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PHTH 550: Orthopaedic Rehabilitation > Cutaneous Wound Healing > Flashcards

Cutaneous Wound Healing Flashcards

1
Q

how thick is skin?

A

1.4 to 4 mm

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2
Q

epidermis is vascular or avascular?

A

avascular

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3
Q

what kind of tissue is the dermis?

A

loose connective tissue

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4
Q

hyperkeratosis is a thickening of what stratum layer of skin? Who usually has this?

A

stratum corneum - people with diabetes

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5
Q

what is maceration?

A

excess humidity of tissue - whitish skin (like when bandaid on too long)

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6
Q

eschar is what?

A

black crust from necrotic cutaneous or mucous covering

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7
Q

in partial thickness wounds, which cells are doing most of the healing work?

A

keratinocytes - reepithelialization from edges and areas around glands and hair follicles (epithelial buds)

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8
Q

in full-thickness wounds, what is the primary mechanism that healing uses? what kind of tissue is laid down?

A

wound contraction - scar tissue

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9
Q

what are the 4 stages of wound healing?

A

hemostasis
inflammatory
proliferation
remodelling

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10
Q

what type of environment is required for autogenic debridement?

A

humid

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11
Q

what three types of cells are involved in the proliferative stage?

A

fibroblasts

endo and epi thelial cells

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12
Q

when is a wound a chronic one?

A

4-12wks +

when it takes forever to heal and does not respond well to treatment

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13
Q

name four types of chronic wounds

A

pressure ulcers
venous ulcers
arterial ulcers
neuropathic ulcers

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14
Q

how long does one have to be immobile before pressure ulcers start?

A

only 1-2 hours

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15
Q

a stage one pressure sore is unbroken skin, but will do what when a persistently red area is pushed with a finger?

A

it will not whiten, it will remain red

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16
Q

stage two pressure ulcers involve loss of dermis or epidermis or both. What will this look like clinically?

A

looks like an abrasion, blister, or shallow crater, occasionally with fibrin and looking light red otherwise

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17
Q

Stage three goes down to the subcutaneous layer but not beyond underlying fascia. It will look like a deep crater. What else can be present?

A

sinus tracts and undermining. Necrotic tissue may also be present

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18
Q

stage four is all the way down and will have necrosis. what other structures might be affected?

A

muscle, bone, joint capsule

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19
Q

unspecified pressure sores may involve what?

A

eschar or humid necrotic tissue covering wound bed, so unable to tell stage of ulcer

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20
Q

does it hurt to push on pressure sores?

A

of course it is

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21
Q

with venous ulcers, venous distension leads to cells leaking out into tissues where they become brown and swollen. What is this browning called?

A

hemosiderin

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22
Q

what happens after the leaking and browning?

A

dermatosclerosis, and finally lipodermatosclerosis

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23
Q

venous hypertension can come from insufficient valves but also obstruction. What are two ways the veins may become obstructed?

A

obesity
pregnancy
thrombosis

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24
Q

what do venous ulcers usually look like?

A

shallow weirdly shaped on the bottom 1/3 of the legs. contains moderate exudate

may have swelling, hemosiderin, varicosities and white athrophies surrounding ulcer

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25
Q

pain from venous ulcers is worst ___

A

at night

26
Q

arterial ulcers come from peripheral vascular disease (artherosclerosis, smoking, hypertension, diabetes all predisposing factors). Where is this most likely to affect?

A

LE - foot/toes/ankle

27
Q

venous ulcers are shallow and wide, what about arterial ulcers? at what level of oxygen might an arterial ulcer be gangrenous?

A

small and deep - 12 mm Hg

28
Q

how does the wound bed of a arterial ulcer differ from a venous ulcer?

A

arterial ulcer will have more fibrin than granulation, and less exudate and will be dry.

The surrounding area will have cold pale shiny skin with thinkened nails and absent pulse

29
Q

will the pain from arterial ulcers go away with elevation of the leg?

A

no, it will get worse

30
Q

what disease tends to cause peripheral neuropathy

A

diabetes

31
Q

sensory neuropathy can lead to what?

A

repeated/continuous trauma

32
Q

motor neuropathy can lead to what?

A

muscle atrophy - abnormal pressure points in gait on metatarsal heads, friction and pressure makes callous and possibly hematoma
with thinning of fat pad = ulceration, malus performans pedis

33
Q

autonomic neuropathy can lead to what?

A

altered sweating and vascular responses = dry cracks and hot swollen feet which is perfect for bacteria and fungi

34
Q

where are neuropathic ulcers found the most? What shapes?

A

bottom of the feet, small and deep

35
Q

what type of wound infection is most common?

A

topical (ie impetigo)

36
Q

what is the difference between a topical and local infection?

A

presence of swelling, redness larger than 2cm surrounding wound, surrounding tissue easily damaged as well as granulation tissue

37
Q

what can one use to measure a wound?

A

cotton swabs and ruler, or use a tracing pad or the clock technique

38
Q

what else is important to assess with peripheral neuropathy?

A

pressure sensitivity - use wire to see if they can feel at least 8/10 points on feet.
skin discolouration and temperature
capillary refill (should be 5s or less)
pulses
raise leg to 30 degrees - toes should stay same colour

39
Q

what does the ankle brachial pressure index check? what other one can you use?

A

if it’s safe to use compression therapy, if enough blood to heal
- divide systolic pressure of ankle over arm or toe (TBI)

40
Q

what ABI values indicate arterial insufficiency?

A

0.8-0.9 = mild insufficiency
0.5-0.7 = moderate, consult vascular surgery
less than 0.5 = severe, don’t do anything else to heal wound

41
Q

what are three important factors to address in local wound care?

A

debridement, hydration, inflammation/infection

42
Q

what can be done for treating the cause of venous ulcers? neuropathic?

A

compression modalities - venous

decrease WB - neuropathic

43
Q

patient centered concerns should involve what?

A

education about foot hygiene, consults to other professionals

44
Q

when should one not debride a wound?

A
  • insufficient blood blow for healing
  • dry gangrene
  • stable eschar on the heels (protects)
  • problems with coagulation that are not controlled
  • irradiated tissue
  • pyoderma gangrenosum
  • if there is a non-breathable dressing on an infected wound + autolytic debridement
  • presence of metal composites
  • wound with vasculitis
45
Q

what is the minimum amount of compression necessary in a preventative drug-store type stocking for helping prevent venous ulcers?

A

30-40 mm Hg

46
Q

if a patient with venous ulcers has pain or lymphedema, which type of compression bandage are they more likely to prefer?

A

inelastic, 10-20 mm Hg which create compression when calf muscles contract

47
Q

high compression bandages offer how much pressure?

A

20-40mm Hg

48
Q

what are some situations where it’s good to be precautious about debridement?

A
  • immunosuppressed patient or high risk of infection
  • very young or old
  • debridement that keeps macerated tissue moist
  • enzymes less effective in dry environment
  • diabetic ulcer
  • mechanical debridement with pulsed flow more than 15lbs/square inch
49
Q

what are three roles of fibrin

A

retains fluids
protects underlying cells
provides substances for coagulation

50
Q

what pressures do mattresses need to be to be curative or preventative?

A

curative - less than 32mm Hg

preventative - 40-70mm Hg

51
Q

what does the darco shoe do?

A

decrease wb on toe area during gait

52
Q

what does compression do

A

improves venous return
reduction of edema
improved tissue perfusion

53
Q

when should you not use compression?

A

arterial insufficiency
localized infection
thrombophlebitis (and 2 wks after)

local pressure hypersensitivity
pulmonary embolism or DVT
congestive heart failure

54
Q

when using an ICP, how should the limb be positioned?

A

elevated

55
Q

what are the parameters of using an ICP pump?

A

5-7x/week
30-60 min, with 3:1 on/off
compression of 40-60mm Hg - only use up to 0.8 ABI

56
Q

how long should hydrotherapy be used for

a) pressure, cellulitis, or burns
b) arterial ulcers
c) venous and neuropathic ulcers

A

a) 10-20 minutes (15-20 for pressure ulcers actually)
b) 2-10min
c) 5-10min

57
Q

when is hydrotherapy a good idea?

A

when there’s lots of crap on the wound

ie bacteria, foreign objects, exudate, topical creams, dead tissue

58
Q

when is hydrotherapy a bad idea?

A
  • wound is already clean or there is a healthy bed of granulation tissue
  • arterial insufficiency (severe)
  • DVT
  • temperature discrimination impairment
  • severe edema
  • maceration tissue
  • hemophilia
  • unstable physically or mentally
  • skin cancer
  • first trimester pregnancy
  • transmissible infection or infection from certain bacterias that cause incontinence or diarrhea
59
Q

does the wound go into a bath with the dressing on?

A

yes

60
Q

what should be done during the bath?

A

AROM

PHTH 550: Orthopaedic Rehabilitation (11 decks)

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