Term
| what are the functions of skin |
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Definition
| protect the rest of the body from trauma and irritants, regulate temperature, signify underlying disease, enable joint motion with good stretchiness and resist it with contracture |
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Term
| what are the 3 layers of skin |
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Definition
| epidermis, dermis, subcutaneous fat layer |
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Term
| what types of stuff do we see in skin? |
|
Definition
| nerves, sweat glands, hair follicles, oil glands around hair follicles, blood vessels |
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Term
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Definition
| a lot of collagen fibers, a lot of elastin fibers |
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Term
| what is the purpose of so many elastin fibers in skin? |
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Definition
| helps skin strain to enable joint motion |
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Term
| how much strain can elastin fibers undergo |
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Definition
|
|
Term
| how much strain can collagen fibers undergo? |
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Definition
|
|
Term
| what is the physiologic loading strain range for collagen fibers |
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Definition
|
|
Term
| in a stress-strain curve, on what axis is strain? |
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Definition
|
|
Term
| in a stress-strain curve, on what axis is stress? |
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Definition
|
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Term
| describe the stress-strain curve of collagen fibers |
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Definition
| the curve goes from 0-10% strain with failure at 10% and a peak around 7%. |
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Term
| describe the stress-strain curve of elastic fibers |
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Definition
| gradual increase in strain and stress up to about 190%, then a sudden increase in stress |
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Term
| what is the collagen fiber orientation in tendon? |
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Definition
|
|
Term
| why is the collagen fiber orientation in tendon parallel? |
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Definition
| to resist the tensile stress that is generated through passive stretching of muscle-tendon untis and active contraction of the sarcomeres in the muscles |
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|
Term
| what is the collagen fiber orientation in ligament? |
|
Definition
| primarily parallel, with some fibers going in random directions |
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Term
| why is the collagen fiber orientation in ligaments primarly parallel with fibers also going in random directions? |
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Definition
| ligaments have to control stress in a variety of conditions |
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|
Term
| what is the orientation of collagen fibers in skin? |
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Definition
|
|
Term
| why is the orientation of collagen fibers in skin irregular? |
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Definition
| because skin is stretched in a variety of directions and collagen fibers are oriented in all those directions to resist the tensile stress that acts in all those directions |
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|
Term
| what do collagen fibers have at rest? |
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Definition
|
|
Term
| when is crimp removed from collagen fibers? |
|
Definition
| with a little bit of tensile stress |
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|
Term
| what should you wear while treating skin? |
|
Definition
|
|
Term
|
Definition
| the dominant orientation of collagen bundles in the skin |
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|
Term
| what is the direction of Langer's Lines in extremities? |
|
Definition
| longitudinal: shoulder to wrist, hip to foot |
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Term
| where are places where Langer's Lines are oriented medial-laterally? |
|
Definition
| posterior elbow, front of knee, palmar and dorsal surfaces of the hand, dorsum of the foot |
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|
Term
| what is the direction of Langer's Lines in thoracic region? |
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Definition
|
|
Term
| what is the direction of Langer's Lines in posterior thorax? |
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Definition
|
|
Term
| what are the clinical implications of langer's lines? |
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Definition
| if there is an incision/cut perpendicular to Langer's lines, it tends to promote hypertrophic scarring, where as cuts parallel to langer's lines have normal scarring |
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|
Term
| why do we see hypertrophic scarring for open heart or abdominal surgery? |
|
Definition
| they go perpendicular to Langer's lines |
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|
Term
| how are laceratiosn/abrasions classified? |
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Definition
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|
Term
| what is the normal result of superficial wounds to epidermis and partial thickness wounds/ |
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Definition
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|
Term
| how to promote re-epitheliazationof superficial wounds to the epidermis? |
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Definition
| clean the wound, apply antibiotics, protective dressing |
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|
Term
| what is needed for healing of full thickness wounds with minimal scarring? |
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Definition
| good opposition of wound edges (sutures, steri-strips, skin glue) to minimize the gap so that you minimize scar tissue and maximize re-epitheliazation |
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|
Term
| when you have a big, full thickness injury, how does scar tissue/collagen tend to lie down? |
|
Definition
| in a circular orientation |
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|
Term
| what does the circular orientation of collagen in a large wound do? |
|
Definition
| causes wound contracture and closure |
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|
Term
|
Definition
| protect underlying tissue, but delay healing by drying out the wound site |
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|
Term
| what is the best way to avoid drying out a wound site from scabs |
|
Definition
| moist dressings with antibitic topical agent |
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Term
|
Definition
|
|
Term
| how and when to release subcutaneous adhesions between skin and subcutaneous tissues? |
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Definition
| Early on, do light massage to relseae adhesions. Othewise, you'll have trouble with independent movement of the skin over underlying tissue, which can be painful and restrict motion. |
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|
Term
| describe skin glue for skin closure |
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Definition
| same mechanical strength as sutures, similar cosmesis. Being used more and more. Twice as fast to apply than sutures. More expensive substance. |
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|
Term
| describe steri-strips for skin clusre |
|
Definition
| inferior mechanical strength and cosmesis |
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|
Term
| what is the reuslt of the inferior mechanical strength of steri-strips |
|
Definition
| because they are weaker, there will be more scar tissue filling in the gap, leading to poorer cosmesis |
|
|
Term
| describe staples for skin closure |
|
Definition
| require special equipment for placement and removal. Sterile technique required with removal. |
|
|
Term
| how is patient satisfaction for skin glue vs sutures vs staples |
|
Definition
|
|
Term
| how to increase hypertrophic scarring after suture removal |
|
Definition
| paper tape that goes along the length of the incision. |
|
|
Term
| how do suture/staples work? |
|
Definition
| when they put the sutures in, they pull the skin together tightly first. Really tight, such that along the incision, it's all raised and bumpy and nasty looking. These sutures become miniature force vectors pulling the skin together tightly so that the skin at the incision doesn't feel the laterally pulling forces of the rest of the skin in the body. The sutures provide stress shielding |
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|
Term
| how does paper tape decrease incidence of hypertrophic scarring after suture removal |
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Definition
| paper tape decreases multidirectional forces imposed on the incision site = the tensile stress pulling on the skin that rquires the skin to strengthen the incision site and produce a hypertrophic scar |
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|
Term
| how to apply and use paper tape to reduce scarring? |
|
Definition
| strip of paper tape along the length of the incision. Carefully peel off the paper tape, dry the incision, and put on a fresh strip of paper tape for 12 weeks |
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|
Term
| does the type of dressing you use make a difference? |
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Definition
| yes, choice of dressings has a major impact on blistering and healing outcomes in orthopedic patients |
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|
Term
| what dressings are best for incision covers |
|
Definition
| occlusive dressings such as OpSite PostOp = they have high moisture vapor transmission rates which provide better covers with less exudate and reduced rates of blistering |
|
|
Term
| what is an occlusive dressing |
|
Definition
| a dressing that allows no transmission from the outside into the wound |
|
|
Term
|
Definition
| a bleed from blunt trauma to skin or from injury to subcutaneous tissues |
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|
Term
|
Definition
| bleed that penetrates to the skin |
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|
Term
| what is needed if blood collets into a confined space such as under a fingernail |
|
Definition
|
|
Term
| what modality to apply initially to limit bleeding |
|
Definition
|
|
Term
| what modality to apply later to aid in blood resorption |
|
Definition
|
|
Term
| what is a subungual hemorrhage |
|
Definition
| blood under the nail, uncomfortable |
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|
Term
| can PTs drain a subungual hemorrage |
|
Definition
| no, but they can tell patients how to do it |
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|
Term
| how to drain a subungual hemorrhage |
|
Definition
| drill a hole through nail with exacto knife twilled or burn a hole with heated paper clip so that the blood can come out |
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|
Term
| what to address for subungual hemorrhage |
|
Definition
| shoe toe box and sock wear |
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|
Term
|
Definition
| entrapment of dirt or particles under the epidermis |
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|
Term
|
Definition
| risk of infection: monitor for redness, irritation, tenderness |
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|
Term
| what is a piezogenic papule |
|
Definition
| herniation of fat pad particles through the skin |
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|
Term
| what is the problem with piezogenic papules |
|
Definition
| they may or may not cause pain, but they are unsightly |
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|
Term
| how to treat piezogenic papules |
|
Definition
| treat with external constraint of gel-like heel cup to fill in space and put pressure all around the heel. Can also tape to do the same thing |
|
|
Term
| what if heel cup or tape doesn't get rid of piezogenic papule? |
|
Definition
| send to dermatologist/podiatrist |
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|
Term
| how will a podiatrist treat piezogenic papules? |
|
Definition
| with steroid/anesthetic injection, since the steroid will destroy the fat pad |
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|
Term
| what are common locations of piezogenic papules |
|
Definition
| heels, anterior leg, wrist |
|
|
Term
| in what population is acne mechanica common? |
|
Definition
|
|
Term
| what causes acne mechanica |
|
Definition
| friction, pressure, and heat form equipment that produce an entrapment of oils in oil glands. The gland becomes infected |
|
|
Term
| how to treat acne mechanica |
|
Definition
| wear underwear that wicks moisture, scrub with soap, apply topical agents |
|
|
Term
| what is an ingrown toenail |
|
Definition
| medial or lateral edge of nail grows down into skin producing irritation, bleeding, swelling |
|
|
Term
| how to treat ingrown toenail |
|
Definition
| rmeove the nail tha tis growing in the downward fashion, elevate the nail edge with cotton wool, and trim a "V" into center of nail to encourage central rather than lateral growth |
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|
Term
|
Definition
|
|
Term
|
Definition
| coefficient of friction x normal force |
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|
Term
|
Definition
| reduce the coefficient of friction or reduce the force |
|
|
Term
| what happens in a blister? |
|
Definition
| friction between epidermis and dermis separates epidermis from dermis. Gap fills in with fluid and sometimes blood. |
|
|
Term
| what causes the friction between the epidermis and dermis |
|
Definition
| friction between epidermis and outside |
|
|
Term
|
Definition
| drain with a steril needle, keep epidermis layer in place, cover with protective dressing |
|
|
Term
|
Definition
| Spenco 2nd skin prophylactically, vaseline to decrease coefficient of friction, 2 layers of socks, protective gloves, socks that wick away moisture, and fix what is causing the friction! |
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|
Term
| what might be the cause of friction |
|
Definition
| pronating too much? Otherwise creating exttra movment or slideing? |
|
|
Term
| what happens when you get a callus |
|
Definition
|
|
Term
| why does callus beget callus? |
|
Definition
| the callus creates more pressure an dmore normal force. In the presence of friction, if you have more normal force you will produce more callus |
|
|
Term
| what exactly is a callus? |
|
Definition
| hyperkeratosis secondary to excessive friction |
|
|
Term
| what to think of when treating callus |
|
Definition
| what is causing the extra movement/friction? |
|
|
Term
|
Definition
| soak and then use pumice stone, graters, scalpel to remove extra tissue; salicylic acid preparations |
|
|
Term
| what is pitted keratolyisis |
|
Definition
|
|
Term
| what does pitted keratolysis look like at first |
|
Definition
| little dried patches along the posterior rim of the heel |
|
|
Term
| what does pitted keratolysis look like over time |
|
Definition
| more dry, cracked, pitted, deeper lesions, green/brown discoloration |
|
|
Term
| what causes pitted keratolysis |
|
Definition
|
|
Term
| what is the most common location for pitted keratolysis |
|
Definition
|
|
Term
| how to treat pitted keratolysis |
|
Definition
| educate the patient, recommend that they go to podiatrist or dermatoligist |
|
|
Term
| how will a podiatrist treat pitted keratolysis |
|
Definition
| topical antibiotic, botox injection, antibacterial soap scrub, cotton socks or other absorbent material |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| where is athlete's foot often contracted |
|
Definition
|
|
Term
|
Definition
| keep area dry with powders, use topical anti-fungal agents |
|
|
Term
|
Definition
|
|
Term
| how are plantar warts spread? |
|
Definition
| from other plantar warts: auto-infection or communal infection |
|
|
Term
| what does a plantar wart look like |
|
Definition
| a rough, raised circular lesion with surrouding smooth hard border that may have central discoloration |
|
|
Term
| how to know it's a plantar's wart and not a callus |
|
Definition
| plantar warts are more tender to pinching and less tender to pressure |
|
|
Term
| how to get rid of plantar wart |
|
Definition
| topical acid, cryotherapy, laser, surgical excision |
|
|
Term
| what causes hypertrophic/keloid scarring |
|
Definition
| individual differnces, racial influences, Langer's Lines |
|
|
Term
| how to prevent hypertrophic scarring |
|
Definition
| try taping initially, massage with cocoa butter, cortison injection, laser resurfacing |
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