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causes and characteristics of superficial burns / first degree burns
Causes: sunburn, flash, scald
Char: epidermis only, erythema, painful, heals fast (3-5 days) physiologically unimportant
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Superficial Partial Thickness burns
causes
effects what part of skin
Boiling water, flash flame, steeam
Epidermis and a little dermis
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Superficial Partial Thickness burns, signs and symptoms
blisters, very red, pain, wet and weepy, heels in 10-14 days, rarely causes permanent skin change
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Deep Partial Thickness burns -- caused by? effects?
Flame, chemicals
Epidermis, most of dermis, and some skin appendages (sweat glands, sebaceous glands, hair follicles)
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Deep Partial Thickness burns signs/symptoms
pain, red/white/yellow areas, not as weepy as superficial second degree, large blisters, edema, heals in 3-4 weeks, scars
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Full Thickness (3rd degree) burns caused by? effects?
Prolonged exposure to flame, hot water, chemical or electrical burns
Epidermis, dermis, appendages in dermis
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Signs and symptoms of full thickness burns
white, red, black, or brown. dry, leathery, and firm. thrombosed vessels, minimal pain initially, often requires skin grafting, takes a long time and heals poorly if left alone.
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2 types of autograft
1 - sheet graft - skin applied as a solid sheet
2 - meshed graft - small holes are added to let it stretch to cover a greater area and allow the wound to drain
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2 depthss of autografts
split thickness skin graft -- epidermis and part of dermis
full thickness skin graft -- epi and all of dermis
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burn ward, goals of splinting
improve positioning, pressure relief, decrease edema, maintain or improve ROM, immobilize skin graft, protect exposed joint, tendons, and other structures, assist w ADLs
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exercise baskics for burn pts
AROM is most functional
no forceful PROM
no resistive exercises while in hypermetabolic state
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what kind of burns don't scar? which scar the most?
superficial partial thickness burns usually do not scar
deep partial and full thickness scar most
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what age group scars most?
kids, bc they're hypermetabolic, so they lay down more scar tissue
(but early healing or grafting can reduce scarring)
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signs of hypertrophic scarring
erythema, elevated skin level surface (collagen), blanching white upon stretch (myofibroblasts)
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stages of hypertrophic scarring
- Immature: red, raised rigid
- Semimature: pink, raised, semi-rigid
- Mature: pale, planar, pliable
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Vancouver scale for hypertrophic scar assessment measures what?
- pliability
- vascularity
- pigmentation
- height
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burn treatmetn pressure principles
- positive pressure - constant and controlled, a bit over the capillary pressure of 23mmHg --- this lowers vascularity which decreases myofibroblast activity and collagen synthesis, and it encourages better orientation of the collagen during scarring phase
- apply it 24h/day for about 1 year or until scars are mature!!!
- begin wearing it when wounds are healed/closed
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TCC reduces pressure by what % compared to shoe w orthosis or barefoot?
- 75% reduction in FF pressures compared to shoe w orthosis
- 87% down from barefoot
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indications for TCC
planar ulcerations, charcot's joints, post op reconstruction immobilization, chronic venous stasis wound
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contraindications for TCC
acute infection or inflamed tissue, bad edema, wanger grade greater than 2 (or up to 4, debatable), ulceration other than WBA foot
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Wagner scale
- 0 = no loss of protective sensation, but at risk
- 1 = superficial ulcer
- 2 = full thickness ulcer
- 3 = deep ulcer with or without osteomyelitis, abscess, or joint sepsis
- 4 = gangreen
- 5 = extensive gangrene, needs amputation
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necessary to have _ degrees of DF and _ degrees of great toe extension for normal gait
10 and 60
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compensatory mechanisms for equinus or inadequate DF
early heel rise observable at HS
subtalar pronation, rearfoot eversion, forefoot abd at midstance
recurvatum at knee in mid stance w hip flexion
collapse of midfoot, development of "rocker foot" deformity
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lymphedema stages
- 0 - at risk
- 1 - reversible (has pitting)
- 2 - irreversible (no more pitting bc stuff turned fibrotic and hard)
- 3/4 - elephantiasis (hard, heavy, abnormal shapes)
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lymphatic fluids big feature
high protein concentration, therefore hydrophilic
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"mechanical insufficiency" regarding lymphedema
lymphedema is a "high-protein load edema." Only the lymphatic system transports and absorbs high-protein load fluids (lymph fluids). Lymph fluid is essentiall the fluid in the body that can't be transported out of cells via the normal means of osmosis.
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high protein edema
edema where there is a buildup of proteins in the interstitium
proteins that aren't reabsorbed into the compormised lymphatic system stay in the body and attract more water, hence, more swelling
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Primary lymphedema def
congenital
due to aplasia, hypoplasia, or hyperplasia (no, less, more lymphatics)
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Secondary lymphedema caused by...?
injury, trauma, radiation therapy, lympy node dissection, skin infections, surgery, cancer, etc.
or in third world countries, cause by parasites
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Stemmer's sign
sign of lymphedema: dorsal hump on hand, heaviness, soreness, fatigue, discomfort
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lymphedema onset
distal to proximal gradual onset
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Complet Degongestive Therapy involves...?
Manual Lymphatic Drainage (MLD = massage), compression bandaging, exercises, intensive skin care
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