Lecture 1 Intro Flashcards
Role of PT: Primary vs. Secondary
Primary: PT is primary provider assessing and treating integumentary dysfunction/wounds. Most likely referral from physician. PTs do not make medical diagnoses, only rehab diagnoses
Secondary: Patient is not seeing PT specifically for skin/wound related issues
In both roles, communication with interprofessional team is required
Characteristics of Epidermis
- Outer layer of skin
- Repair and regenerates every 28 days
- Consist of 5 layers
General Function of Epidermis
- Protective barrier
- Differentiates into hair, nails, sweat glands, and sebaceous glands
Characteristics of Dermis
- Consist of two layers: Papillary dermis and reticular dermis
General function of Dermis
- Supports structure
- mechanical strength
- resists shear force
- supplies nutrition
- inflammatory response
characteristics of subcutaneous tissue
- composed of adipose and connective tissue
General function of Subcutaneous tissue
Thermal insulation
Mechanical “shock absorber”
Controls body shape
3 wound categories
superficial, partial-thickness, full-thickness
Superficial Wound
Tissue involved: epidermis
Examples: Abrasion, Superficial burn
Partial thickness
Tissue involved: Epidermis, Dermis
Examples: Blister, Stage 2 pressure injury
Full thickness
Tissue involved: Epidermis, Dermis, Subcutaneous tissue
Examples: Full-thickness burn, Stage 3 pressure injury
The process of wound healing requires?
- complete wound closure and successful functional scar tissue organization
Tissue repair is a?
- Continuous process
What are the four phases of wound healing?
Hemostasis, inflammation, proliferation/repair, Maturation/remodeling
What happens during hemostasis
Clotting, Vascular response
Platelet aggregation and Vasoconstriction
Main Actor: Platelets
What happens in Proliferation / repair
Epithelial healing, Contraction, angiogenesis
- Formation of granulation tissue in the wound space
- Fibroblasts move into the wound space and proliferate
Importance of Proliferative Phase
- Type III collagen in the wound has decreased tensile strength, patient is at risk for wound dehiscence or openning of wound edges
Key events at Proliferative Phase
- Angiogenesis: Capillary growth into ECM
- Reepithelialization: Migration of marginal basal cells
- Wound contraction: Contraction of fibroblasts and myofibroblasts to bring wound edges closer
What happens in Inflammatory Phase
- Bacteria and other pathogens enter the wound, stimulating tissue repair
- Increase vasodilation, allowing for delivery of blood and nutrients to injured area
What are two inflammatory cells attracted to the wound space to mount an acute inflammatory response?
- Neutrophils: reach peak numbers within 24-48 hours, destroy bacteria by phagocytosis
- Macrophages: arrive 2-3 days after injury, activate cells involved in tissue repair
What are normal signs of inflammation?
- redness
- swelling
- heat
- pain
what are red flags of infection
- excessive bleeding
- wound breakdown
- increased pain
- Pus or unusual drainage
- Spreading redness around the wound
- Flue like symptoms
Abnormal Inflammatory Responses
- can be a significant factor in delayed wound healing
- Re injury, infection, poor tissue perfusion
Maturation (Remodeling) Phase
- gradual return of tensile strength of skin wounds
- 3 weeks up to 20%, can reach a maximum of 70 - 80%
what is the final product of wound healing?
- scar
- relatively avascular and acellular mass of collage
- restore tissue continuity
Primary Intention
- Wound edges are approximated and closed with sutures to facilitate re-epithelialization
- occurs in acute wounds with minimal tissue loss, with smooth, clean edges
- minimal scarring and heal quickly
Secondary Intension
- Wounds close on their own without superficial closure
- occurs in wounds with significant tissue loss or necrosis
- Requires ongoing wound care and have significantly larger scars
How do Wounds heal with secondary intension?
- Granulation and contraction
Granulation
- development of beefy red tissue that appears bumpy
- represents new vascular growth
Contraction
- edges start marching together
Positive signs of healing in Secondary Intention
- Healthy pink tissue in the wound bed
- Signs of new tissue growth at the wound edges
- Decreasing wound size over time
Tertiary Intension
- delayed primary intention healing
- wound at risk for developing complications may be temporarily left open
- once problem has been addressed, the wound is closed by the usual primary intention methods
Contamination
- Presence of non-replicating bacteria on a wound surface
- no tissue injury & does not stimulate an inflammatory immune response
Colonization
- does not invade or further injury tissue & does not stimulate an inflammatory immune response
- can delay wound healing or may benefit wound healing
Infection
- visible inflammatory immune response
- will delay wound healing
Poor tissue perfusion
- can limit the wound’s ability to sustain cellular activity
what happens to epidermis with age?
- thins with age, making it more fragile and susceptible to injury
The presence of nonreplicating microbes is called?
- contamination
Which lines of defense produces the classic signs of infection?
- Second line of defense
- Redness, Swelling, Pain, Heat
How does wound infections delay wound healing?
- affect collagen metabolism
- decreases synthesis and increases lysis of collagen
- decrease amount of oxygen & nutrients needed
Erythema
Inflamed: Well defined borders, not as intense
Infected: intense/ discoloration, red stipes / streaking
Temperature
Inflamed: Elevated locally
Infected: Systemic Fever
Exudate Character
Inflamed: Bleeding and serosanguinous > Serous
Infected: Serous and seropurulent > purulent
Exudate amount
Inflamed: usually minimal, decrease in 3-5days
Infected: Mod-Heavy and remains high
Pain
Inflamed: Variable
Infected: Persistent
Edema and Induration
Inflamed: Slight swelling, firmness at wound edge
Infected: If edema and induration are localized with warmth
Local Infection
- Erythema or skin discoloration
- Edema
- Warmth
- Induration
- Increased pain
- Purulent wound exudate with / without foul odor
Systemic Infection
Increased temperature
increased WBC
confusion or agitation
red streaks from wound
tachycaardic
tachypneic
Local Factors: Pressure
ischemia within 2-6 hours
necrosis after 6 hours
Local Factors: Shear
causes wound undermining
Local Factors: Friction
Causes skin erosion
Local Factors: Moisture
Causes tissue friability
