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וונדכר פניל > BURNS > Flashcards

BURNS Flashcards

1
Q

Depth of Burns

A

1st Degree: superficial
2nd Degree: Partial Thickness (superficial and deep)
3rd Degree: Full thickness

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2
Q

Superficial Burn

  1. layer
  2. sx
  3. heal time
  4. physiology
A
  1. epidermis only
  2. erythema (redness), painful
  3. heals quickly (3-5 days)
  4. physiologically unimportant
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3
Q

Superficial Partial Thickness

  1. layer
  2. sx
  3. heal time
  4. physiology
A
  1. epidermis and some dermis
  2. blisters, very red, edema, pain, wet, weepy
  3. heals in 10-14 days
  4. permanent changes are rare
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4
Q

Deep Partial Thickness

  1. layer
  2. sx
  3. heal time
  4. physiology
A 
1. epidermis, most of dermis
some skin appendages intact
2. pain, mottled, red/white/yellow, mot as weepy as superficial, large blisters, edema
3. heals in 3-4 weeks!
4. get scars
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5
Q

Full Thickness

  1. layer
  2. sx
  3. heal time
  4. physiology
A
  1. epidermis, dermis, appendages
  2. white/red/black/brown, dry, leathery, firm, thrombosed vessels, minimal pain initially, need skin graft
  3. heal time -not given
  4. poor skin quality, thick scarring
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6
Q

Phases of Wound Healing

A
  1. inflammatory: cleaning
  2. proliferative: rebuilding
  3. remodeling
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7
Q

Inflammatory Phase of Wound Healing

A

Time: 24hrs-5 days

vascular response: vasoconstriction (clotting) and then vasodilation

cellular/molecular response: phagocytosis

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8
Q

Proliferative Phase of Wound Healing

A

rebuild:
DERMIS: need GRANULATION TISSUE
1. fibroplasia: fibroblasts produce collagen [strength]
2. angioplasia: (neovascularization)–new blood supply (endothelial buds) [vascularity]

EPIDERMIS: heal outside in and bottom up:
Epithelialization: epithelial cells do mitosis and rebuild the epidermis
contact inhibition: resurface the wound and add to the thickness
-mitosis-epidermal thickness of cells that migrate from edge to center
-epithelial buds-epidermal cells from dermal appendages move up from the bottom

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9
Q

Remodeling Phase of Wound Healing

A

Time: 3-18 Months
MATURATION PHASE
-Hypertrophic Scar: fibroblasts produce collagen in disorganized bundles
-myofibroblasts
-rich blood supply
-imbalance between collagen production and lysis

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10
Q

rule of 9s

A

measure size of wound (more specific if use the lund browder chart)

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11
Q

color coding

A

red/pink: clean, granulation or epithelial tissue
yellow: epithelial buds,
eschar (black?)
black: dirty, necrotic tissue

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12
Q

goals of dressing

A 
clean and prevent infection
moist environment to heal
temporary wound coverage
decrease evaporative water and heat loss
protect exposed tendons from desiccation
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13
Q

dressing types

A
  1. biological dressing

2. silver

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14
Q

surgical manage: indicated, benefits

A

indicated:

  1. facilitate healing time
  2. decrease inflammation
  3. limit scar formation

benefits:
increase function
decrease hospital stay
decrease long term rehab, follow up, and reconstruction surgery

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15
Q

skin graft types

A

temporary:
allograft (homograft)-cadaver
heterograft (zenograft)-pigskin
integra-bovine collagen and silicone

permanent:
autograft
cultured epidermal autograft (CEA)

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16
Q

sheet vs mesh grafts

A

sheet grafts: skin applied as solid sheet

mesh graft: small holes to stretch graft to allow wound drainage

17
Q

depth of graft:

A

split thickness skin graft: (STSG)
-Epidermis and part of the dermis [just cover donor site with dressing]

full thickness skin graft: (FTSG)
-epidermis and all of dermis [donor site will need a graft]

18
Q

Donor Sites

A
  • donor skin
  • resultant partial or full thickness wound
  • partial thickness site covered with a dressing
  • full thickness site closed primarily or with STSG (split thickness skin graft)
19
Q

Wound intervention

A 
edema manage
scar manage
splint
cast
ther-ex
functional mobilization
modalities
20
Q

edema management

A
  1. pressure therapy: (ace, self adhesive wraps)
  2. mobilize/funciton
  3. positioning
  4. exercise
21
Q

integumentary impairments

A
  1. open wound
  2. hypertrophic scarring
  3. scar contracture
22
Q

integumentary evaluation

A
  1. wound assess: color coding
  2. hypertrophic scarring: vancouver scar assess tool
  3. scar contracture: R/O limitations from joint and muscle
23
Q

vancouver scar assess scale

A

pliability
vascularity
pigmentation
height

24
Q

principles of hypertrophic scarring

A

superficial partial thickness dont usually scar

deep partial thickness and full thickness burns scar

early healing/grafting decreases scar

80% of original strength

children scar more, asian/AA/redheads scar more

25
Q

clinical signs of hypertrophic scarring

A

RAISED: elevated skin level (collagen)
RED (erythma - red, vascular)
RIGID

blanching-white upon stretch, myofibroblasts

26
Q

Stages of Hypertrophic Scarring

A
  1. Immature: RED, RAISED, RIGID
  2. Semi Mature: pink, raised, semi-rigid
  3. Mature: pale, planar, pliable
27
Q

Treatment of Hypertrophic Scarring

A
  1. apply pressure:
    - decrease vascularity, myofibroblast activity,
    - collagen synthesis, better collagen orientation to be parallel
  2. positive pressure therapy: constant and controlled, slightly above capillary pressure (23mmHg)
28
Q

Hypertrophic Scarring Pressure Principles

A

24hrs/day (could be for a yr) from when the scar is closed and the garment should fit tight (24mmHg) and patient should have 2
once scar is set, you cant change the alignment

29
Q

Hypertrophic Scarring Rehabilitation Considerations

A

tx effective on immature scars:
immature scar change from bulk and strength, 1-2 years in duration

hypertrophic scar tissue will bridge a joint and contract until it meets an opposing force

30
Q

Hypertrophic Scarring Scar Management

A
  • ace bandage
  • self adhesive wraps
  • custom made pressure garments
  • pre-fabricated pressure garments
  • inserts (silicone, cushion to add pressure)
  • splints (transparent face mask)
31
Q

Hypertrophic Scarring indications for inserts

A
  1. increase pressure
  2. conformity in concave areas (palm, web spaces)
  3. contours
32
Q

Hypertrophic Scarring insert types

A
  1. foam cushions
  2. silicone products
  3. gel sheets
  4. splint material
33
Q

Hypertrophic Scarring

Contracture Evaluation

A
  • -question where it is coming from
  • -based on ruling out limitations from joint, muscle, or scar
  • -blanches upon stretch
34
Q

Hypertrophic Scarring

Contracture Tx

A
  1. pressure
  2. stretching–low load, long duration
    - -Types: manual exercise, splinting, casting
    - -Principles: facilitates collagen fibers in parallel alignment, static stretch of low load and high duration
  3. modalities

וונדכר פניל (4 decks)

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