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310 Cards in this Set
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- 3rd side (hint)
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Name the 5 layers of the epidermis
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stratum corneum, stratum lucidum, sratum granulosum, stratum spinosum, stratum germinativum (Basal layer) [californians like girls in stringy bikinis)
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Primary cell in dermis
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fibroblasts
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responsible for the formation of collagen matrix and elastic proteins during the proliferative phase
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fibroblasts
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fibroblasts occasionally transform into these cells during the latter part of the inflammatory phase leading to wound contraction
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myofibroblasts
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myofibroblasts produce this substance during the formation of granulation tissuec
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collagen type 3
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Basophils release these 2 substances during the inflammatory phase
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histamine and heparin
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Along with neutrophils, these cells are the major phagocytic cells of the immune system
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macrophage
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On the braden scales, what is the significance of lower scores?
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lower function and higher risk of developing pressure sores
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cut-off for high risk on Braden scale in hospitalized patienst
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16
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Score of 15-16 on Braden scale indicates what?
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mild risk, 50% chance of developing stage 1 ulcer
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score of 12-14 on Braden scale indicates what?
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moderate risk 65-90% chance of developing stage I or II lesions
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scores<12 on Braden scale indicate this
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90-100% chance of developing stage II or deeper pressure ulcer
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elements of Braden scale
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Sensory perception, moisture, activity, mobility, nutrition, susceptibility to friction and shear
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5 components of norton scale
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physical condition, mental state, activity, mobility, incontinence
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Epidermis is composed of this cell
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keratinocytes
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fibroblasts synthesize this type of collagen during formation of granulation tissue
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collagen type 3
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These cells are located in epidermis (stratum spinosum) and digest invading bacteria and antigens
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langerhans cells
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What is responsible for darker pigmented skin?
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size and activity of melanocytes (not the number)
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What are the calorie needs per day in wound healing?
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30-35 cal/kg/day
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What are the protein needs for day in wound healing?
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1.25-1.5g protein/kg/day (sometimes up to 2g protein/kg/day
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What are the 4 phases of wound healing?
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1) hemostasis
2) inflammatory phase 3) proliferative phase 4) maturation phase/remodeling phase |
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Melanocytes are located in this layer of epidermis
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stratum basale
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The stratum basale is separated from the dermis by this layer
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basement membrane (attached by hemidesmosomes)
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complete epidermal renewal takes this many days
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45 days
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Vitamin D is synthesized in this skin layer
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epidermis
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How does hyperbaric oxygen facilitate wound healing/
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1) support WBC bacterial destruction
2) allow fibroblasts to proliferate and build collagen 3) develop new epithelial tissue |
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skin is made up of this type of collagen
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type 1
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This dermal layer has capillary loops which supply oxygen and nutrients to the epidermis
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papillary dermis
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Vascular vessels are in this layer of the dermis
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reticular dermis
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elastin is secreted by this cell
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fibroblasts
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This is secreted by keratinocytes in response to hypoxia
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vascular endothelial growth factor
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2 major proteins found in dermis
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colagen and elastin
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primary cell in hypodermis
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adipose
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epithelial cells secrete this enzyme to break up a scab
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matrix metalloproteases
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what is diapedesis?
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leukocytes migrate through dilated capillaries into wound bed during inflammatory phase
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which leukocyte contributes the most to the wound repair process?
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macrophages
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What is hydroxylation?
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crosslinking of proline and lysine molecules in collagen (requires o2, Vit C, copper and iron); essential for development of tensile strength
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Tensile strength of remodeled scar tissue is never more than ___% of the tensile strength of nonwounded tissue
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80
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The first phase of wound healing by primary intention
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epithelialization
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The last phase of wound healing by secondary intention
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epithelialization
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in a chronic wound, there is no initial bleeding event to trigger this:?
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fibrin production and release of growth factorst
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This proinflammatory cytokine attracts neutrophils and macrophages to the wound bed and is present in high concentrations during the inflammatory phase.
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TNF-alpha
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3 risk factors for keloid formation
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1) family history
2) pigmented skin 3) age 10-30 |
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An individual who has sustained more than ____serious sunburns is at increased risk of melanoma
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6
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This growth factor is a potent stimulant of collagen deposition
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transforming growth factore
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most common classification for skin tears
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Payne-Martin
Category 1: skin can fully approximate wound Category 2: skin tear with partial thickness loss Category 3: skin tear with complete tissue loss |
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most frequent site of skin tear
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forearm
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erythrasma (mildly pruritic, reddish brown pigmentation, seen in skin folds of overweight/diabetic) is caused by this bacteria
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corynebacterium (if you apply UV light, the skin will glow a coral color)(
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when are the greatest skin reactions to radiation seen?
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at the end of therapy since effects are cumulative.
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What is "radiation recall"?
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"recalling" by skin of previous radiation exposure following administration of certain chemotherapy agents (docetacel, doxorubicin, gemcitabine, and paclitaxel)
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Do products containing aluminum, magnesium and zinc cause a "Bolus effect" with radiation dermatitis
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no
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Which product may decrease radiation dermatitis in breast cancer patients?
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calendula
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This drug may reduce the severity of late radiation therapy when administered preventatively in the postradiation period
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pentoxyfylline
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Which type of foam is better at pressure ulcer prevention? - open cell or closed cell?
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open cell
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Mattress overlays are in this medicare group
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group 1 -
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air flotation beds are in this medicare group
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group 2
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air fluidized beds are in this medicare group
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group 3
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atrophic think smooth white plaque with a hyperpigmented border seen Lower extremity venous disease (looks like a healed ulcer); presence = high risk for ulceration
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atrophic blanche
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During the assessment of elevation pallor in lower extremities, pallor within 25seconds indicates what?
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severe occlusive disease (40 sec - moderate, 60sec - mild)
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ulcer with a "punched out" appearance
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arterial ulcer
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normal ABI range
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1-1.3
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ABI range for lower extremity arterial disease
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< or equal to 0.9.
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severe ischemia as per ABI
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< or equal to 0.5 (Wound healing unlikely unless revascularization occurs)
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If ABI >1.3, what should you suspect?
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noncompressible arteries as seen in diabetes
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Transcutaneous oxygen pressures less than this reflect tissue hypoxia and are associated with delays in wound healing
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40mmHg
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skin perfusion pressures greater than this value are needed for wound healing
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>30mmHg
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Most commonly recommended drug for symptomatic lower extremity arterial disease due to antiplatelet and vasodilatory effects
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cilostazol.
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sustained compression hose should be avoided in patients iwth this ABI
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0.5 or less
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What is Stemmer Sign
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not possible to pinch fold of skin over dorsum of 2nd toe - early indicator of lymphedema
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antiembolism stockings provide this much pressure
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15-17mm Hg
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negative prognostic factors for venous wound healing
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1) ulcer size >5cm
2) longer duration >6 months 3) failure to show healing during first 3-4 weeks of compression therapy |
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What is subfascial endoscopic perforator surgery
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ligation of incompetent perforator veins which prevents backflow from deep to superficial venous system
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The thoracic duct (Drains legs) empties into this
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left subclavian vein
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lymph drained from the right side of the head, neck, thorax and right arm drains into this
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right thoracic duct -->right subclavian vein
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The left arm and left head drain into this lymphatic duct
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left thoracic duct
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define acute lymphedema
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< 6months, pitting edema, no brawny skin changes
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congenital lymphedema is detected within this age
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by 1 year of age
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lymphedema praecox is detected from these ages
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1-35
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lymphedema tarda is detected after this age
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35
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familial form of congenital lymphedema
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Milroy disease
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Most common type of primary lymphedema
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lymphedema praecox (Meige disease) - usually involves foot or calf
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parasitic infection of lymph system
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filariasis (Wuchereria bancrofti)) transmitted by mosquitos
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most common cause of lymphedema worldwide
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filariasis
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list stages of lymphedema
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stage o: subclinical
stage 1: reversible pitting stage 2: nonpitting edema, +stermmer sign stage 3: elephantiasis, ulcerations |
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what is bioimpedance spectroscopy?
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electrical current is passed through the limb and impedance flow is measured. Increased impedance= lymphedema
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What is the Wagner classification?
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diabetic ulcer classification system
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Why was the Wagner classification system modified by the WOCN society?
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Wagner only classified on the depth of the lesion and the presence of osteo/gangrene. WOCN added ischemia and infection (does not address neuropathy)
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Infection rarely causes diabetic foot ulcers - true or false
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true - ulcers provide a portal of entry for pathogens
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ideal PH for collagenase
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6-8
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majority of cellular products used in chronic wound care are produced with these types of cells
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allogeneic cells (cells derived from other humans) - usually derived from neonatal foreskin
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oasis is derived from this
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porcine small intestine submucosa
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typical HBO treatments take place at a pressure of ? ATA or ?psig
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2.0-2. ATA (Atmosphere absolute) or 14.7-22.0psig
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transcutaneous oxygen readings greater than ?mmHg are associated with wound healing
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400mmHg
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transcutaneous oxygen readings less ?mm Hg when breathing room air and less than ? mm Hg during HBO exposure are predictive of wound healing failure
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15, 100
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patients who have history of taking this chemotherapy agent cannot use HBO
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bleomycin - associted with oxygen toxicity
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Describe UV treatment procedure for wound healing
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lamp is kept 1 inch from wound perpendicular to surface. Treatment last 90-120seconds. Treatment should be discontinued when bioburden is adequately reduced
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If erythema is present from last UV treatment, is it ok to proceed with the next?
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no
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List contraindications to UV therapy?
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skin cancer, SLE, fever, radiation therapy in last 3 mo, sarcoidosis, treatment over eye, redness from last treatment
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freqeuncy of traditional high frequency US
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1-3.3Mhz
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what are the 2 benefits of low frequency ultrasound
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wound size reduction and bioburden reduction
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Low frequency US is used for what?
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debridement
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marasmus
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protein-calorie malnutrition
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kwashiorkor
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protein malnutrition
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energy needs are usually based on this equation
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harris-benedict equation
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usual caloric needs for wound healing
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20-35 calories per kilogram
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protein need for wound healing
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1.25-1.5g/kg per day
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amino acid necessary for collagen formation
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arginine
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Vitamin A reverses all effect of corticosteroids except for their impairment of this?
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contracture
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length of treatment of zinc deficiency
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7-10 days
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risk of overtreatment with zinc
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copper deficiency, disruption in normal phagocytic activity
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daily vit C requirement for wound healing
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1000mg
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daily zinc requirement for wound healing
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30mg
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daily vit A requirement for wound healing
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2000 retinol equivalent
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2 spider bites that cause tissue damage
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brown recluse and black widow
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describe the classic sign of a brown recluse spider bite
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"red, white, and blue": ring of blanched skin due to vasoconstriction, surrounded by erythema with gray to red purple bullae at the site of the bite
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brown recluse spider bites are more likely to be necrotic on these parts of the body
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thighs and buttocks due to significant adipose tissue
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pyoderma gangrenosum affects can be seen in these 2 disease
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IBD and RA
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this lesion has irregularly shaped wound edges that are elevated and violaceous
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pyoderma gangrenosa
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Abnormal or exaggerated inflammatory response to noxious stimuli seen in pyoderma gangrenosum
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pathergy
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systemic treatment of pyoderma gangrenosum
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corticosteroids and cyclosporine
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why is sharp debridement and skin grafts contrainidcated in pyoderma gangrenosum
|
will extend lesion by pathergy
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silver sulfidiazine is contraindicted in newborns for what reason
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increased risk of kernicterus
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skin condition characterized by indurated, necrotic lesions with a violaceous discoloration seen in 5% of dialysis patients
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calciphylaxis
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antibiotics most commonly associated with TEN
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sulfa
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slight thumb pressure applied to intact skin next to blisters causes the skin to wrinkle and slide laterally = hallmark sign in TEN
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Nikolsky's sign
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How should a biopsy be done for suspected marjolin's ulcer?
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from multiple sites and multiple depths
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etiology of TEN
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T-cell mediated immune reaction leading to massive keratinocyte death leading to epidermal detachement
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name the 3 zones of a burn
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zone of coagulation, zone of stasis, zone of hyperemia
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most accurate method for calculation of burn surface area
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Lund-Browder chart
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side effect of silver sulfadiazine
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leukopenia (resolves are first week even with continued use)
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side effect of mafenide acetate
|
metabolic acidosis
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List most commonly contracted joints after burns
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shoulders>elbow>knees
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What is an axial flap?
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contains an artery which increases vascularity and chances for flap survival
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What is a random flap?
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depends on dermal and subdermal vessels for blood supply
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high output fistulas produce this much fluid in 24 hours
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500ml
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low output fistulas produce this much fluid in 24h
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200ml
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~how many fistulas close spontaneously
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20-40%
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what is a simple fistula?
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short direct tract, no abscess and no other organ involved
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what is a complex fistula?
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+abscess, multiple organ involvement, may open into base of wound
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Layer of epidermis that replaces shed corneum and is only found on soles, palms and fingertips
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stratum lucidum
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cell contact to basement membrane is via this structure
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hemidesmosomes
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cell to cell contact in epidermis is via this structure
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desmisomes
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This layer of the dermis has pain touch receptors
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papillary dermis
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This layer of the dermis forms strucures with the rete ridges of the epidermis
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papillary dermis
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forms base of dermis
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reticular dermis
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primary type of collagen in dermis
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type 1
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secreted by fibroblasts and gives skin its elastic recoil
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elastin
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this growth factor is a potent stimulant for collagen production
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transforming growth factor
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This transforming growth factor is important for the regulation of inflammation and blocking it may decrease scar formation
|
TGF-B1
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electrical current used for wound healing
|
high voltage pulsed current
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Contraindications to E-stim
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1) CA in the wound
2) osteomyelitis (if not responding to ABX) 3) iodine/isilver in wound 4) over electronic implants 5) over the heart |
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True or false: The higher the frequency of US, the less penetration
|
true
(3mhz- superficial dermal wounds 1mhz= deeper structures |
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what is the main benefit of UV light therapy for wound care?l
|
bacteriocidal properties
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What is the main benefit of ultrasound therapy for wounds?
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increase circulation, debridement,
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what is the ideal pressure for delivery of wound cleaning solution?
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8-15 psi (35ml syring with 19 guage needle)
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hydrophilic colloid particles bound to polyurehan foam or film
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hydrocolloid
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contraindication to hydrocolloid dressing
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infection
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noncrosslinked polymers plus water and/or glycerin
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hydrogel
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major advantage of hydrogels
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hydration of the wound bed
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composite of fibers derived from seaweed
|
calcium alginate
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can calcium alginates be used with infected wound?
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yes
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regranax is used for this type of wound
|
lower extremity diabetic neuropathic ulcers
|
platelet derived growth factor
|
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braden scale scores
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mild risk: 15-18
moderate risk 13-14 high risk: 10-12 very high risk: 9 or below |
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When should you advance to next level of risk for braden scale?
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other major risk factors are present: age, fever, poor dietary intake of protein, diastolic pressure< 60, hemodynamic instability
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hyperglycemia interferes with cellular transport of this into fibroblasts and leukocytes
|
vitamin C
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Is hyperglycemia's effect on inhibiting endothelial cell activity reversed with insulin?
|
no
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This equation is most commonly used for basal energy expenditure
|
harris-benedict equation
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protein requirements for wound healing
|
1.5gm/kg/ (may go up to 3gm in burns)
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mechanism of omega 3 fatty acid impairment on wound healing
|
decreased cross linking of collagen
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Vit A has these 2 mechanisms in vitro
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1) increases collagen synthesis of fibroblast cell cultures
2) increases epidermal growth factors |
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essential co-factor in hydroxylation of lysine and proline in collagen synthesis and crosslinking of mature collagen
|
Vitamin C
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cofactor required fro conversion of hydroxyproline to proline in collagen maturation
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iron
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Inducible isoform is synthesized early in the inflammatory phase of wound healing, primarily by macrophages
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Nitrous oxide
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most virulent wound bacteria
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beta hemolytic Group A strep
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this wound medication can cause metabolic acidosis by inhbiting carbonic anhydrase
|
sulfamylon
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gas gangrene is typically caused by this bacteria
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clostridum perfringens
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safe debridement can be carried out if the transcutaneous oxygen is greater than?
|
30mmHg
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in the formation of collagen, hydroxylation of these 2 amino acids requires oxygen
|
proline and lycine
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If transcutaneous o2 is less than this, the wound will not heal
|
20mmHg
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amount of compression to treat lymphedema
|
40-60mmhg with compression stockings
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treatment of varicose veins with compression stockings (what gradient?)
|
20-30mmhg
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most common cause of lymphedema worldwide
|
filariasis
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What grading scale is used for neuropathic foot wounds?
|
Wagner scale
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0- preulcer
2-superficial ulcer 3-full thickness ulcer 4-deep ulcer with infection/osteo/abscess 5-gangrene of part of foot 6-gangrene of entire foot |
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What is Wagner Level 5?
|
gangrene of entire foot
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What is Wagner Level 4?
|
gangrene of toes or forefoot
|
0- preulcer, @ risk
1-superficial ulcer 2-full thickness ulcer 3-deep ulcer with abscess, osteo 4- gangrene of part of foot 5- gangrene of whole foot |
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What is Wagner Level 3?
|
extensive ulceration with exposed bone or deep infection (this includes necrotizing fasciitis)
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What is Wagner level 2?
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ulcer penetration through subq tissue
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what is Wagner level 1?
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superficial ulcer
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What is Wagner level 0?
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preulcerative lesions- healed ulcers, neuropathy, presence of bony deformity
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semmes-weinstein filament test bends at this amount of pressure
|
10g
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Greatest risk factor for diabetic foot ulcer
|
neuropathy
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what is the greatest risk fo amputation?
|
diabetic foot ulcer
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Most common bacteria found in diabetic foot ulcer infections?
|
streptococcus (others include E coli, proteus, pseudomonas)
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what layers of the skin are involved in superficial 2nd degree burn?
|
epidermis and papillary dermis
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do deep 2nd degree burns blister?
|
no
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When should you refer partial thickness burns to a burn center?
|
10% of TBSA in children <10 or adults >50
or any burns involving face, eyes, ears, hand, feet, perineum |
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When should you refer full thickness burns to a burn center?
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all the time
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What are the 3 zones of burn injury?
|
1) zone of coagulation
2) zone of stasis 3) zone of hyperemia |
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primary intention healing heals by these 2 processes
|
1) CT deposition
2) epitheliazation |
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these cells are essential for transition from inflammatory to proliferative phase of healing (initiate angiogenesis and granulation tissue formation)
|
macrophages
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The center for medicare and medicaid services defines significant weight loss as:
? in 30 days, and ? 180 days |
5% in 30 days, 10% in 180 days
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protein needs for wound healing
|
1.5-2gm/kig
|
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name 2 drawbacks of using gauze as primary dressing?
|
permeable to bacteria, adherent (can traumatize wound when removed),
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name 2 wound types in which topical antiseptics are indicated
|
burns and traumatic wounds
|
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Name 2 dressings that can be used directly over a sutured wound
|
transparent film, faoms
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cell of origin for scar tissue
|
fibroblasts (which are stimulated during inflammatory phase of wound healing)
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What is the difference between a keloid and hypertrophic scar?
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keloid is raised and goes beyond the original wound boundaries. hypertrophic scar is raised but stays within original wound boundaries.
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what are predictors of scars?
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depth of wound, pigmentation, tension in skin (younger people scar more easily than elderly), genetcs
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most prevalent fungal pathogen in foot
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trichophyton rubrum
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tinea pedis usually infects this layer of the foot
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stratum corneum
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What property of US make its useful for thrombolysis
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acoustic cavitation.
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How is US bacteriocidal?
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stimulation of NO
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How is microstreaming in US useful for wound healing?
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stimulates cell activity, synthesis and release of growth factors (chemotactic to fibroblasts and endothelial cells)
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What is US effect on the inflammatory phase of wound healing?
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accelerates the inflammatory phase of wound healing leading to a more rapid entry into the proliferatie phase
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What is US's effect on the proliferative phase?
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fibroblasts produce more collagen and endothelial cells have more prolific growth.
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What is the difference between diagnostic and wound therapeutic frequencies in US?
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diagnostic US uses 20-50MHz
Wound: 0.5-3MHZ (3mhz is preferable) |
Use 0.5W/cm2 for intensity
Frequency 3x per week |
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Frequency of mist therapy
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25-40khz
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what is the FDA approval for MIST?
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debridement/cleaning of wounds
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At what level of leg elevation can you expect some edema reduction?
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7-8 inches above the heart
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wHAT IS 4+ pitting?
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> 1inch pitting
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what are the early cutaneous changes induced by ultraviolet radiation/
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skin reddening 2-3 hours later, (via stimulation of the inflammatory response that leads to increased vascularity of the dermis) and skin thickening by cellular proliferation of stratum corneum
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How does UVB stimulate epitheliazation?
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stimulate IL-1alpha production by keratinocytes which enhances epitheliazation
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What are 2 late cutaneous effects of UV?
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elastosis (loss of elasticity) and carcinogenesis
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How can you protect periwound skin from UV?
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draping or UV blocking agent like petrolatum
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What type of UV has the best germicidal actiivity?
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UVC 250-270nm
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How far does UV penetrate?
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100-200um
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How far should you hold UVC lamp from wound? how bout UVA or UVB
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1inch; 30 inches
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what is the depth of penetration for lasers?
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muscles
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What are normal values of transferrin?
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200-300
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These type of ulcers begin a palpable purpura and progress to shallow well demarcated ulcers
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vasculitic ulcers
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complication of end stage renal disease characterized by indurated, painful, necrotic lesions with violaceoous wound margins
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calciphlaxis
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Approximately what percentage of pyoderma gangrenosum is idiopathic?
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50%
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What are the 2 most common diseases associated with pyoderma gangrenosum?
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IBD and RA
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characterized by extremely tender lesions that begin as a nodule, pustule or bulla and develop significant induration, erythema and proceed to ulceration
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pyoderma gangrenosum
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What is pathergy?
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abnormal and exagerrated inflammatory response to noxious stimuli
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seen in pyoderma gangrenosum
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when biopsing pyoderma gangrenousum, where should the biopsy be taken?
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from the erythematous margin of the wound
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best treatment for pyoderma gangrenosum
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corrticosteriods and cyclosporine
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Why are skin grafts contraindicated in pyoderma gangrenosum?
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pathergy
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What percentage of patients with ESRD experience calciphylaxis?
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up to 5%
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Toxic epidermal necrolysis involves what % of body surface area?
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30%
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mucosal surfaces are often involved (unlike Steven Johnson syndrome)
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caused by massive keratonocyte cell death via apoptosis caused by activate ion of cellular immunity
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TEN
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most common medications causing TEN
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antibiotics (particularly sulfa) and anticonvulsants
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symptoms typically appear within first 14 days of taking antibiotic and first 2 months of taking anticonvulsant
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slight thumb pressure applied to intact skin next to blisters causes skin to wrinkle and slide laterally - name this sign
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Nikolsky sign
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hallmark sign for TEN
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biopsy of TEN shows this
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necrosis of epidermis
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What is the best treatment course for TEN?
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transfer to burn units has been shown to decrease mortality
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when should a culture of a wound be taken?
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When clinical signs of infection are present or when a clean wound does not show signs of healing with 2 weeks of topical treatment
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gold standard for wound culture
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tissue biopsy
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in a needle aspiration culture, where should the needle be inserted?
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in tissue just adjacent to the wound
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compared to tissue biopsy, tends to underestimate the number of organism
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what are the 2 types of swab techniques for wound culture?
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z technique and the levine techniques
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What is the Z technique for wound culture.
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move swab back and forth across wound in criss cross fashion
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less sensitive and specific than levine technique
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What is the Levine technique for wound culture
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while applying pressure, rotate swab within 1-2cm of clean wound tissue
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analysis of risk factors and follows a group of people who do not have the disease, and uses correlations to determine the absolute risk of subject contraction
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cohort study
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when does fetus lose ability to do scarless healing?
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22-24 weeks
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which 2 constituents of amniotic fluid are thought to aid in fetal wound healing?
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fibronectin and hyaluronic acid
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fetal wound healing differences
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fetus is hypoxic, absence of myofibroblasts, absence of inflammatory phase
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what is fibronectin?
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part of primary matrix that collagen is laid down on
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How does fibronectin differ in chronic wound vs acute wounds?
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in chronic wounds fibronectin is partially degraded (fibronectin is crucial for laying down of collagen)
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visible scar that is not raised beyond height of skin
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normotrophic scar
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scar that is raised but does not grow past the original boundaries of the wound
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hypertrophic scar
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scar that is raised and does extend past the original boundaries of the wound
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keloid
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who scars more easily the young or the elderly?
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the young
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more active lifestyle leads to more frequent skin tension
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parts of the body where keloids most commonly appear
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between ears and waist and between elbow and shoulder
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how do cortisone injections improve appearance of small scars
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increase actiivty of collagenase
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pressure therapy for scars is recommended when a wound takes longer than this many days to heal
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14 days (the longer the healing time, the more likely that scar tissue will form)
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if a rash develops when using silicone to treat hypertrophic scar, what should you do?
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stop using it until rash resolves and then restart medication. The rash does not reoccur in the same location
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what are risk factors for scarring?
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1) depth of wound, length of time to heal wound, pigmented skin, youth, location of wound
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what is responsible for necrosis seen after brown recluse spider bite?
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accumulation of neutrophils
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<10% develop skin necrosis
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what is the red, white and blue sign of brown recluse spider bite?
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ring of blanched skin (due to vasoconstriction) surrounded by erythema with gray to red purple bullae at the site of bite.
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what is the treatment for necrotic brown recluse spider bites?
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ice packs, empiric abx for cellulitis, nsaids, tetanus, nonocclusive dressings. If severe can give dapsone which inhibits neutrophil function
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what is the typical atmospheric pressure for hyperbaric therapy?
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2.0 to 2.5 ATA
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how long does it take for oxygen from the hyperbaric chamber to plateua in soft tissues?
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1 hour (effect declines after 2-4 hours)
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effect of HBO in blood is instantaneous however
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What are the medicare criteria for use of HBO with a diabetic lower extremity wound?
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must be Wagner stage III or higher and all other aspects of wound care must be optimized
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What is the goal transcutaneous oximetric values for wound healing in HBO?
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400mmHG
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<100 is predictive of wound healing fialure
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Can HBO be used in clostridium myonecrosis?
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yes it has been shown to neutralize the effecto of the toxins and halts progression of tissue destruction
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used as adjunct with surgery
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What is the rationale for using hyperbarics for irradiated areas of body?
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induction of neovascularization which can offset the radiation induced hypoxia (helps lessen delayed radiation injury)
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what are the absoluate contraindications to HBO?
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untreated pneumothorax, h/o bleomycin, adriamycin, disulfiram, cis-platinum, sulfamylon (mafeneide acetate)
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why should blood sugar be checked during HBO?
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can significantly lower blood sugars
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why should all alcohol and petrolatum based products not be used in HBO>
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risk of fire
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all costemtic products should not be used (hair spray, deoadrants)
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what is ABI?
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foot pressure divided by arm pressure
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What is a normal toe brachial index?
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>0.75
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how is pressure redistribution accomplisched with support surfaces?
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1) immersion: refers to sinking into surface
2) envelopment ability of support surface to conform to irregularities |
the opposite of immersion and envelopment is "bottoming out"
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When can a patient with a stage II pressure ulcer who is on a group 1 mattress be upgraded to a group 2 mattress?
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after 1 month of comprehensive care
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For a patient to receive a group 3 support surface at home after myocutaneous flap, how long must they have tried the group 2 surface
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at least 1 month
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When using a wound VAC, a setting of 125mmHg increases blood flow to the wound by this many times
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4x times the blood flow
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it does this by removing interstitial fluid and decompressing microcirculation
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cutaneous blood supply arises from arterial branches found in this layer of the skin
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subcutaneous fat
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what is the cause of dry skin as you age/
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less sweat glands
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why is elderly skin more prone to skin tears?
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decreased size of rete ridges
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What is the provisional matrix?
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fibrin scaffolding created during hemostasis, fibronectin (glycoprotein) binds with this network and facilitates movement of cells into wound site
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At what pH (Acidic or basic), do macrophages work best at?
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acidic
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Process by which leukocytes adhere to endothelial cells lining capillaries
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margination
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adhere to selectin molecules
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process by which leukocytes squeeze throught endothelial cells
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diapedesis
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facilitated by integrins on the neutrophil surface
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which 2 cytokines are most important for fibroblast migration?
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PDGF and TGF-B
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TGF-B stimulates fibroblasts to secrete MMPs to facilitate migration
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at what orientation do type collagen fibers arrange themselves during remodeling?
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parallel to the skin stresses
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what catalyzes conversion of fibrinogen to fibrin?
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thrombin
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fibrin forms the meshwork that stabilizes the platelet plug and is a key component of provsional matrix
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what are the 2 key components of the provisional matrix?
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fibrin (derived from fibrinogen from platelets) and fibronectin (from fibroblasts and epithelial cells)
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Why is there impaired wound healing in factor VIII deficiency?
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absence of fibrin stablizing factor (cannot make provisional matrix)
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what are the 2 main cytokine producers in wound healing?
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platelets and macrophages
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what cytokine is simulates fibroblasts to secrete MMP to remove residual debris that is impeding migration?
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TGF-beta
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which 2 cytokines are primarily responsible for fibroblast proliferation?
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PDGF and TGF-B
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what are the 2 most important cytokines for angionesis?
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FGF and VEGF
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what are the components of the mature wound matrix?
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collagen and proteoglycans
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both are secreted by fibroblasts
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what 2 conditions can lead to underhydroxylation of collagen and inadequate crosslinks?"
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vit C deficiency and/or corticosteriods
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what is the most often used current in e-stim?
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high voltage monophasic pulsed
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whjch 2 cells are attracted to cathode (-) in estim?
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neutrophils and fibroblasts
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which 4 cells are attracted to anode in E-stim?
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neutrophil, macrophage, epidermal, endothelial
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In estim, + or - current stimulates blood flow?
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negative current
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+ current leads to vasoconstriction
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when do you usually see radiation dermatitis?
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within 2-3 weeks after beginning therapy.
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when are the greates reactions seen with radiation dermatitis?
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at the end of therapy as effects are cumultative
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when does radiation dermatitis resolve?
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usually within 1-3 months
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what is radiation recall?
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recalling by skin of previous radiation exposure following administration of certain chemotherapeutic agents (most occur within 2 months of completion of radiation()
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hold chemo, once resolved restart with prophylactic steriods
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