PTs role in wound care?
- Comprehensive eval
- sharp debridement
- education and prevention
- seating/bed/footwear assessments
- gait training
- making referrals
PT goals for wound care?
- optimal healing
- healing with least energy
- max functional outcomes
- minimize expenditure
What is wound healing?
Dynamic and highly regulated process of cellular and molecular mechanisms. MAY take years.
5 wound healing models?
- Superficial wound healing
- primary intention (surgical wounds)
- delayed primary intention (surgical wounds)
- partial-thickness wound healing
- full-thickness wound healing
what are the phases of wound healing?
Who are the major players in the inflammatory phase of wound healing***?
- mast cells
Who are the major players in the Proliferative phase of wound healing***?
- endothelial cells
Who are the major players in the Remodeling phase of wound healing***?
What are platelets?
Small, irregularly shaped clear cell fragments which circulate in the blood and are involved in hemostasis
What are neutrophils?
phagocytic cells that clean up debris and bacteria, migrate into the wound within 24 hours of injury
What are monocytes?
white blood cell that in response to inflammation will differentiate into macrophages
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
What are endothelial cells?
cells that form the endothelium (lining of blood vessels)
What are fibroblasts?
produce protein fibers (collagen, elastin) and extracellular matrix (ECM)
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
What are keratinocytes?
predominant cell found in the epidermis
what are mast cells?
- specialized secretory cell that helps to promote fibroblast proliferation
- releases histamine (vascular dilation - edema)
- produces heparin (stimulates endothelial cells
What are cytokines?
- Large group of proteins with immunoregulatory and hematopoetic effects
- produce alterations in the cells they bind to
- originally studied by immunologists
What are growth factos?
- proteins that are able to effect cell reproduction, movement, and function.
- promotes endothelial migration and proliferation
Distinctions between cytokines and growth factors?
- Cytokines are released in response to cellular stress
- GFs are released in response to homeostatic control signals
How long does the inflammatory phase last?
from beginning of injury to 2-5 days
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
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
Effects of necrotic tissue?
will NOT allow the wound to move into the next phase of healing