Transcript

That's a big question. And I agree, workflow, skin protection, to be honest, it's not considered at all in clinical practice. So if I were designing the ideal workflow for today, again, I would actually not start with the products. I would start with the way we are thinking about skin and skin protection. 

So for me, every dressing change should begin with a very simple question. What is the skin telling me today? And not just the wound, really the skin, the surrounding skin. So we have to go beyond the wound bed. Did the skin become more fragile? Is it drier than yesterday? Is it wetter? Is there more pain? Is the patient telling me something that has changed? And those observations, they are as important as, for example, measuring the wound itself. And I'm not undervaluing and underestimating the importance of wound bed preparation and wound assessment, etc. It's just trying to refocus on wound bed plus surrounding skin. 

So the next step then is to understand why the skin and why the patient experience is changing. And I think one of the biggest mistakes we sometimes make is treating the symptom instead of understanding the real cause. If the skin is becoming macerated, I don't immediately ask which barrier product I should use. Again, I ask why did the skin become more macerated than before? More exudates, more edema. Dressings that saturate too quickly, any leakage. 

So we really have to understand the mechanism because otherwise we are just treating the consequence and not the cause. Once we understand that cause, the interventions and the selection of products, that it just becomes more logical. We optimize the exudate management. We reduce unnecessary adhesive trauma. We protect the exposed skin. Don't forget to maintain the hydration, if appropriate, of course, and we have involved the patient in recognizing those early warning signs. 

But perhaps the most important part of the workflow is not only the assessment, but also the reassessment. We know that the skin is not static. Wounds are not static. And definitely patients are not static. So our treatment should become static or should not become static either. Every dressing change should include a small moment of reflection. Is what we're doing still the right approach? Or has the situation changed? Where are the biggest gaps? And interestingly, I don't think that the biggest gaps is the scientific knowledge anymore. There is a lot of science. There is a lot of good research out there. And of course, we can comment and we can critique the research. But actually, we understand the skin physiology remarkably well. 

The challenge for me is the implementation. And I've spent much of my career as a researcher working on implementation science. And one thing we have learned repeatedly is that the evidence does not automatically support the change of practice. Publishing guidelines. is not enough and education is not enough either so real change really happens when there is clinical leadership when there are documentation systems when there is an organizational culture where there is audit feedback procurement rules education of course all of frontline practice and we all have to work together. This is a highly interdisciplinary field.

Another gap, and it's definitely at the same level of importance, is that wound care and skin care are often and still too often viewed as separate activities. And of course, I don't think they are and they should. The skin surrounding the wound is part of the wound healing environment. So protecting is not enough by adding additional tasks. It's really part of the integral wound management. 

And finally, I think that we need to make our patients more active partners in the care that we deliver. Patients often notice those small and subtle changes before we do, before we even can think about them. So they know when a dressing starts leaking. They know when removal becomes painful. They know when the skin begins to sting. And if we genuinely listen to them, they really can become part of our monitoring system. And that is what we need. We need at least one extra pair of eyes. 

So perhaps if I had to summarize this kind of a philosophy, I would say that the skin protection is proactive rather than reactive. It is to be personalized rather than standardized. And we use standardization so much in our narrative. And it should be centered on understanding the mechanism rather than simply treating any visible signs. 

And this is just to end my reply to your question. For me, ultimately, protecting the surrounding skin is not just about preventing a complication. It is about your patient's comfort, preserving the comfort, preserving the dignity, also the function. And in the end, it's about the quality of life. So in many ways, that is what good wound care is all about. So we have to look at it in a very holistic, more structured, and even more compassionate way.