Chapter 15 - Wound healing/Diabetes

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Chapter 15 - Wound healing/Diabetes
2011-12-12 20:58:23
Podiatry boards II

Pocket podiatrics
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  1. Name 2 rapid, 2 intermediate and 2 long acting insulins
    • Rapid:
    • Regular- duration 30-60 hrs IV
    • Semilente- duration 10-15 hrs SC
    • Intermediate:
    • NPH (Humilin N)- 18-24hrs SC
    • Lente (Humulin L)- 18-24 hrs SC
    • Long Acting:
    • Protamine zinc- 36 hrs SC
    • Ultralente (Humulin U)- 36 hrs SC
  2. Pt presents with a full-thickness ulcer that extends to bone, no acute signs of infection, no absess or osteomyelitis. What is the Wagner and UTWCS classificaton?
    • Wagner: Grade 2
    • Texas: Grade III A

    • Wagner:
    • Grade 0: Intact skin (cellulitis, erythema)
    • Grade 1: Superficial ulcer involving the skin (no subQ involvement)
    • Grade 2: Ulcer extending to tendon capsule or bone (through subQ)
    • Grade 3: More extensive ulcer with associated abscess, OM, or joint sepsis
    • Grade 4: Local gangrene of the toes or forefoot
    • Grade 5: gangrene of the entire foot

    • Texas
    • Grade 0: pre or postulcerative site
    • Grade 1: ulcers are superficial wound through the epidermis
    • Grade II: wound penetrates to tendon or capsule
    • Grade III: Wound penetrates to bone or into a joint

    • Stage:
    • Stage A: clean
    • Stage B: non-ischemic infected
    • Stage C: ischemic
    • Stage D: infected ischemic
  3. When is the best time to take blood culture?
    • When pt is spiking a fever
    • -Must take three samples, each from a different location or from the same spot 10 min apart.
  4. Pat was presents with new ulceration he just noticed yesterday. Ulceration PTB. You decide to get Tc-99 bone scan which is negative. Xrays are also negative. Does this r/o OM?
    No, in most cases bone scans become (+) within 48-72 hours and XRAYS usually take 2 weeks.
  5. What are three ways you can obtain OM?
    • 1. Hematogenous - enters bone via blood
    • 2. Contiguous - spread from adjacent soft tissue
    • 3. Direct inoculation: trauma or surgical
  6. Name two heat stable antibiotics that are often mixed with PMMA impregnated beads
    • tobramycin or gentamicin
    • Cephalosporin, vancomycin, or Ticarcillin may be used.
  7. Differentiate sequestrum, involucrm, cloaca, and brodie's abscess
    • Sequestrum: a piece of necrotic bone separated from living bone by granulation tissue
    • Involcrum: a layer of living bone that has formed around the dead (infected) bone
    • Cloaca: an opening in the involucrum that may form a sinus and drain.
    • Brodies Abscess- a chronic abscess in bone surrounded by dense fibrous tissue and sclerotic bone, most commonly found in the metaphysis
  8. What are the 3 phases of wound healing?
    • Inflammatory phase
    • 1-7 days
    • Influx of platelets and leukocytes
    • coagulation
    • Proliferative phase
    • 5-20 days
    • Collagen fibers are produced and lend strength to wound
    • Reepithelialization
    • Angiogenesis
    • Fibroplasia
    • Wound contraction
    • Remodeling phase
    • 3 weeks- 2 years
    • Deposition of matrix materials
    • collagen deposition/remodeling
    • return to preinjury state
    • as long as the scar or past ulcer site is erythematous, remodeling is occuring
  9. Pt presents with a suspected charcot foot, foot is edematous, war and redness has began to diminish. What phase of Charcot deformity is present?
    Stage II (Coalescence)

    • Stage 1 (Fragmentation) - acute inflammatory process
    • - foot is hyperemic, swollen, red, and hot
    • - dissolution, fragmentation, and dislocation

    • Stage II (Coalescence)
    • -beginning of the reparative process
    • -edema, warmth and redness begins to diminish

    • Stage III (Remodeling)
    • -marked by bony consolidation and healing
    • -residual bony deformity is common most notably collapse of the longitudinal arch resulting in the classic "rocker-bottom" foot.
  10. What wound dressing has the highest and lowest hydrating ability?
    • Hydrocollowid: high
    • Hydrogels: high
    • Alginates: medium
    • Collagens: low
    • Foam: low