Physiology of Healing Flashcards
3 phases of healing
inflammatory response
fibroblastic repair
maturation-remodeling
T or F: the body must go through the inflammatory response to heal
T
symptoms of inflammation
swelling, pain, warmth, redness, crepitus, loss of function
what happens during the inflammatory phase? how long is it?
- the injured area is walled off and leukocytes phagocytize foreign debris
- lasts 2-4 (up to 10) days after injury
physiological cause of edema
increased permeability of blood vessels
physiological cause of erythema and warmth
increased blood flow
what are some factors that influence inflammatory phase?
- medical conditions
- meds
- immobilization
- location of injury
- age
- nutrition
- physical agents
acute inflammation
local tissue damage
pain all the time
sub-acute inflammation
pain is actively related
can last 4-6 weeks if not managed
chronic inflammation
the longer pain lasts, the high the chance of pain being referred away from original location
* sign of impaired healing
what happens in the fibroblastic repair (proliferative) phase? how long is it?
- regeneration leads to scar formation and repair of injured tissue
- lasts 4-6 weeks
fibroplasia
the formation of fibrous tissue beginning within the first few hours after injury
clinical signs of fibroplasia
- inflammation signs subside
- if open wound you will be able to see tissue formation
by 6-7 days after injury fibroblasts begin producing _________
collagen
T or F: A persistent inflammatory response can lead to abnormal proliferation
T: due to extended fibroplasia and fibrogenesis (hypertrophic and keloid scars may result)
what happens in maturation-remodeling phase? how long?
- realignment of collagen fibers along lines of tensile force
- ongoing breakdown/ synthesis of collagen
- may require several years to complete
how is scar tissue different than normal tissue
lacks elastin and weaker
scar tissue is initially type ___ collagen in a random pattern and once it matures it is type _______ in an organized pattern
3,1
*no elastin like in normal skin
what are some local factors associated with delayed healing
moisture
pressure
friction
shear
continued injury
inappropriate management
what are some systemic factors associated with delayed healing?
circulation
sensation
inadequate nutrition
age
body habitus
co-morbidities
meds
behavioral risk taking
hydrostatic pressure
pressure exerted by a fluid on an immersed body
osmotic pressure
pressure that causes diffusion between fluids with different concentrations
dependent position
feet lower than the rest of the body
subjective questions to ask related to edema
- when did it start
- injury/surgery?
- what makes it better/worse?
- is it always like this?
- both legs or one leg?
- pain?
- are shoes and socks fitting?
- heavy legs?
- tightness in legs?
objective measures related to edema
assess skin
decreased hair growth
decreased pulses
erythema/cellulitis
thickening of skin
ulceration
Homan’s sign assesses for?
DVT
gold standard for DVT assessment?
ultrasound
2 indications to take a circumferential measurement
edema
atrophy/hypertrophy
*could also use volumetrics
adverse consequences of edema
- delayed healing
- restricted ROM
- function limitations
- pain
- increased infection risk
- subcutaneous tissue fibrosis
- ulceration
when determining treatment for edema what should you determine first?
etiology
PRICE treatment
Protect
Restricted activity
Ice
Compression
Elevation
what does ice (cryotherapy) do?
- decreased metabolism to control secondary hypoxic injury
- analgesia
- possibly cause vasoconstriction
how long should you use ice
20 mins to 1 hour, depending on the agent
effects of compression
- controls peripheral edema
- manages scar formation
- prevents DVT
- promotes lymphatic and venous return
- shaping of residual limb
contraindications for compression
- circulatory obstruction
- DVT
- heart failure
- infection of treated area
- malignancy of treated area
- unstable or acute fracture
- pulmonary edema
compression options
- elastic wraps (short or long stretch)
- compression garments
- intermittent pneumatic compression
- cryocuff
- deep water submersion
indications for intermittent compression
edema, venous insufficiency, prevention of DVT, lymphedema
the pressure for intermittent pneumatic compression should be greater than _______. why?
30mmHg
this is arterial capillary pressure
total treatment time for intermittent pneumatic compression
at home: >1 hour, 2-3 times a day
long stretch elastic wraps have a ________ working load and ______ resting load
low
high
long stretch elastic wraps should be applied in what pattern
figure 8
*from metatarsal heads to tibial plateau
should you wear long-stretch elastic wraps at night
no
should stretch bandages have a ________- working load and a _______- resting load
high
low
short stretch bandages are applied how
circumferentially with padding
primary use of short stretch bandages
lympedema
how long should you elevate legs
30mins to 1 hour at a time
*try to get them above your heart
kinesiotaping works on what system
lymphatic
how do you start the anchor in KT taping for edema?
in direction you want the lymphatics to flow
contraindications for kinesiotaping for edema
- fragile or healing skin
- over malignant areas
- areas cellulitis/infection
- allergies to tape
is ice and rest appropriate if a patient’s edema is due to a medical condition
no
treatment options for edema due to a medical condition
- calf muscle pump
- elevation
- compression
