Wound Hygiene 2020, Wounds International 2019, WoundSource 2022, Schultz 2017, and Nowak 2022)
 
Chronic wounds, also referred to as hard-to-heal wounds, are frequently colonized by polymicrobial communities that form biofilm. The presence of biofilm sustains inflammation, delays healing, contributes to progressive tissue damage, and is associated with increased morbidity and mortality due to localized infection, spreading cellulitis, osteomyelitis, and systemic sepsis.
 
The Wound Hygiene model parallels oral hygiene with repetitive cleansing and disruption to prevent microbial recolonization as a core component of care.
 
Wound Hygiene has four pillars of care (Murphy et al., 2020):
1. Cleanse
2. Debride
3. Refashion wound edges
4. Dress for antibiofilm protection
The 2024 Best Practice for Wound Debridement consensus paper reinforces that biofilm management begins with early and repetitive physical removal of harmful constituents, encouraging clinicians to NOT delay wound hygiene until infection symptoms are visible. 
Clinical takeaway: Wound hygiene is intervention that should be performed with EVERY dressing change and is a core element of best practice.
 
Stay tuned for details on how to cleanse, debride and incorporate Wound Hygiene and Debridement safely and effectively into your clinical practices.


Pamela Scarborough,PT,DPT,CWS,FAAWC

10/09/2025

Pamela’s Pearl with Pamela Scarborough,PT,DPT,CWS,FAAWC.

This week we are talking about: How to recognize Chronic Symptomatic Peripheral Arterial Disease (PAD). As part of your vascular assessment for the lower extremity, are you asking your ambulatory patients and residents:
“Do your legs or feet hurt when you walk and is the pain relieved with a short rest?”

Claudication is recognized as a manifestation of chronic symptomatic PAD and should be a component of the history and physical examination for PAD.

Claudication is defined as fatigue, cramping, aching, pain, or other discomfort of vascular origin in the muscles of the lower extremities that is consistently induced by walking and consistently relieved by rest (usually within approximately 10 minutes). Claudication that limits functional status is known as functionally limiting claudication.

References: Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online May 14, 2024.

10/08/2025

Accurate PU/PI staging and reporting are essential to both compliance and quality care. Yet, MDS Section M remains one of the top areas where teams struggle.

On October 23rd at 12 PM PST, join me and wound care expert and Director of Education & Fellowship Program here at United Wound Healing, Pamela Scarborough,PT,DPT,CWS,FAAWC for a 🆓, practical, solutions-driven webinar:
Staging Pressure Ulcers/Injuries and Coding Tips from MDS

Pamela will walk us through:
Common errors in PU/PI staging—and how to avoid them.

CMS “Present on Admission” criteria explained
Identifying when worsening triggers F686 and other tags
If you’re an RN, wound nurse, provider, or MDS coordinator, this one-hour session is designed to strengthen your knowledge and keep your team compliant.

🤩Register here, and share with you colleagues: https://zoom.us/webinar/register/9317581296636/WN_Umbist2STLSfNXThLKx5ZQ

10/07/2025

Accurate PU/PI staging and reporting are essential to both compliance and quality care. Yet, MDS Section M remains one of the top areas where teams struggle.

On October 23rd at 12 PM PST, join me and wound care expert and Director of Education & Fellowship Program here at United Wound Healing, Pamela Scarborough,PT,DPT,CWS,FAAWC for a 🆓, practical, solutions-driven webinar:
Staging Pressure Ulcers/Injuries and Coding Tips from MDS

Pamela will walk us through:
Common errors in PU/PI staging—and how to avoid them.

CMS “Present on Admission” criteria explained
Identifying when worsening triggers F686 and other tags
If you’re an RN, wound nurse, provider, or MDS coordinator, this one-hour session is designed to strengthen your knowledge and keep your team compliant.

🤩Register here, and share with you colleagues: https://zoom.us/webinar/register/9317581296636/WN_Umbist2STLSfNXThLKx5ZQ

Accurate staging and coding of pressure ulcers/injuries (PU/PIs) are essential for compliance and quality care—but also among the most common error areas in the MDS. In this 60-minute session, Dr. Pamela Scarborough, PT, DPT, MS, CWS, FAAWC - Director of Education & Fellowship Program at United Wo...

10/03/2025

Please join me and giving a warm welcome to our newest skin and wound care provider, Jill Barrett MPAS, PA-C! She will be partnering with her teams and patients to prevent, heal, prevent, and to educate. You can learn more about this exceptional healer here: https://www.unitedwoundhealing.com/specialist/jill-barrett-mpas-pa-c/

10/01/2025

Today’s question: Do vascular exams still matter?
 
Absolutely, YES!!!
 
Despite advanced diagnostics, physical examination of the legs and feet is a critical first step in assessing vascular function. 
 
Four quick bedside tests provide essential information:
1. Pulse Palpation – Femoral, popliteal, posterior tibial, dorsalis pedis.
◦ Absent/diminished pulses are often the earliest sign of PAD.
2. Buerger’s Test (Elevation Pallor) – Pallor with leg elevation suggests impaired arterial perfusion.
3. Rubor of Dependency – Delayed color return or dusky rubor upon lowering indicates arterial insufficiency.
4. Venous Filling Time – 20 sec = arterial insufficiency.
Why It Matters
• Each exam evaluates different vascular components: large arteries, microvascular reactivity, gravity-induced ischemia, and venous outflow.
• Together, they screen for PAD, guide urgency for ABI and imaging, and support clinical decision-making in wound care, compression safety, and vascular referral.
• These tests are inexpensive, repeatable, and provide real-time functional insight not captured by Doppler alone.
Bottom line: A careful vascular exam of the legs and feet remains indispensable for early detection of PAD, triage for further testing, and ongoing monitoring of disease progression.
Resources:
1. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
2. UWH-Lower Extremity Physical Examination Recommendations – From the 2024 ACC/AHA PAD Guidelines.