Principles of Wound Healing part 2 Flashcards
How does pressure mapping help the clinician?
Helps them obtain objective, real-time levels of pressure under the foot
What type of conditions can you use pressure mapping in?
In the shoe
Prosthetic
Wheelchair seating system
Standing
What is hyperbaric wound therapy and what is the point?
Place patient in 100% oxygen environment below sea-level to improve oxygen levels in the body
What limits hyperbaric wound therapy?
RBC only have so many bonding sites for O2
What are the hyperbaric wound indications (14)
Air or gas embolism Carbon monoxide poisoning Gas Gangrene Crush injury, compartment syndrome, and other acute traumatic ischemia Decompression Sickness Arterial insufficiencies Severe Anemia Intracranial Abscess Necrotizing Soft Tissue infections Osteomyelitis (refractory) Delayed radiation injury (soft tissue & bony necrosis) Compromised graft and flaps Acute thermal burn injury Idiopathic Sudden Sensorineural Hearing Loss
What type of wound therapy removes fluid from open wound through sealed dressing and tubing connected to a collection container?
Negative Pressure Wound therapy
How does negative pressure wound therapy work?
Vacuum suction creates pressure on the tissues
What is dermal closure?
Anchors placed in the skin around the wound with a tensioning cable to improve tissue extensibility on a subnormal level
What type of closure is used with dermal closure?
Tertiary Closure (once skin is stretched enough)
How can you provide some edema management?
Provide external support to vascular structures
Increase extracellular pressure which can force fluid back into vasculature
Works best with assistance of muscle pump
What is LA Place’s Law?
(tension)(#of layers)(Constant)
________________________
(circumference of limb)(bandage width)
More layers and tension increase compression
Bigger the leg/wider the bandage decrease compression
What are some systematic questions you want to know with edema management?
CHF
Renal Status
Respiratory status
What are some temporary compression options?
Unnaboot
Multi-layer compression bandaging
Elastic Compression Bandages
Elastic Compression Tubing
What is a Unnaboot and what does it do??
Type of multilayer wrap
Applies approximately 20-30 mmHg pressure
What is the 1st layer of a unnaboot composed of?
Impregnated gauze layer
(forms soft cast around the foot, second skin that isn’t rigid, but doesn’t expand)
Has zinc oxide or calamine lotion on it
What is the top layer of a unnaboot?
Conan or ACE wrap
can put a layer of cotton padding between if needed
What type of patients does a unnaboot work best with?
Active patients
- Higher active pressure
- Lower resting pressure
How tight do you want the unnaboot?
Make sure there is still a capillary refill of at least 3 seconds
What are they types of Multi-layer compression bandages?
2-layerd (coban 2, coban2lite, ProGuide)
3-layered (dyne-flex)
4-layered (profore)
What does pressure depend on with multi-layered compression?
Amount of layers & amount of tension
more layers more compression
What type of patients does multi-layered work best for?
Less active patients
have a higher resting pressure
What are the types of stretch an elastic compression bandage can have? (3)
Variable = (long stretch, ACE bandage) Measured = (have indicators markings to assist clinician, Setopress and Surepress) Short = Less elastic with better memory (higher resting pressure)
What are some characteristics of variable stretch bandages?
- Should be limited if used for extremely short term use in non complicated wounds
- Only used to manage edema on patients with good blood flow
- Extra care taken to prevent a tourniquet-like effect and skin damage
What are some characteristics of short stretch elastic compression?
- Apply higher resting pressure
- Less elastic with better memory
- Treatment often used with lymphedema
- Protective padding placed below short stretch wraps to protect skin and improve comfort
