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
Superficial Partial Thickness burns
effects what part of skin
Boiling water, flash flame, steeam
Epidermis and a little dermis
Superficial Partial Thickness burns, signs and symptoms
blisters, very red, pain, wet and weepy, heels in 10-14 days, rarely causes permanent skin change
Deep Partial Thickness burns -- caused by? effects?
Epidermis, most of dermis, and some skin appendages (sweat glands, sebaceous glands, hair follicles)
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
Full Thickness (3rd degree) burns caused by? effects?
Prolonged exposure to flame, hot water, chemical or electrical burns
Epidermis, dermis, appendages in dermis
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.
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
2 depthss of autografts
split thickness skin graft -- epidermis and part of dermis
full thickness skin graft -- epi and all of dermis
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
exercise baskics for burn pts
AROM is most functional
no forceful PROM
no resistive exercises while in hypermetabolic state
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
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)
signs of hypertrophic scarring
erythema, elevated skin level surface (collagen), blanching white upon stretch (myofibroblasts)
stages of hypertrophic scarring
- Immature: red, raised rigid
- Semimature: pink, raised, semi-rigid
- Mature: pale, planar, pliable
Vancouver scale for hypertrophic scar assessment measures what?
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
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
indications for TCC
planar ulcerations, charcot's joints, post op reconstruction immobilization, chronic venous stasis wound
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
- 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
necessary to have _ degrees of DF and _ degrees of great toe extension for normal gait
10 and 60
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
- 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)
lymphatic fluids big feature
high protein concentration, therefore hydrophilic
"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.
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
Primary lymphedema def
due to aplasia, hypoplasia, or hyperplasia (no, less, more lymphatics)
Secondary lymphedema caused by...?
injury, trauma, radiation therapy, lympy node dissection, skin infections, surgery, cancer, etc.
or in third world countries, cause by parasites
sign of lymphedema: dorsal hump on hand, heaviness, soreness, fatigue, discomfort
distal to proximal gradual onset
Complet Degongestive Therapy involves...?
Manual Lymphatic Drainage (MLD = massage), compression bandaging, exercises, intensive skin care