Chapter 15 - Wound healing/Diabetes
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. What would you like to do?
Name 2 rapid, 2 intermediate and 2 long acting insulins
- Regular- duration 30-60 hrs IV
- Semilente- duration 10-15 hrs SC
- 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
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
- 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
- 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 A: clean
- Stage B: non-ischemic infected
- Stage C: ischemic
- Stage D: infected ischemic
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.
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.
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
Name two heat stable antibiotics that are often mixed with PMMA impregnated beads
- tobramycin or gentamicin
- Cephalosporin, vancomycin, or Ticarcillin may be used.
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
What are the 3 phases of wound healing?
- Inflammatory phase
- 1-7 days
- Influx of platelets and leukocytes
- Proliferative phase
- 5-20 days
- Collagen fibers are produced and lend strength to wound
- 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
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.
What wound dressing has the highest and lowest hydrating ability?
- Hydrocollowid: high
- Hydrogels: high
- Alginates: medium
- Collagens: low
- Foam: low
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