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CHT- Wound Healing
ASHT Test Prep Book Chapter 3
| Term | Definition |
|---|---|
| Epidermis | -Outer layer of skin -Avascular -Thickest in the palms of the hands |
| Epidermal Layers (from superficial to deep) | 1. Stratum Cornenum 2. Stratum Lucidum 3. Stratum Granulosum 4. Stratum Spinosum 5. Stratum Germinativum/Stratum Basale |
| Stratum Corneum | -Outermost layer of the epidermis -Consists of dead, tightly packed keratinocytes |
| Stratum Lucidum | A few layers of dead keratinocytes found only in thick skin (palms of hands) |
| Stratum Granulosum | -Granular, compressed, multi-layered cells -aide in keratin formation |
| Stratum Spinosum | -Several layers of more mature, flattening keratinocytes -aides in keratin production |
| Stratum Germinativum/Stratum Basale | -Single row of keratinocytes which undergoes mitosis to produce keratin -Forms the junction between epidermis and dermis -Role is to increase surface area, provide nutrient transfer, and resist shearing forces -Function decreases with age |
| Epidermis Cell Types | -Keratinocyte -Desmosome -Melanocyte -Merkel Cells -Langerhan's Cells |
| Keratinocyte | -Produces keratin, which is a protective protein that makes skin tough |
| Desmosome | -Binds adjacent Keratinocytes and provides cohesion during keratinocyte migration through epidermal cell layers |
| Melanocyte | -Produces and distributes melanin which absorbs harmful UV radiation |
| Merkel Cells | - Specialized mechanoreceptor that provides information on light touch -function= constant touch pressure; slow adapting STUDY TIPS: MerKONSTANT & MerKONSLOW |
| Langerhan's Cells | -Located in the deeper layers of the epidermis and is the first line of defense against environmental antigens to fight off inflammation |
| Functions of the Epidermis | - protective barrier -immunological response -fluid regulation/homeostasis -sensation -thermoregulation -vitamin D metabolism -cosmetic, emotion expression |
| Dermis | - second layer of skin, 2-4 mm thick |
| Two Layers of the Dermis | 1. Papillary Dermis 2. Reticular Dermis |
| Papillary Dermis | -Most superficial layer of the dermis consisting of ground substance -Conforms to the basement membrane of the epidermis to supply nutrition -Blisters occur here if there is friction between the epidermis and dermis |
| Reticular Dermis | -Deeper, thicker layer of the dermis that provides structural support to the skin -Full of thick fibrous connective tissue |
| Dermis Cell Types | -Fibroblast -Macrophage -Mast Cells -Sensory receptors -Langerhan's Cells |
| Fibroblast | -Produces collagen and elastin, giving the dermis its strength and flexibility |
| Macrophage | -Scavenger cells that ingest dead tissue, repair injured tissue, secrete growth factor to stimulate the cascade of healing, and assist white blood cells in defending against infection |
| Mast Cells | -Produces histamine which causes inflammation -Plays a role in the cellular defense mechanism and blood clotting during injury or infection |
| Sensory Receptors | -Provide information for touch, pressure, vibration, and temperature |
| Types of Specialized Sensory Receptors | -Merkel Cells -Pacinian Corpuscles -Meisner Corpuscles -Ruffini End Organs |
| Pacinian Corpuscle | -256 Hz; movement and vibration -Rapidly adapting -Tested with tuning fork -STUDY: P56 CoRAPID |
| Meisner Corpuscle | -30 Hz; movement and vibration -Tested with tuning fork/moving 2 point discrim -STUDY: MeisneR (R=rapid) MoVement (V=vibration) |
| Corpuscles are consistent with what function? | -MOVEMENT -Rapid adapt and vibration |
| Cells/Organs are consistent with what function? | -PRESSURE -Slow and constant |
| Ruffini End Organs | -Constant pressure, lateral stretch -Slow adapting -Tested with steady pressure, stretching of the skin, joint movement -STUDY: Stretch skin to END with CONSTANT pressure from hands |
| Return in sensibility sequence: | 1. Deep Pressure/Pinprick (Most pressure/time) 2. Moving Touch (more time on skin) 3. Static Light Touch (One single spot with longer pressure) 4. Discriminative Touch (able to locate more specific quicker touch) |
| Dermis Function | -Supports and provides nutrition to Epidermis -Houses epidermal appendages -Infection control against microorganisms -Thermoregulation -Deeper sensation -Protection against mechanical injury |
| Hypodermis/Subcutaneous Tissue | -Hypodermis cells are found in loose connective tissue under the dermis. -This includes adipose tissue, fascia, major blood vessels. nerves, and lymphatic vessels |
| Hypodermis Function | -Energy through storage of calories -Thermal insulation to deeper tissues -Cushioning or a mechanical "shock absorber" to deeper tissues -Supports blood vessels -Controls body shape |
| Types of Blood Components | -Red Blood Cells (RBCs) -White Blood Cells (WBCs) -Lymphocytes -Neutrophil -Platelets |
| Red Blood Cells (RBCs) | -Transport oxygen via hemoglobin to cells of the body and help remove carbon dioxide |
| White Blood Cells (WBCs) | -Part of the immune system and help the body fight infection |
| Lymphocytes | -Identify foreign substances and produce antibodies to target them |
| Neutrophil | -The most common type of WBC -They move from a blood vessel into infected tissue to perform phagocytosis to attack bacteria |
| Platelets | -Play a crucial role in the blood clotting process upon injury -They stimulate fibrin which stabilizes the clot to allow injuries to heal |
| Partial Thickness Wound | -Skin loss through the epidermis and into, but not through the dermis -Epidermal elements remain intact within hair follicles and sebaceous glands in the deeper dermis -Epidermal cells migrate across the wound bed to promote coverage and close the wound |
| How do partial thickness wounds heal? | -Through re-epithelialization, no granulation tissue is present |
| Full Thickness Wound | -Skin loss through the epidermis, dermis, and into the subcutaneous tissue -Can extend into bone, muscle, and tendon -Wound closure achieved by 4 overlapping phases that begin at the time of injury |
| How do full thickness wounds heal? | -Through granulation tissue and angiogenesis |
| Phases of Wound Healing | I. Hemostasis II. Inflammation/Substrate/Lag/Exudative/Defense III. Proliferative/Fibroplasia/Migratory/Reparative IV. Remodeling/Maturation |
| Hemostasis (Phase I) | -Begins at wound onset and lasts up to 24 hours -Platelets from damaged blood vessels come into contact with collagen in the damaged tissue and release growth factors to stimulate thrombin to form a fibrin mesh to bind platelets together (Coagulation) |
| Fibrinolysis | -Describes enzymatic breakdown after clot formation that dissolves the fibrin clot. -This allows cell migration into the wound space, allowing progression to the next phase of healing |
| Inflammation (Phase II) | -Lasts from onset of injury to 4-6 days -Vascular and cellular response is designed to defend the body from further injury and remove dead tissue to prepare for the repair process -Epithelialization and Vasodilation |
| Critical Cells of Inflammation | -Platelets: close off lymphatic channels to increase edema -Neutrophils: enter the wound to destroy bacteria through phagocytosis for 24-48 hours -Macrophages: arrive 2-3 days post injury to remove bacteria and debris. If absent, delayed healing |
| Cardinal Signs of Inflammation | -Redness from the arterioles dilating -Warmth due to increased blood flow -Pain due to change in pH balance and increased pressure from edema -Swelling occurs from transfer of exudates |
| Chronic Inflammation | -Occurs with a complication or contamination -If an inflammatory stimulus persists, WBCs remain in the wound indefinitely, resulting in pus formation and delayed healing. -Overactive macrophages can lead to tissue destruction. |
| Proliferative Phase (Phase III) | -Begins between days 2-5 and ends between days 14-28 -Restoration of mechanical integrity of the wound includes 4 events: 1.) Angiogenesis 2.) Granulation 3.) Wound contraction 4.) Epithelialization |
| Angiogenesis | -Endothelial Cells (angioblasts) form budding capillaries for nutrition to the fibroblasts -Prominent feature of granulating tissue that fills a full thickness wound |
| Granulation | -Tissue is formed with fibroblasts beginning collagen synthesis by manufacturing collagen, ground substance, various proteins, & peptide chains. -Collagen synthesis gives tensile strength & structure to the healing wound so keratinocyte can be produced |
| Wound Contraction | -Myofibroblasts contracting and pulling the wound margins together towards the center of the defect |
| Epithelialization | -Regeneration of the epithelial layer that covers the wound surface -Begins in the inflammatory phase but continues through the proliferative phase. -Epidermis eventually thickens and layers are re-established and the surface becomes keratinized |
| Remodeling/Maturation Phase (Phase IV) | -Starts at approx. day 21 but can start as early as day 7; can last 6 months to 2 years. -Collagen cross linking results in major gains of tensile strength, newly formed scar shrinks, fibroblast and capillary density decreases, causing less redness |
| The healed would will only gain _______% of normal tensile strength of non-injured skin. | 80% |
| Factors that Influence Wound Healing | -Local Wound Environment -Mechanical Influences -Systemic Factors -Clinician-Influenced Factors |
| Scab | -Serves as a biologic dressing for superficial wounds but also acts as a mechanical barrier to epithelialization. -Scab must be softened and debrided if it covers exudate, infection, or a wound of any depth, or it will impede wound resurfacing. |
| Chronic Inflammation | -Leads to increased scarring -Gross edema results in decreased vascularization |
| Dead Tissue can... | -Prolong the inflammatory response, decreases oxygen to healing tissues, and impedes call migration, which prevents re-epithelialization. |
| Hematoma can... | -Separate graft or cause dehiscence, serve as a medium for bacterial growth, and block cell migration which can increase the inflammatory response |
| Systemic factors of wound healing include: | -Comorbid Illness including diabetes, renal failure, etc. -Nutrition/Obesity -Advancing age can cause the dermal layer to thin and flatten the basement membrane between epidermis and dermis. This leads to decreased nutrient transfer and shearing forces |
| Wound Assessment Observations: | -Physical location -Partial/Full thickness depth -LengthxWidthxDepth in cm -Wound bed characteristics -Draining/exudate |
| Types of Tissue within a Wound | - Epithelial -Necrotic -Drainage/Exudate |
| Epithelial Tissue | -Presents as pearly to deep pink in partial thickness wounds and light purple in full thickness wounds. -It is created by new skin cells that migrate from islands or edges across wound surface |
| Types of Necrotic Tissue | -Eschar -Slough -Granulation Tissue -Hypergranulation tissue |
| Eschar | -Dry, desiccated necrotic tissue that feels firm, dry, and leathery. -Brown-Black in color |
| Slough | -Moist necrotic tissue that appears loose, stringy, and fibrinous. -Yellow, gray, tan, or brown in color |
| Remnants of subcutaneous tissue that indicate full thickness damage: | -Slough & Eschar |
| Granulation Tissue | -Presents as beefy, red granular tissue. It grows from base of wound to replace dead tissue in healing full thickness wounds |
| Hypergranulation Tissue | -Tissue that forms and projects above the skin surface and delays epithelialization |
| Drainage/Exudate | -Identified by how much of the dressing is covered in exudate |
| Descriptions of Exudate | -None: wound is dry -Scant: wound is moist, dressing is dry -Minimal: <25% dressing is covered in exudate -Moderate: 25-75% dressing covered in exudate -Copious: >75% dressing covered in exudate |
| Types of Exudate | -Serous -Sanguineous -Serosanguineous -Seropurulent -Purulent/Pus |
| Serous Exudate | -clear, transparent, watery, or yellowish/plasma -normal in acute infmallatory stage |
| Sanguineous Exudate | -Active red bleeding, blood serum -Found in deep partial thickness and full thickness wounds during angiogenesis -Small amounts are normal in acute inflammatory phase -Should not be found spontaneously in chronic wound |
| Serosanguineous Exudate | -Thin, watery blood and serum -Sign of healing wound |
| Seropurulent Exudate | -Thin, watery, cloudy, yellow-tan -Consider the possibility of infection |
| Purulent Exudate/Pus | -Thick, opaque, yellow, tan, green or brown -Not normal in the wound, not always an indicator of infection |
| Red Wound | -Healthy, good blood flow |
| Pale Pink Wound | -Poor blood flow, ischemia |
| White Wound | -Ischemia, maceration |
| Yellow or Grey Wound | -Slough, non-viable necrotic tissue |
| Brown of Black Wound | -Eschar, non-viable necrotic tissue |
| Purple Wound | -Trauma, may indicate high bacteria count |
| Green Wound | -Non-viable tissue, associated with pseudomonas infection |
| Heat, redness, swelling (and discomfort) during the inflammatory phase is ____________________ | -NORMAL -due to cellular processes occurring -Likely not to be a sign of infection |
| Increased warmth may indicate _____________________ | -INFECTION -if past the inflammatory phase |
| Vascularity is determined by... | -wound edema, presence of hematoma, or passing of fluid through spaces |
| Causes of odor may include: | -Hydrocolloid (occlusive) Dressing -A saturated dressing -Necrotic tissue in the wound bed |
| Erythema | -Redness of the skin surface produced by vasodilation -Natural sign of inflammation and can be associated with infection |
| Induration | -Hardening of edges of wound perimeter associated with infection |
| Colors Found in Peri-Wound Tissue: | -Angry Red: infection, often with warmth and edema -Pink: inflammation, possible high bacteria count -White: excess moisture or decreased blood flow -Blue: poor vascularity -Black: necrotic tissue -Purple: tissue trauma |
| Maceration | -Wrinkled white skin from excess moisture |
| TIME (acronym for principles of wound bed preparation) | T= Tissue management I= Infection control and inflammation M=Moisture Balance E=Topical wound management |
| Autolytic Debridement | -Uses the body's own cells and enzymes to break down and liquefy necrotic tissue. -Slow and painless natural physiologic process -Not appropriate for wounds with large amounts of eschar, infections, or with immunocompromised patients |
| Enzymatic Debridement | -Applies an exogenous enzyme ointment to the wound to expedite debridement -Selectively degrades denatured collagen anchored to the wound -Not compatible with silver |
| Biological Debridement | -Uses medicinal sterile maggots to remove devitalized tissue. -Maggots liquify necrotic tissue to ingest and remove bacteria from the wound |
| Types of Selective Debridement | -Autolytic Debridement -Enzymatic Debridement -Biological Debridement |
| Selective Debridement | -Removes only non-viable tissues |
| Non-Selective Debridement | -Removes viable tissue in the process of removing non-viable tissue |
| Types of Non-Selective Debridement | -Mechanical Debridement -Sharp Debridement |
| Mechanical Debridement | -When an external force separates necrotic tissue from the wound base. -This includes scrubbing, irrigation, and whirlpool -It is not used on wounds with granulation or epithelial tissue present (red/bloody looking) |
| Sharp Debridement | -Utilizes a sharp instrument (scalpel, scissors, etc.) to remove necrotic, devitalized tissue at bedside by an experienced practitioner or in an OR by a surgeon for complete transformation to an acute wound bed -The fasted method & the gold standard |
| Contamination | -The presence of bacteria in a wound -Bacteria is not multiplying, do not elicit a host reaction, and od not impair wound healing |
| Colonization | -Replicating bacteria in a wound -Bacteria are attached to the wound surface but do not invade healthy tissue. -Does not elicit a host reaction and does not impair healing process |
| Critical Colonization | -Replicating bacteria in a wound that begins to cause local tissue damage -One or two signs and symptoms of bacteria in the wound may be present |
| Signs and Symptoms of Bacteria in the Wound | -Erythema, pain, heat, swelling, drainage, odor, tissue discoloration, delayed healing, edema in peri-wound, induration, increased pain in wound, absent/abnormal granulation tissue. |
| Infection | -An invasion of bacteria into healthy surrounding tissue. -Lab results indicate 100,000 organisms per gram -Overwhelms the host's immune response and results in multiple host reactions |
| Local infection is described using the acronym NERDS: | N=non-healing E=Exudative R=Red & bleeding at wound site D=Debris or necrotic tissue covering wound bed S=Smell or unpleasant odor |
| Systemic Infection | -Includes 3+ signs/symptoms plus an elevated WBC count, elevated body temperature, confusion and/or agitation, and red streaks extending away from the wound |
| STONES (acronym to describe systemic infection) | S= Size of wound increasing T=Temperature increased O=Exposed or probing bone N= New areas of breakdown E= Exudate/Erythema/Edema S=Smell or foul odor |
| Conditions that limit the expression of inflammation include: | -Neuropathy, ischemia, and venous insufficiency |
| Moisture Balance | -A primary treatment goal is to maintain a moist wound environment because a moist wound heals faster than a dry wound -Excessive moisture adversely affects wound healing, causing tissue maceration and peri-wound inflammation. |
| Dressing options for moist wounds | -Alginate and hydrofiber dressings are used to absorb excess moisture -Should be changed when a "strikethrough" occurs (exudate observed on outermost dressing layer) |
| Epithelial or Edge Advancement | -Epithelialization will occur in an optimum wound environment to decrease wound size. -Undermining, tunneling, and epiboly indicate impaired healing with open wound edges -Dead space is packed to decrease bacteria and avoid abscess formation. |
| Wound Packing | -When undermining, tunneling, and epiboly is present -Plain woven gauze, wound fillers, hydrogel impregnated gauze, or alginates can be used to loosely pack dead space -Avoid tightly packing dead space which can cause pressure and ischemia |
| Topical Wound Management | -Normal saline or potable tap water is suitable for cleansing clean, healing wounds. -Cleansing solutions should be used to cleanse wounds with debris and suspected or confirmed infection. -Wound healing will not occur if infection is present |
| Topical antiseptics/antibiotics should not be used longer than _____ weeks. | -TWO |
| Acetic Acid | -Anticeptic -A bactericidal effective against pseudomonas |
| Betadine | -A fast acting, broad spectrum antiseptic. -It is cytotoxic to healthy tissue and should only be used when the primary objective is to reduce bacteria. -It is used when tissue toxicity is not the primary concern |
| Hydrogen Peroxide | -Anticeptic -Should not be used on wounds -It is cytotoxic to healthy tissue and has limited effects as an antiseptic |
| Types of Topical Antiseptics | -Acetic Acid -Betadine -Hydrogen Peroxide |
| Types of Topical Antibiotics | -Bactroban -Bacitracin -Silvadene (Silver Sulfadiazine) |
| Bactroban | -Active against Methicillin-resistant Staphylococcus Aureus (MRSA) |
| Bacitracin | -Wide spectrum, commercially available over the counter as a triple antibiotic ointment |
| Silvadene (Silver Sulfadiazine) | -Broad spectrum and appropriate for burns, cuts, incisions, and ulcers. -It hampers contraction of fibroblasts but does not hinder epithelialization |
| Impregnated Gauze | -Non-adherent covering, readily available and easy to use -Used for healthy tissues, over sutures, wounds with minimal absorption with a secondary layer -Contraindications= high exudate or maceration |
| Transparent Film | -Thin, clear, polyurethane, waterproof semi-permeable adherent dressing that allows visualization -Used for skin tears and superficial wounds -Contraindications= wounds with exudate because there is no absorption |
| Contact Layer | -Thin, porous, non-adherent sheet that is placed directly on the wound bed for protection -Used for partial and full thickness, draining wounds, and donor sites -Contraindications= Wounds with eschar or viscous exudate |
| Hydrocolloids | -Opaque wafer dressing that turns moisture into gel; provides moist environment to promote autolytic debridement. -Used over exposed tendons, partial/full thickness, and clean, minimally draining wounds -Contraindications= infection & heavy exudate |
| Hydrogel | -Hydrophilic polymer networks that absorb and donate moisture to the wound; promotes autolytic debridement, granulation & epithelialization -Used for minimally draining wounds and painful areas -Contraindications= high exudate |
| Foams | -Open cell polyurethane-based covering that adheres to intact peri-wound & can be impregnated with antimicrobial agents; left on for 7 days -Used for mod-heavy exudate and with presence of hyper-granulation -Contraindications=dry eschar &full thickness |
| Active Leptospermum | -Medical grade honey in gel, alginate form that decreases wound colonization of bacteria and promotes autolytic debridement -Used for minimal necrotic tissue or slough -Contraindications = heavy exudate & excessive necrosis |
| Alginates | -Seaweed dressing made with calcium fibers in rope or flat sheets that interacts with sodium ions to draw exudate and bacteria out of wound & promotes autolytic debridement -Used for heavy exudate & bleeding- highly absorptive -Contraindications= dry |
| Hydrofibers | -Soft sterile pad made of sodium carboxymethylcellulose & can be impregnated with antimicrobial agents -Highly absorptive & ideal for heavily draining wounds, partial or full thickness -Contraindications= dry wounds |
| Negative Pressure Wound Therapy (Vacuum-Assisted Closure/VAC) | -Mechanical treatment that applies suction to the wound bed -Uses negative pressure to eliminate fluid collection, increases oxygen tension, and decreases contamination |
| Benefits of Wound VAC | -Increases perfusion & maintains moist wound environment -Prevents hematoma -Improves graft take in burns |
| Primary Intention/Primary Closure Healing | -Wound edges are brought together and held in place by mechanical means like suture, staple, tape, etc. -Reliance on artificial means to hold the wound together stops at 10-14 days |
| Secondary Intention/Secondary Closure Healing | -When a wound is not closed mechanically, but allowed to remain open and closes by the biological process of tissue granulation, wound contraction, and epithelialization. |
| When is Secondary Intention appropriate? | -For untidy wounds or procedures where complications of hematoma, skin slough, or loss of motion is a concern. -It is acceptable where tissue loss is small, and deformity will not occur |
| When is Secondary Intention NOT appropriate? | -When crossing a joint -Requires more time and therapeutic management due to more scar tissue, scar contracture, and fixed/rigid scars |
| Delayed Primary Closure/Tertiary Intention | -A wound allowed to heal for a short time by secondary intention and then closed surgically via primary closure -Appropriate for untidy and/or infected wounds |
| Split Thickness Skin Graft (STSG) | -A graft that consists of the entire epidermis and part of the dermis. -Typically viable between days 3-5 -Sometimes meshed to allow drainage & increase surface area -Secondary contraction (AKA wound bed contraction) is high |
| Full Thickness Skin Graft (FTSG) | -Consists of the entire Epidermis and Dermis -Donor site requires primary closure or STSG to heal -Typically viable in 5-7 days but greater risk of nonadherence compared to STSG -Often harvested from hypothenar eminence, medial arm, or groin |
| Skin Flap | -For wound beds with limited blood supply or where gliding structures are exposed (i.e. blood vessels and tendons) -The pedicle refers to the local blood supply of the flap that is preserved |
| Random Flap | -Receives blood supply from sub dermal or subcutaneous plexus |
| Axial Flap | -Receives blood supply from a single blood vessel |
| Local Flap | -AKA Random pedicle flap -Comes from the tissue adjacent to the wound and receives blood supply from the sub-dermal layer |
| Z-Plasty | -Generally used for defect on the volar surface of the hand and is useful in reducing scar contractures that cross the normal skin creases |
| V-to-Y Advancement Flap | -Indicated for transverse and/or dorsal oblique fingertip amputations with exposed bone and intact nail bed. -Provides excellent sensation and soft tissue coverage -Contraindicated in volar oblique tip amputations |
| Moberg Advancement Flap | -Used to maintain length in distal thumb amputation -May require positioning for tension as it may cause a secondary thumb IP flexion contracture, but places the thumb in a functional position. |
| Pedicle Flap | -Requires vascular dissection and microvascular anastomosis to blood supply. -The defect is attached to the recipient site and approximately 3 weeks later is separated with another surgical procedure |
| Free Tissue Transfer | -Requires vascular dissection and microvascular anastomosis -Provides immediate vascularity but may need vein graft if the vascular pedicle is tight -Early mobilization and positioning for edema management |
| Skin Substitutes | -Cellular and acellular tissue products engineered to prepare the wound bed for autograft application or designed as a substitute for human skin. -Can be temporary or permanent solutions |
| Integra Bilayer Matrix Wound Dressing | -Synthetic, permanent, acellular bilayer matrix dressing consisting of epithelial and silicone layers comprised of bovine tendon collagen and glycosaminoglycan -Promotes revascularization and neodermis formation -Appropriate for clean, noninfected wound |
| Apligraf Living Cellular Skin Substitute | -Bioengineered cellular skin substitute created from bovine collagen and foreskin derived neonatal keratinocytes and fibroblasts -Appropriate for clean, noninfected wounds |
| Cultured Epidermal Autograft (CEA) | -Permanent skin substitute that replaces the epidermal tissue layer with murine fibroblasts to form into sheets of new skin. -It is then transferred from culture vessel to wound bed -Used on large surface area burn patients without remaining skin |
| Thermal Burn | -The most common type of burn -Caused by moist or dry heat, flame, scald, or contact with hot structures |
| Chemical Burn | -Require identification of caustic material and the neutralizing agent because the chemical can stay active and continue to destroy tissues |
| Electrical Burn | -Have an entrance and an exit wound and are caused by hi-voltage or low-voltage currents. -Peripheral nerve injuries occur in association with high voltage injuries from the current passing through nerve or muscle compartments |
| Friction Burn | -Caused by a mechanical force rubbing against the skin surface |
| Radiation Burn | -Occur as a direct result of radiation therapy -It damages proliferative (normal, non-targeted) skin cells in the lower epidermis |
| Burn size is described as... | -The total body surface area (TBSA) as a percentage |
| Palmar Method | -Hand and fingers of the patient equates to 1% |
| Lund Browder Method | -Assigns percentages to different regions of the body based on age. -This is the most accurate for adults and children |
| Rule of Nine | -Applies as a multiple of nine assigned to each body part as percentage of burn |
| Superficial Burns | -Involve only the epidermis -Erythematous and painful -Cell damage occurs without cell death, allowing complete scarless healing in 3-5 days via re-epithelialization -Not included in TBSA % |
| Superficial Partial Thickness Burns | -Involve the epidermis and the superficial dermal layer (papillary dermis) -Red, shiny, blistering, weepy, and wet & extremely painful -Tissue blanches upon palpation with quick capillary refill -Can heal o their own in 14-21 days |
| Deep Partial Thickness Burns | -Involve the epidermis and extend into the deep dermal later (retinacular dermis) -White, yellow, or charred with eschar adherent to the wound surface -Deep wounds are less painful due to destroyed nerve endings -Heals in 3+ weeks, may require graft |
| Full Thickness Burns | -Extend through the epidermis, dermis, subcutaneous tissue, and into muscle, tendon, and bone. -Deep red, white, or black with a dry, leathery appearance with total loss of sensibility and no pain -No capillary refill and not capable of healing |
| Dakin's Solution | -Burn cleaning solution made from bleach that has been diluted and treated to decrease irritation -Effective against microorganisms known to infect burn wounds |
| Debridement | -Removal of necrotic tissue to lower infection risk, prevent impaired blood flow, and ischemia. |
| Dorsal Hand Burn Orthotic Positioning | -Resting Pan or Intrinsic Plus Orthosis |
| Palmar Hand Burn Orthotic Positioning | -Volar digital abduction orthosis |
| Circumferential Hand Burn Orthotic Positioning | -Modified resting pan orthosis |
| Biologic Dressing Options for Superficial Burn | -Moisturizers, creams, and petrolatum topicals |
| Biologic Dressing Options for Superficial Partial Thickness Burns | -Petrolatum topicals, petrolatum gauze, hydrogels, contact layers, foams |
| Biologic Dressing Options for Deep Partial Thickness Burns | -Foams, hydrofibers, alginates, antimicrobials, active leptospermum (medical grade honey) |
| Biologic Dressing Options for Full Thickness Burns | -Antimicrobials, sulfamylon, collagenase |
| Which type of cell produces histamine? | -Mast Cell -REMEMER: HistaMAST |
| Epibole | -Occurs when the upper edge of the epidermis rolls under the basement membrane and prevents epithelial migration -Prolongs wound healing |
| Undermining | -Involves a portion of the wound edge and proceeds as tissue destruction under intact skin |
| Scar | -Fibrous tissue that replaces normal tissue destroyed by injury or disease -Wound depth and duration until closure directly correlate with increased scar formation |
| Abnormal Scars Occur... | -By an excessive accumulation of collagen, increased collagen synthesis, or decreased collagen degradation -If the rate of production exceeds breakdown, abnormal scar develops |
| Keloid Scars | -Extend beyond the original wound border and lack regression -Higher incidence in darker pigmented skin, trauma, delayed healing, and after burns |
| Hypertrophic Scars | -Bulky scars that are elevated above the skin and stay within the boundaries of the wound & are more common than keloid scars -Improves with therapy and eventually flattens in 1-2 years -Can be found across joints and in areas of motion |
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