Term
| What is transepithelial potential? |
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Definition
| It is the difference with respect to electrical charge from the outside of skin to the inside. |
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Term
| With respect to deeper layers, what is the average charge of skin? (positive, negative or the same?) |
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Definition
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Term
| Is there increased or decreased magnitude of gradient at the edge of a wound? |
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Definition
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Term
| Is there increased or decreased magnitude of gradient at the center of a wound? |
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Definition
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Term
| In normal people, what happens to the direction of the current when tissue regenerates? |
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Definition
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Term
| In galvanotaxis, what does the negative pole attract? (5 Major things) |
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Definition
| Positive Ions (Na+, K+, H+), Fibroblasts, Lymphocytes, Neutrophils (if infected), Platelets. |
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Term
| In galvanotaxis, what does the positive pole attract? (3) |
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Definition
| Macrophages, Neutrophils (if not infected), Epidermal Cells |
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Term
| There are 8 major effects of estim on tissue. What are they? |
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Definition
| Galvanotaxis, Incr. Bld flow, Decr. Edema, Debridement, Antibacterial effects, incr. tissue oxygenation, increased epithelialization, acceleration of wound healing. |
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Term
| How does estim decrease edema? |
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Definition
| By activating a muscle pump. So to help w/ edema the current must be strong enough to get small (not tetanic) contractions. |
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Term
| How does estim increase tissue oxygenation? |
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Definition
| by stimulating angiogenesis during small contractions. |
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Term
| How does estim increase epithelialization? Would you use a positive or negative polarity to help achieve this? |
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Definition
| It attracts epithelial cells via galvanotaxis. You would use a positive polarity. |
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Term
| What will HVPC do, regardless of presence of infection? |
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Definition
| Increase macrophages and leukocytes. |
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Term
| In what stage of healing would you use a negative polarity? |
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Definition
| granulation stage - to attract fibroblasts and lymphocytes, as well as neutrophils in the infected wound to clean the area. This will decrease the chance for infection, and promote production of collagen and elastin. |
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Term
| When would you use a positive polarity? |
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Definition
| During the epithelialization and autolysis stages to attract macrophages and help the healing process, and attract epidermal cells. |
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Term
| What can you do in terms of estim when healing stops progressing? |
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Definition
| Switch back and forth between positive and negative polarities. |
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Term
| What is the affect of ultrasound in the inflammatory phase? what are the appropriate parameters during this phase? |
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Definition
| It accellerates the inflammation process. Parameters: 1MHz, .5W/cm sq, 20% Duty cycle, once daily for 5mins to periwound area, |
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Term
| What is the affect of ultrasound during the proliferation phase? what are the appropriate parameters? |
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Definition
| Stimulates fibroblast migration and proliferation, angiogenesis, myofibroblast development, and regeneration of epithelial cells by stimulating relase of growth factors.. Parameters: Low intensity, nonthermal US within 72hrs post injury: 1MHz, .5W/cmsq, 20% Duty cycle, daily for 5 minutes to the periwound area for 2-3 weeks. |
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Term
| Would US be an appropriate modality choice for a proliferating wound with a 3cm tunnel? |
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Definition
| Yes, as 1MHz US can reach 5cm. |
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Term
| What benefit arises from using US during the remodeling/maturation phase? |
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Definition
| Incrased tensile strength of the scar, Increased elasticity, deposition of collagen fibers in a pattern close to that of intact tissue. |
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Term
| What are the effects of whirlpool therapy on a wound? (4) |
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Definition
| Circulatory, Nutrient Delivery, Pain Relief, Mechanical effects. |
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Term
| How does whirlpool affect nutrient delivery to a wound/periwound area? |
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Definition
| Increased circulation --> increased nutrient delivery. |
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Term
| What are the mechanical effects of whirlpool on a wound? (4) |
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Definition
| Loosening of necrotic tissue, debridement, cleansing, dressing removal. |
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Term
| What are the two major disadvantages of using whirlpool treatment? |
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Definition
| Can lead to maceration, and there is a risk of passing infection from one pt to another if the pool isn't properly cleaned between uses. |
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Term
| What type of wounds do you need to be careful of when thinking of using whirlpool? |
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Definition
| clean granulation wounds, epithelializing wounds, new skin grafts. They're all very fragile and can be easily agitated by the moving water. |
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Term
| What are the contraindications to using whirlpool for wound care? (7) |
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Definition
| Moderate to severe edema, lethargy, maceration, acute phlebitis, comprimised heart status, incontinence, dry gangrene. |
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Term
| Describe your preparation for US on a patient with a full thickness wound. |
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Definition
| Apply a transparent film to the wound, or use underwater US. If using a transparent film, you need to apply gel to the intact periwound skin you will be USing, as well as over the wound itself. |
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Term
| How will you apply US to a partial thickness wound? |
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Definition
| By first applying a hydrogel sheet directly over the wound and a few cm of periwound skin. Make sure you clean the US head with an antibacterial before use with any wound, and tell the pt to tell you if they feel any pain w/ the procedure. |
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Term
| With what frequency and duration will you apply US to a remodeling wound? |
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Definition
| for 5 mins, once a day for 3 times a week, for 2 weeks to increase tensile strength of the scar. |
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Term
| When you do underwater US, you can't do it in a metal whirlpool tank! |
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Definition
| That's all. It wasn't a question :) |
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Term
| If a wound is acute, do you want to use thermal or athermal US? |
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Definition
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Term
| How can you perform US over a bony prominence? |
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Definition
| use an underwater application. |
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Term
| What are the indications for estim with wound healing? (4) |
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Definition
| pain modulation, tissue healing, transdermal drug delivery, muscle contraction. |
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Term
| what do you need to be careful of when considering estim for wound healing? |
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Definition
| skin irritations or tingling under the electrodes, patients w/ severe PVD may have pain w/ estim, young kids. |
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Term
| Why do you have to careful when using estim w/ young kids? |
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Definition
| Their healing mechanisms are not well understood. |
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Term
| There are 6 contraindications to using estim for wound healing. what are they? |
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Definition
| When stim of cell proliferation is contraindicated, when there's evidence of osteomyelitis, presence of metal ions, when it's in close proximit to a reflex center (carotid sinus, heart, parasymp nerves, phrenic nerve, etc), where current can affect function of electric implant, pregnant uterus. |
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Term
| Why would you use whirlpool therapy? (5) |
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Definition
| To achieve superficial heating/cooling, for wound care, water exercise, pain control, edema control. |
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Term
| What are the indications for vacuum assisted closure? (negative pressure wound therapy) (4) |
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Definition
| Chronic wounds, acute and traumatic wounds, in conjunction w/ meshed grafts and flaps, with partial thickness burns. |
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Term
| In what situations do you need to be careful about use of VAC? |
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Definition
| When there is active bleeding, use of anticoagulants, or when there is difficulty with homeostasis after debridement. |
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Term
| In which situations is VAC contraindicated? |
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Definition
| Cancer in wound margins, untreated osteomyelitis, fistulas to organs or body cavities, or presence of necrotic tissue. |
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Term
| What are the indications for use of total contact casting? (3) |
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Definition
| To protect limb from further trauma, to control edema, to decrease pressure over the wound by redistributing weight over the entire foot/ increasing the area of contact. |
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Term
| In what situations do you need to be careful about use of total contact casting? |
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Definition
| W/ fragile, atrophic skin, w/ narrow/deep ulcerations, when there is inconsistancy in returning for follow-up appointments. |
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Term
| In what 6 situations is total contact casting contraindicated? |
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Definition
| Cellulitis, palpable tender nodules, deep sinus tract, profuse drainage, febrile pt, in presence of osteomyelitis or other infection. |
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Term
| 45y/o male patient w/ a large, deep necrotic wound on his R thigh. Rest of medical history is uncomplicated. What would be your best modality choice? |
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Definition
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Term
| Pt is a 37y/o F w/ a wound on her lower calf. The wound is necrotic, and there is mild edema in the limb. The patient will need sharp debridement. What modality will you choose to start the Tx with? |
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Definition
| Whirlpool, to loosen necrotic tissue for debridement. |
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Term
| Pt. is a 55y/o male with a partial thickness burn on his R forearm. The wound has no necrotic tissue, and no active bleeding, but there is severe edema in the affected extremity. Medical history is uncomplicated. What modality will you use? |
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Definition
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Term
| Your diabetic patient presents with a fairly shallow wound on the bottom of her heel. She is currently not walking on the affected heel, and there is a moderate amount of edema in the ankle and foot of the affected extremity. What modality will you use? |
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Definition
| Total contact casting - to promote mobility and control edema. |
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Term
| You have a 12y/o patient with a small necrotic wound on his L elbow. You would like to do US to promote healing. But you have two major concerns. What are they? |
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Definition
| His age. You need to be careful w/ young children and US over apophyseal plates (like the one at the elbow). Also, it is over a bony prominence, and US to those areas can be difficult. |
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Term
| You have a patient who has a large necrotic wound on her R thigh. There is moderate edema in the area, and the wound is macerated around the edges due to exudate. Is whirlpool an appropriate Tx for this pt? why/why not? |
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Definition
| NOPE. Whirlpool Tx is contraindicated in the presence of maceration. |
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Term
| T/F : Sharps debridement can be used in conjuction with whirlpool, US, or estim to remove necrotic tissue before wound closure. |
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Definition
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