Denuded Wounds and the Nurse's Role in Treatment

Nurses play a vital role in the recognition and treatment of denuded wounds. In acute care settings, the nursing staff is responsible for assessing the level of damage to a patient's skin and determining the best course of treatment.

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Denuded Wounds and the Nurse's Role in Treatment

Damage to the skin includes moisture-associated skin damage, pressure injuries, incontinence-associated dermatitis, skin tears due to inappropriate caregiver handling, and slow or non-healing surgical wounds. Nurses will also be responsible for monitoring the wound for any signs of infection and providing necessary preventive care. In addition, nurses must educate the patient and their family/caregiver on how to care for the wound at home and provide emotional support and reassurance. With their knowledge, expertise, and compassion, nurses are essential to helping patients heal from denuded wounds.

What is a Denuded Wound?

Table of Contents

A denuded wound is an injury that occurs when the protective top layer of the skin is gone, leaving the underlying tissue exposed. This wound is the most severe type and requires immediate medical attention. Denuded wounds are particularly common in elderly patients with fragile skin and an impaired ability to heal. These wounds are especially vulnerable to infection and require special treatment for proper healing and to prevent further damage.

Anatomy of the Skin

Difference Between Excoriation and Denuded Skin

An excoriation is a wound caused by rubbing or scratching the skin. It is usually superficial and appears as a linear scrape or abrasion on the skin. Denuded wounds occur when the entire upper layer(epidermis) and even parts of the dermis is stripped away or removed due to severe trauma. This type of wound is usually deep and can cause significant damage to the underlying tissue. An excoriated wound typically heals within a few days, while denuded skin wounds may take much longer to heal, depending on the severity of the injury. Additionally, denuded skin wounds are more prone to infection and other complications, making it essential to clean and care for the wound promptly and properly. All nurses and medical professionals should know what can cause a denuded wound, as this education will help prevent its occurrence.

Causes of Denuded Wounds

Common causes of denuded wounds include trauma, burns, surgical procedures, and wound debridement. Trauma can include lacerations, abrasions, and puncture wounds. In addition, medical practices can cause denuded wounds if they involve scraping away the skin, such as in wound debridement. Other causes of denuded wounds include chronic diseases, such as diabetes and vascular disease, which can lead to ulcerations. Additionally, the skin can become denuded by prolonged contact with waste body fluids such as urine, wound exudate, and stool. Nurses must be aware that medical equipment can create a denuded wound. Some equipment responsible for denuded wounds are

  • Oxygen and CPAP mask and tubing
  • Tracheostomy connections
  • Face mask loops on the ears
  • Urinary catheters
  • Restraining devices
  • Fecal incontinence management devices
  • Central venous catheters
  • Compression stockings
  • Ostomy bag connections

Many more devices can create denuded wounds, and they all require careful monitoring by the nurse. Most patients requiring these devices cannot voice complaints about the pain they are experiencing from the device. The nurse must be alert to any damage to the patient and be ready to provide treatment.

Nurse Treating Patient

Treating Denuded Wounds

Nurses must be aware that a denuded wound can become infected quickly. This infection can spread to the bloodstream, creating sepsis (a deadly response to widespread infection). To avoid this, the nurse must be skilled at wound management which involves the following:

  • Clean the wound bed with a saline solution and apply a topical antibiotic or antibacterial ointment.
  • A dressing may also be applied to the wound to keep it moist and covered. Ensure the area of the wound has adequate circulation.
  • Sometimes, a skin graft may be necessary to help the wound heal and reduce the risk of infection. 
  • Applying honey to wounds helps prevent infection and supports faster healing due to honey's antibacterial properties.
  • Studies performed in the nursing department at Arak University, Iran, reported that using aloe vera in wound healing is beneficial. Aloe vera effectively heals burns and wounds faster than some traditional treatments. It is rich in anti-viral, antibacterial, and anti-inflammatory properties.
  • A study on the use of maggots in open-denuded wounds beds filed with slough and eschar was reported in 2016 by Advance Wound Care. The study showed the benefits of maggots in preventing infections. They eat necrotic skin and speed up healing.
  • Other treatments for deep wounds include nanofibers, gels, hydrocolloids, collagen, alginate, and silver-based dressings.

Nurse Treating Hand Wound

Most Common Complications Associated with Denuded Wounds

The area where the wound is located may be exposed to repeated trauma such as the perianal area of the elderly. This prevents healThe open condition of a denuded wound makes it particularly difficult to manage and may lead to various complications. The most common complications associated with denuded wounds include infection, poor healing with dehiscence and wound bleeding, necrosis, and scarring.

Increased Risk of Infection

Infections occur when bacteria and other harmful organisms enter the wound and cause an inflammatory (bacteria or trauma damages tissue, causing blood vessels to leak fluid in the tissues, resulting in swelling and pain). The wound can enlarge; tunneling (bacteria eating a hole deeper in the wound) can occur and may result in sepsis. The nurse must check the wound and dressing at least once every 24 hours. Is it hot to touch? Is there a foul odor? Is there increased pain and swelling? Is the wound red and the drainage yellow and copious? Infection is indicated if the answer is yes to any of these questions.

Risk of bacteria infection

Poor Healing and Dehiscence

Poor healing can also result from infection. Obesity can cause poor wound healing and dehiscence (reopening a closed wound). Wound bleeding and reopening occur when there is pressure on the wound. The patient's medical condition such as malnutrition and diabetes can cause poor healing and wound dehiscence, which may require emergency surgery to reclose the wound.

Necrosis

Necrosis is a form of tissue death. It can occur if blood circulation to the wound is poor. The healthcare provider must remove the skin, and it will be irreversible. Necrosis looks different; in some wounds, it is a thick yellow liquid; sometimes, it is white and soft, and sometimes it appears as a fibrinous wound. The fibrinous wound occurs when infection damages the blood vessels. Gangrenous necrosis occurs when there is no blood flow to the wounded area. Nurses must ensure this does not happen, as necrosis can quickly cause death. The healthcare provider must remove necrosis for healing to occur.

Scarring

Denuded wounds often result in long-term scarring that can cause disfigurement and permanent changes to the appearance of the skin. Scarring that results from a denuded wound can be particularly severe and may not respond to standard treatments. Treatment for denuded wounds is often expensive and may not always successfully eliminate the scarring, though specific techniques may help minimize its appearance.

Preventive Measures to Reduce the Risk of Developing a Denuded Wound

All nurses must know how to prevent or reduce the risk of developing a denuded wound.

  • Ensure the skin is not in contact with moisture for extended periods.
  • Look out for a macerated wound. This sign is the beginning of an injury that can become denuded. Skin is soft and pale or discolored.
  • Check the patient's skin when admitting them and each shift forward.
  • Turn and position patients unable to move.
  • Check skin where devices touch.
  • Check skin folds in bariatric patients.
  • For minor scratch wounds, provide optimal wound care to prevent infection, which can result in a denuded wound.
  • Ensure the patient has optimal nutrition to speed up healing.
  • Teach the patient to recognize and report the signs and symptoms of a denuded wound.

The ANA (American Nurse Association) national standards of nursing practice include preventing and controlling healthcare-associated infections and recognizing and responding to clinical deterioration in acute healthcare. All nurses must adopt this practice. Patients will benefit, and you will have the satisfaction of providing care that matches the national standard of nursing care.

STAFF NOTE: Original Community Post 

This article was created in response to a community post. The comments and responses have been left intact as they may be helpful. Here's the original post:

Quote

Hello all. I recently started at a home health agency and have found myself doing a lot of wound care. I have come accross a few terms I am not too familar with.

Could someone please offer a good resource or describe what denuded means in terms of an ulcer? Also, what is the difference between granulating and clean-non granulating? Which is better?

Thank you in advance!

References

  1. Yousef, H., Alhajj, M., & Sharma, S. (2022, November 14). Anatomy, Skin (Integument), Epidermis. StatPearls Publishing. Retrieved February 19, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK470464/ 
  2. Zulkowski, K. (2020, July). Wound classification. Agency for Healthcare Research and Quality. Retrieved February 19, 2023 from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/webinars/webinar6_pu_woundassesst.pdf 
  3. Nagle SM, Stevens KA, Wilbraham SC (2022) Wound Assessment. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2023 Jan-.Retrieved March 23, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK482198/#_NBK482198_pubdet_
  4. Steinhauser, M ( 2020) Why Do Older People Heal More Slowly? | University of Pittsburgh Retreived March 23, 2023 from https://www.pitt.edu/pittwire/features-articles/why-do-older-people-heal-more-slowly 
  5. Wound Care Surgeon (n.d) Symptoms, Causes, And Treatment Of Traumatic Wounds. Retrieved March 23, 2023 from https://www.woundcaresurgeons.org/blogs/symptoms-causes-and-treatment-of-traumatic-wounds 
  6.  Willacy, H. (2020, November 1). Infected wounds: Signs, symptoms, and treatment. Patient. Retrieved February 19, 2023 from https://patient.info/infections/wound-infection 
  7. Kim, J.Y., Lee, Y.J., & Korean Association of Wound Ostomy Continence Nurses. (2019). Medical device-related pressure ulcer (MDRPU) in acute care hospitals and its perceived importance and prevention performance by clinical nurses. International Wound Journal, 16(Suppl 1), 51–61. doi: 10.1111/iwj13023 https://pubmed.ncbi.nlm.nih.gov/30793861/ 
  8. Hekmatpou, D., Mehrabi, F., Rahzani, K., Aminiyan, A. (2019). The effect of aloe vera clinical trials on prevention and healing of skin wound: A systematic review. Iranian Journal of Medical Sciences, 44(1), 1–9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330525/#!po=1.06383   
  9. Pereira, R., & Bartolo, P.J. (2016). Traditional therapies for skin wound healing. Advances in Wound Care New Rochelle, 5(5), 208 - 229. doi: 10.1089/wound.2013.0506 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827280/ 
  10. Rosen, R.D., & Manna, B. (2022, May 8). Wound dehiscence. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551712/#:~:text=Dehiscence is a partial or,still in the early stages 
  11. Cleveland Clinic. (2022, August 9). Necrosis. Retrieved February 19, 2023 from https://my.clevelandclinic.org/health/diseases/23959-necrosis 
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Lydia Seales-Fuller

About Lydia Seales-Fuller, BSN

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Lydia has over ten years of experience as a medical-surgical nurse.

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Specializes in PICU, Sedation/Radiology, PACU.

Denuded means excoriated/eroded. Type "denuded skin" into google images and you'll find lots of examples.

Granulating tissue (Google "granulation tissue") is healthy, beefy red tissue in a wound. It's a good sign that the wound is healing.

Clean, non-granualting tissue is also just as it sounds. There are no signs of infection or growth of bad tissue (slough, eschar) so it's clean, but it's also not growing granulation tissue, so it's not actively healing.

Sounds like a basic wound care textbook might be of some use to you. I found "Wound Care Made Incredibly Easy" a very easy, informative read and also a great resource for all varieties of wound care.

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Thank you! I will def be looking for that book

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Denuded means skin gone via chemical means (urine, feces, sweat). Excoriation means linear scratching by mechanical means.

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