AI/VI characteristics Flashcards
Location of AI wounds
Commonly below the ankle
- foot, heel, met heads, tips of toes, bunion areas
- possible superior lateral malleolus or anterior lower leg
AI Presentation
- Starts shallow then deepens
- Punched out appearance
- Usually round
AI Drainage
Minimal to none
Usually dry and hard
AI Tissue
- Black and brown eschar
- Pale granulation
- Mixed
Dry Gangrene
- Mummification
- no drainage, hard
- Little/no odor
- Clear demarcation
Dry Gangrene treatment
Protect/off load
Monitor for conversion
-Auto Amp
Wet Gangrene
- Drainage
- Odor
- Fluctuance /edema
- Erythema
- Less clear demarcation
Wet Gangrene Treatment
- Urgent referral
to Vascular surgeon
Should you place a moist dressing on dry eshcar?
- NEVER
- careful at other times, depends on surgical candidacy
Moist dressing on unhealable AI ulcer?
Keep dry until proven healable
- AVOID ADHESIVES
What is the healable conditions for AI ulcers?
Vascular status ABI > .5 and consultant with MD
- slow progression
- AVOID ADHESIVES
What is the PT role in AI wounds?
ID, Refer, protect, monitor, educate
- wound care exercise
- Treatment after re-vascularization/AMP. team effort
Debridement precautions for AI
ABI and Compression
- ABI > .08 35-40mmHg OK
- ABI < .8 but >.6 caution but light compression 17-25mmHg
- ABI
After Re-Vascularization/AMP
GO AFTER IT - moist wound environment, debridement
VI location
- Above the malleoli in distal 3rd of lower leg (medial and lateral)
- If outside the area, may not have VI etiology
Surrounding Skin VI
-Hyperpigmentation - hemosiderin staining
- Lipodermatosclerosis
(scarring of skin/fat, results in hard thickening, immobile skin, can cause “champagne bottle leg, scarring can restrict fluid)
- Thick and scaley epidermis
-Irritation from chronic
-exposure to large amounts of drainage
- Varicose veins
VI would characteristics
- Uneven edges (can be diffused or rolled)
- Highly exudative (esp at initiation of tx)
- Pain not bad, if severe consider AI/vasculitis
VI periwound
- Maceration common (intially or w/inadequate dressings or change schedule
- Diffuse edges
- irritation
VI compression
- Comfrt, cosmesis, tolerance (some compression is better than none)
- Ok to compress over most wound dressings
- Ambulation?
- Vascular status?
Tube-like (Tubigrip)
- least compression, inexpensive, east to apply
- light compression but can be doubled
- Conservative trial to determine tolerance
- Utilized with UE and LE issues or with at risk sprains, wounds
- Variation in compression
(different sizes, can pair different stizes, depends on limp contour, 10-12mmHG)
Long Stretch
- Stretches a long way
- ACE wrap
- delivers constant compression, can feel tight at rest
- Applied with figure 8 or spiral technique
- CAUTION with AI
Short Stretch
- Short distances
- Applied with consistent tension/spiral layering
- can telescope
- Use ABI levels to determine safe
- HIGH compression during contraction
- LOW during rest
In Elastic
- Unna Boot
- enough tension to hold in place
- 2-3 layers over entire LE or UE
- Secondary wrap
- Longer wear time (1 week)
- Telescopes
- Can rub against bend at ankle
Multi Layer
- 2-4 layers
- More layers = higher levels of compression 30-40mmHg
- On during work or rest
- Specific layering techniques and sequence
- More expensive, More time for application
- Long wear - 1 week
- Both ambulation and non
Stockinga
Not just for VI, can be support/Vein health
- replace 6 months
Custom vs OTC
- Lowest effective level for maintenance - comfort, application, heat
Compression levels
- 15-20 mmHG SUPPORT - w/o ulcer, lite prophylaxis for high risk pt’s (tired legs)
- 20-30mmHG THERAPEUTIC Mild VI w/wo uler, prophylaxis, inability to tolerate high compression
La Place’s Law
- Adjustments to overal amount of compression graded or graduated
- increase/decrease tension
- # layers
- based on girth
Exercises for VI ulcers
- Gastoc stretches ROM (muscle pump)
- ankle pumps, circumduction, ABCs
- Heel toe raises in sitting
- Step overs - Step over 3-4 inch obstacle using heel strike in foot, toe push off
- Exaggerated heel toe sequence during walking
- biking, Aquatics
Education VI
Compression (chronic situation)
- Extend standing, sitting crossing legs, ankle pumps
- Elevation above heart level
- Care and replacement of compression stocking
- Lifestyle
Spiral / Figure of 8
50% overlap, 50% tension
Base of toes over gastroc 2 fingers
Leg shape and padding
Want Graduated/Graded Compression
Ankle -30-40mmHG, proximal calf ~18mmHG
- Ankle circumference w/ multilayer systems due to higher levels of compression
- Leg shape & padding
