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PTs role in wound care?
- Comprehensive eval
- diagnosis
- sharp debridement
- modalities/interventions
- there-ex
- education and prevention
- seating/bed/footwear assessments
- gait training
- making referrals
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PT goals for wound care?
- prevention
- optimal healing
- healing with least energy
- max functional outcomes
- minimize expenditure
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What is wound healing?
Dynamic and highly regulated process of cellular and molecular mechanisms. MAY take years.
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5 wound healing models?
- Superficial wound healing
- primary intention (surgical wounds)
- delayed primary intention (surgical wounds)
- partial-thickness wound healing
- full-thickness wound healing
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what are the phases of wound healing?
- Inflammatory
- epithelialization
- proliferation
- remodeling
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Who are the major players in the inflammatory phase of wound healing***?
- Platelets
- fibrin
- neutrophils
- macrophages
- mast cells
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Who are the major players in the Proliferative phase of wound healing***?
- Fibroblasts
- myofibroblasts
- endothelial cells
- keratinocytes
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Who are the major players in the Remodeling phase of wound healing***?
collagen
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What are platelets?
Small, irregularly shaped clear cell fragments which circulate in the blood and are involved in hemostasis
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What are neutrophils?
phagocytic cells that clean up debris and bacteria, migrate into the wound within 24 hours of injury
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What are monocytes?
white blood cell that in response to inflammation will differentiate into macrophages
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What are Macrophages?
- Responsible for phagocytosis of debris, secrete GF that stimulate angiogenesis and secretes collagenases (debridement in preparation for new collagen)
- important throughout all phases of healing
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What are endothelial cells?
cells that form the endothelium (lining of blood vessels)
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What are fibroblasts?
produce protein fibers (collagen, elastin) and extracellular matrix (ECM)
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What are myofibroblasts?
cells that are differentiated from a fibroblast. Contains an actin and myosin contractile system similar to what is found in smooth muscle
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What are keratinocytes?
predominant cell found in the epidermis
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what are mast cells?
- specialized secretory cell that helps to promote fibroblast proliferation
- releases histamine (vascular dilation - edema)
- produces heparin (stimulates endothelial cells
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What are cytokines?
- Large group of proteins with immunoregulatory and hematopoetic effects
- produce alterations in the cells they bind to
- originally studied by immunologists
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What are growth factos?
- proteins that are able to effect cell reproduction, movement, and function.
- promotes endothelial migration and proliferation
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Distinctions between cytokines and growth factors?
- Cytokines are released in response to cellular stress
- GFs are released in response to homeostatic control signals
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How long does the inflammatory phase last?
from beginning of injury to 2-5 days
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major events of the inflammatory phase?
- clotting takes place in order to obtain hemostasis (clotting and vasoconstriction to reduce blood loss)
- factors are released to rid wound of debris, bacteria and damaged tissue
- platelets are activated by injured collagen (release cytokines and growth factor that attracts neutrophils and changes monocytes --> macrophages)
- wound characterized by redness, warmth, pain, edema, and decreased ROM
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What is wound space hypoxia?
- vasoconstriction causing decrease in O2 during the inflammatory phase
- a key signal that controls wound healing
- causes a shift to anaerobic glycolysis leads to increased lactate production and therefore an acidotic wound
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Effects of necrotic tissue?
will NOT allow the wound to move into the next phase of healing
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