INSIGHTS FROM THE FRONT LINES:
INTERVIEW WITH DR. DIANNE RUDOLPH, WOUND CARE SPECIALIST
Our editors continue expanding our coverage on the science of WOUND HEALING by connecting with current experts in the field. From a recent presentation at the AAWC (Association for the Advancement of Wound Care), we are fortunate to interview Dr. Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN, a board-certified gerontological nurse practitioner and wound care specialist with over 30 years of experience across trauma, acute, home, hospice, and long-term care. Passionate about complex adult and geriatric care, she serves as adjunct faculty at the University of Texas Health Science Center in Houston and has contributed extensively to lectures, publications, and book chapters. Dr. Rudolph currently practices at South Texas Wound Associates, providing advanced wound care in clinical, acute, and long-term care settings. I’ve been Wound Care certified for quite a few years. I first obtained my wound certification in 1996 after attending a program at MD Anderson Cancer Center. Since then, I’ve been practicing wound care in various capacities. In 2004, I became a nurse practitioner and naturally incorporated my passion for wound care into my practice as an advanced clinician. Over the years, I’ve worked in multiple settings, including acute care hospitals, outpatient clinics, long-term care, home health, and hospice/palliative care.
Currently, I work with Tenet, a large hospital corporation in San Antonio, Texas, where I practice both in inpatient and outpatient settings. In our busy clinic, we specialize in wound and hyperbaric medicine, and I also round on inpatients who require wound care.
Wound Care Certification
There are several national organizations that offer wound care certifications. I chose to certify through the Wound Ostomy and Continence Nurses (WOCN) Board, which provides recognition in three areas: wound care, ostomy care, and continence care. I hold certifications in all three. Another highly reputable organization is the American Board of Wound Management (AABWM), which offers the Certified Wound Specialist (CWS) designation. Depending on your education and training, you can obtain a CWS certification as an advanced practice clinician, physician, or nurse.
There are also other respected organizations, such as the Wound Care Education Institute. While I can’t name all of them off the top of my head, I strongly believe that certification is important. It demonstrates a clinician’s proficiency and specialized skills in wound care, which is far more complex than simply choosing the right dressing. It requires a comprehensive understanding of the patient’s overall health and healing process.
Publications and Training I’ve published several articles and contributed chapters to books, including Chronic Wound Care by Dr. Jay Shah and his Wound Care Certification Guide. My journey in wound care began with my training at MD Anderson Cancer Center. At the time, they had a specialty program that combined classroom instruction with clinical experience. Since MD Anderson is at the forefront of cancer care, their interest in wound, ostomy, and incontinence education likely stemmed from their work with patients undergoing treatment for intestinal malignancies, which often required ostomy management.
Wound Care and Dermatology
There is significant overlap between wound care and dermatology. For example, we often see patients in our clinic with atypical lesions that require biopsies, which sometimes reveal malignancies. In such cases, we refer them back to dermatology for further excision or Mohs surgery. Conversely, dermatologists refer patients to us when wounds are not healing properly. We frequently manage non-healing wounds that develop after excisions for basal or squamous cell carcinomas.
Advances in Wound Care in the U.S.
The U.S. has made significant progress in wound care, though regulatory barriers can sometimes slow innovation. The approval process for new treatments, such as advanced wound dressings and therapies, often involves extensive FDA oversight. However, clinicians increasingly recognize the importance of treating not just the wound but the whole patient. Alongside traditional wound care techniques, we’re seeing an exciting rise in advanced topical therapies, as well as a more holistic approach to patient management. For instance, a diabetic patient with poor glycemic control will struggle to heal, regardless of the wound care interventions used. Similarly, vascular ulcers won’t improve unless perfusion, venous, or lymphatic issues are addressed.
Emerging Technologies in Wound Diagnostics
Advanced imaging and diagnostic tools are underutilized in wound care, often due to insurance limitations and access issues. However, promising technologies include:
• Near-infrared imaging, such as the Snapshot tool, which allows us to assess tissue perfusion noninvasively.
• Bacterial mapping technologies, like the MolecuLight, which helps us determine bacterial bioburden in a wound before and after debridement.
• Transcutaneous oxygen measurements (TCOM), which measure tissue oxygenation and help assess a patient’s healing potential, often used in hyperbaric medicine.
Hyperbaric Oxygen Therapy (HBOT)
Insurance restrictions limit the use of hyperbarics, but we commonly treat:
• Diabetic foot ulcers
• Gas gangrene
• Compromised surgical flaps
• Crush injuries
• Radiation-induced wounds
Hyperbaric oxygen therapy has been beneficial in these cases, though its accessibility depends on insurance coverage.
Legal Aspects of Wound Care
In addition to my clinical work, I’ve done extensive legal consulting as a nurse consultant. I was recently asked to give a talk on the legal aspects of wound care, covering key concepts in medical malpractice and case analysis. The goal was to help clinicians understand what factors could lead to lawsuits and how to mitigate legal risks in their practice.
Challenges in Wound Care: Denial, Neglect, and Fungating Lesions
In my experience—especially in home care and palliative settings—I’ve seen many patients with late-stage cancer present with fungating lesions, which can be extremely difficult to manage. A crucial issue in wound care is the psychological and emotional component of seeking treatment. Some patients delay care due to denial, fear, financial concerns, or lack of knowledge. Understanding these barriers is essential to improving patient outcomes.
Women’s Health and Wound Care
Wound care overlaps significantly with women’s health. Many patients require wound care following mastectomies or gynecological surgeries. Additionally, research suggests that menopause may affect wound healing, yet this area remains largely unexplored. Hormonal changes could impact healing outcomes, making this an important topic for further study. Historically, menopause was seen as an inevitable phase with little medical intervention. However, as awareness grows, more women are seeking treatments to manage its effects. I find this a fascinating and valuable area to explore further.
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