Lecture 4 Integumentary Diagnoses, Part 2 Flashcards
Skin Tears Pathophysiology
- traumatic wounds
- resulted from friction or shear separating the epidermis from the underlying dermis
- Partial-thickness wound
Horizontal vs Vertical Skin Tears
- often edges are jagged and cannot be approximated
Which population are at higher risk for skin tear?
- older adults due to age-related skin changes
Skin Tear can result from?
- sliding down in bed
- bump into objects
- removal of dressings
- nails or jewelry
Most common sites for skin tears?
- arms, hands, and pretibial region
How long should you leave the dressing in place for skin tears?
- for several days to avoid disturbing the skin flap
The skin flap should not be disturbed for how many days to allow for adherence to the cellular structures below?
- at least 5 days
An abrasion is caused by?
friction to the skin’s surface and may result in superficial or partial-thickness wound
Characteristics of Abrasions
- likely to be contaminated and have increased risk for infection
- generally accompanied by a mild stinging sensation, which increases during irrigation or bathing
Superficial Abrasions vs. Deeper Abrasions
- Superficial abrasions may bleed slightly, wheres deeper ones will have a moderate amount of bleeding due to the involvement of dermal vessels
Abrasion Clinical Management
- irrigation with water or normal saline
- Extensive abrasions may benefit from whirlpool therapy
- Contaminated wounds may be treated with antimicrobial
Lacerations is caused by?
- cutting or tearing into the skin’s surface
Lacerations wound edges may be
- smooth or irregular
Laceration treatment depends on?
- size and depth of the injury
Interventions for Laceration
- Tissue adhesives / adhesive strips
- Primary closure
- Wound dressings
Most surgical wounds are closed by what methods?
- Primary intention methods
Surgical Wound ( Primary Intention): Typical Presentation
- small amount of bleeding or drainage for the first 24-36 hours
- Mild edema and ecchymosis is normal due to expected inflammation
- Sutures are more likely to cause an inflammatory response
- signs of infection? Excessive redness or induration?
what is the first thing to check for surgical wound?
- observe signs of infection
- palpate for temperature & tissue texture
Surgical Wound: Inflammatory Phase
- Normal signs of inflammation: warmth, redness, edema, pain
- Approximation of wound edges: epithelialization; no tension on sutures
Surgical Wound: Proliferative Phase
- Healing Ridge occurs
- Drainage should be serosanguinous > serous > nil
Surgical Wound: Remodeling Phase
- incision color changes from red/pink silvery > gray > white
- Healing ridge gradually softens
- wound strength reaches 80% of previous state
Abnormal scar responses in Remodeling Phase
- Keloid: Beyond borders of initial wound
- Hypertrophic: stays within wound borders
Surgical Wound (Primary Intention) Clinical Management
- kept clean and dry for the first 24-48 hours
- Gauze dressing or adhesive strips to avoid friction and tension
- Most stitches are removed in about 7-10 days
Infection can lead to?
- dehiscence and/or need for surgical debridement
what does dehiscence mean?
- Separation of wound margins
When does wound dehiscence generally occur?
- 4 to 14 days after surgery
Wound Dehiscence is associated with?
- high mortality rate, especially abdominal wounds
Risk Factors for surgical wound dehiscence
- Increased age
- malnutrition
- diabetes
- anemia
- COPD
- Smoking
- Abnormal tension across the incision
- infection
When is Surgical reconstruction wounds required?
- if the area is missing tissue
Reconstructive Ladder
- Split-thickness skin graft (least amount of loss)
- Full thickness skin graft
- Tissue flaps (MOST amount of loss)
Split-Thickness Skin Graft (STSG)
- Consist of epidermis and dermis
- are used for large wounds
- donor sites are usually the thigh, buttocks, and trunk
- donor areas usually heal within 14-21 days
Split-thickness skin grafts are typically adherent after how many days?
5-7 days upon completion of wound healing
Once the graft has integrated into the wound bed
it undergoes a maturation process that takes over one year to complete
Skin graft maturation process includes?
- changes in pigmentation
- flattening and softening
- may maintain a cobblestone appearance
Full-Thickness Skin Graft
- Reserved for small areas only, such as on the face and hands
- Donor sites are closed by primary intention
Full-Thickness Skin Graft Management
- graft secured with sutures and donor site is repaired with a layered closure
- patient should avoid trauma to the site and strenous activity for at least 2 weeks after surgery
What is tissue flap?
- a unit of tissue that can be moved to cover a wound while surviving on its own vascular supply
-named for their composition
what type of wounds are tissue flaps used for?
- damaged tendon, muscle, bone
Tissue flaps are transplanted to provide?
- form & function
Tissue Flap management focuses on which three areas?
- close monitoring of the patient and fresh flap
- anticoagulation
- fluid resuscitation
What are the four major factors contribute to free flap failure?
- venous thrombosis
- arterial thrombosis
- tissue condition
- mechanical compression
Wounds/ Skin changes may be related to?
- Disease process
- Functional changes
- Treatment interventions
Radiation-induced skin reactions
- skin cells are highly sensitive to the damaging effects of radiation
- results from both direct tissue destruction and indirect damage from free radical production
Effect of radiation
-delays normal healing
- damage may become visible within 2-3 weeks of the start of treatment or as long as 4 weeks after finishing radiation therapy
Radiation-induced skin reactions: Early Stage
- Mild inflammation, slight erythema, and local edema
- Dryness
- skin might feel tight, itchy, tender to touch
Radiation-induced skin reactions: Later Stage
- Increased pain
- Ulcer formation
- Radiation necrosis
- Presence of open wounds increases risk for infection
What is Radiation Fibrosis?
- Chronic changes in which the skin appears discolored, dry, hairless, atrophied, fibrotic, and inelastic due to increased collagen deposition and vascular damage
- Superficial blood vessels readily visible
- Ulceration can occur 9 years after radiation therapy
Precautions for Patients with irradiated skin
- Daily skin checks
- Diabete patterns
Infection: Cellulitis
- Acute bacterial skin infection causing inflammation of the deep dermis and surrounding subcutaneous tissue
Risk Factors for cellulitis
- skin injuries
- surgical incisions
- intravenous site punctures
- fissures between toes
- insect bites
- animal bites
what type of patients are at high risk for developing cellulitis?
- diabetes mellitus
- venous insufficiency
- peripheral arterial disease
- lymphedema
Cellulitis Clinical Presentation
- presence of spreading erythematous inflammation
- worsening erythema, edema, warmth, and tenderness
- redness can present as streaky
- generalized malaise, fatigue, and fevers
Most common presentation of Cellulitis
- most common on the lower extremities
- most often unilateral
Cellulitis Management
- Oral antibiotics first line of defense, minimum of 5 days
- Hospitalization may be requires and will include IV medication
