Advanced Wound Care

Types of Wounds We Treat

Dermatology of Seattle specializes in the management of chronic and complex wounds. These are wounds that have failed to heal through the normal process — often because of underlying medical conditions, poor circulation, infection, or inadequate prior care. Our expertise spans a wide range of wound types:

Venous Leg Ulcers

The most common type of chronic leg wound, venous ulcers result from venous insufficiency — a condition in which the veins of the leg struggle to return blood to the heart, causing pressure buildup, fluid leakage into tissue, and skin breakdown. They typically appear on the lower leg or around the ankle and are often shallow with irregular borders. Treatment centers on compression therapy to address the underlying venous hypertension, combined with advanced wound dressings to promote healing.

Diabetic Foot Ulcers

Diabetic neuropathy reduces sensation in the feet, allowing wounds to develop and deepen without causing pain. Poor circulation impairs healing, and elevated blood sugar impairs immune function, making infection a constant threat. Diabetic foot ulcers carry serious risks, including osteomyelitis (bone infection) and amputation if not treated aggressively. Our approach includes meticulous wound assessment, debridement, infection control, and coordination with your diabetes care team.

Pressure Injuries (Pressure Ulcers)

Pressure injuries develop when sustained pressure over a bony prominence cuts off blood supply to the overlying skin and tissue. They are especially common in patients with limited mobility. We manage wounds across all stages, from superficial skin breakdown to deep tissue involvement, and provide guidance on pressure redistribution strategies in partnership with the patient's care team.

Post-Surgical Wounds

Surgical wounds may become chronic if they dehisce (open), become infected, or heal slowly due to poor vascular supply or underlying disease. We manage post-surgical wounds from a variety of settings, providing wound assessment, debridement as needed, appropriate dressing selection, and close follow-up.

Post-Mohs Surgical Wounds

Mohs micrographic surgery is highly effective for skin cancer removal, but large wounds — especially on the face, scalp, ears, and lower extremities — require attentive aftercare. We provide detailed written wound care instructions, supply appropriate dressings, and see patients for follow-up visits to ensure optimal healing, minimize scarring, and promptly address any complications.

Why Wounds Become Chronic

Normal wound healing proceeds through four overlapping phases: hemostasis, inflammation, proliferation, and remodeling. When any of these phases is disrupted or prolonged, healing stalls. Common reasons wounds become chronic include:

• Poor circulation — venous insufficiency, peripheral arterial disease, or microvascular disease (as in diabetes) reduces the delivery of oxygen and nutrients needed for tissue repair
• Infection and biofilm — bacterial biofilms are structured communities of bacteria embedded in a protective matrix that resist standard antibiotics and keep wounds in a persistent inflammatory state
• Uncontrolled diabetes — elevated blood glucose impairs neutrophil function, reduces growth factor activity, and slows collagen synthesis
• Malnutrition — deficiencies in protein, vitamin C, zinc, and other micronutrients critically impair the cellular machinery of wound repair
• Excessive mechanical stress — continued pressure, friction, or shear force re-injures healing tissue before it can consolidate
• Underlying inflammatory or autoimmune conditions — pyoderma gangrenosum, vasculitis, and calciphylaxis produce wounds that will not heal without addressing the systemic disease

Our Advanced Wound Care Approach

Effective wound care is systematic and individualized. At Dermatology of Seattle, our approach includes:

Comprehensive Wound Assessment

Each visit begins with a thorough evaluation of the wound — its dimensions, depth, tissue quality (granulation vs. necrosis vs. slough), exudate type and volume, periwound skin condition, and signs of infection. We document wound measurements at each visit to objectively track progress.

Debridement

Removing non-viable tissue is foundational to wound care. Depending on the wound and the patient's overall status, we employ sharp debridement (using surgical instruments to precisely remove necrotic tissue), enzymatic agents, or autolytic strategies using advanced moisture-retentive dressings.

Advanced Dressings

Modern wound dressings are selected based on the wound's specific needs — not a one-size-fits-all approach. We use foam dressings, hydrocolloids, alginates, silver-impregnated antimicrobial dressings, hydrofiber dressings, and other advanced materials to maintain an optimal moist wound environment, manage exudate, control bioburden, and protect fragile new tissue.

Infection & Biofilm Management

We assess for clinical infection at every visit and treat promptly with topical or systemic antimicrobials as appropriate. For wounds with suspected or confirmed biofilm, we employ anti-biofilm agents and strategies to disrupt the protective matrix and restore antibiotic sensitivity.

Compression Therapy

For venous leg ulcers, compression therapy is the cornerstone of treatment — addressing the underlying venous hypertension that drives the wound. We prescribe and fit appropriate compression systems and educate patients on lifelong compression to prevent recurrence.

When to Seek Wound Care

Seek evaluation at Dermatology of Seattle if you or a loved one has:

• A wound that has not healed after 4 weeks of basic home care
• Increasing pain, redness, warmth, or swelling around a wound
• A foul or unusual odor from the wound
• Thick, discolored, or purulent discharge
• A wound that appears to be expanding or deepening
• A history of diabetes, venous insufficiency, or peripheral artery disease with any new skin wound
• A wound that developed after Mohs surgery or another skin procedure

A Collaborative Approach to Wound Healing

Wound care is a specialized field requiring deep clinical experience. Our team at Dermatology of Seattle brings expertise across the full spectrum of chronic wound management: venous and arterial ulcers, diabetic wounds, pressure injuries, post-surgical complications, and complex skin conditions that cause cutaneous ulceration.

Our collaborative approach — working closely with each patient's primary care team, vascular surgeons, and endocrinologists — ensures that the whole patient is treated, not just the wound.