Surgical Wounds and Amputees
What is the most common cause of amputations?
Disease complications due to peripheral vascular disease and/or diabetes mellitus
What is lymphedema?
chronic inflammatory condition that develops as a result of lymphatic insufficiency.
What is the difference between cellulitis and necrotizing fasciitis?
Cellulitis is non-contagious inflammation of connective tissue of the skin resulting from bacterial infection and can spread via lymphatics or blood stream
NF: presents first with the appearance of cellulitis but is highly contagious and is a rare life-threatening deep-seated bacterial infection of subcutaneous tissue that progresses rapidly along fascial planes.
When should you not use hyperbaric oxygen treatment (HBO)?
on patients with untreated pneumothorax and precautions for patients with emphysema, CHF, or uncontrolled HTN because their systems are already deprived of appropriate nutrients/affect the pulmonary/cardiovascular system in negative ways.
Diabetic Ulcer
What positions should we avoid for patients with BKAs to prevent contractures?
Hanging residual limb over the bed
sitting with w/c with residual limb flexed
pillow under hip or knee
crossing legs
Name the stage of Lymphedema:
reversible; accumulation of protein rich fluid, edema variable, soft, easy pits, elevation reduces swelling, may report heaviness, tightness, and/or sensory changes
1 hint available
Stage 1
What is Calciphylaxis?
relatively rare and potentially life-threatening extremely painful calcification of the skin, blood vessels, subcutaneous tissue, or internal organs that leads to tissue necrosis, skin discoloration and/or systemic changes.
what is a non-thermal effect of ultrasound?
Acoustic Cavitation
explain in more detail if you want but we know this from Starsky's class :)
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Burn (Flash burn)
What are the indications of skin grafts?
clean and vascularized wound bed
wounds that could close on their own but consideration of contractures/function
Name at least 3 contraindications for MLD (manual lymphatic drainage)
acute cardiac edema
renal failure
acute infections
acute bronchitis
acute DVT
malignancies
bronchial asthma
HTN
Name the different types of Burns in order from least severe to most severe.
Superficial burns
superficial partial thickness burns
deep partial thickness burns
full thickness burns
What is light therapy used for?
Used to medically treat psoriasis and other dermatological conditions
UVC = bactericidal effects (good for treating chronic wounds)
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Pyoderma Gangrenosum
What is the timing of each healing phase for surgical wounds?
Hemostasis: immediately upon when surgery causes bleeding
Inflammation: inflammatory signs within 4 days and epithelial resurfacing in 2-3 days
Proliferative: day 4 and lasts up to 3 weeks
Remodeling: may take up to 2 years
What are Watersheds?
division area between lymphotomes that slightly directs the lymph in a different direction
What is TBSA and when should a patient be treated in a burn center?
total body surface area (extent of burn injury)
Calculated using the rule of 9s
10% TBSA burns should be treated in a burn center
BONUS Burn Question because I Couldn't fit it in the other category whoops...
Name the causes of burns and point out the most common cause.
Flame/Flash Burns (most common)
Scald Burns
Electrical Burns (including lightening strikes but they are rare)
Chemical Burns
Radiation Burns
Frostbite
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Calciphylaxis
Name the strategies used to manage phantom limb pain/sensation:
massage, rubbing, tapping, different textures = desensitization techniques
want to give sensory input to the residual limb
Why would a stroke/SCI cause secondary lymphedema?
Bonus - what is the difference between primary and secondary lymphedema?
If there was an initial trauma that injured the lymphatics, or weakness/instability to use some muscles. If the muscles cannot be used, the muscle pumps that help encourage the movement of lymph would not be active --> stasis of fluid --> accumulation--> presence of protein rich fluid would progress over time into a chronic lymphedema
Primary Lymphedema: occurs due to blockage of lymphatic system (no insult)
Secondary Lymphedema: occurs due to a trauma or insult to the lymphatic system (identifiable cause)
How is pyoderma gangrenosum treated?
Bonus question: what should you not do to treat PG?
topical applications, intralesional steroid injections, prevention of infection and basic wound care.
in patients without underlying disorder - the treatment of choice is systemic corticosteroids (otherwise need to treat underlying cause as well)
Bonus question A: surgical debridement/debridement because it makes these wounds worse
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Fournier's Gangrene - type of NF