Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen frequently associated with delayed wound healing, particularly in chronic skin injuries. Its capability to form biofilms, secrete virulence factors, and the faculty to compete with other microorganisms makes it a major challenge in clinical wound management. Recent literature reveals different molecular and cellular mechanisms through which P. aeruginosa disrupts the wound healing process. Findings highlight that it interferes with key phases of healing by modulating host immune responses, degrading extracellular matrix components, and inhibiting keratinocyte migration. Its quorum-sensing systems regulate the expression of critical virulence factors such as exotoxin A, elastases, pyocyanin, and rhamnolipids. Additionally, the production of the biofilm matrix components alginate, and polysaccharides provide protection against host defenses and antibiotics. Interactions with other microorganisms, including antagonistic effects on Staphylococcus epidermidis and synergistic relationships with Staphylococcus aureus, modify the wound microbiota. Promising therapeutic alternatives have shown efficacy in disrupting biofilms and reducing virulence. These insights remark the importance of targeting both P. aeruginosa and its ecological interactions to enhance wound healing outcomes and develop more effective treatments. This review aimed to highlight the pathogenic role of P. aeruginosa and its interactions with other microbial species in the context of skin wound healing.