Presentation covering topics I learned during my independent study in my last semester of graduate school.

1. BURNS, WOUNDS,
AND PHYSICAL THERAPY!
BY: MICHELLE STAUFFER, SPT CLASS OF 2017
FACULTY MENTOR: DANIEL MALONE, PT, PHD, CCS
CLINICAL MENTOR: JODIE ROYER, RN, CNC (AT PRESBYTERIAN ST. LUKE’S)
CLINICAL MENTOR: DARCIE LUBY, PT, DPT, WCS (AT UNIVERSITY HOSPITAL INPATIENT)

2. OVERVIEW
 Discuss various certifications available involving burn/wound care
 Share interesting cases I experienced during my observations
 Discuss key topics I researched
 Explore physical therapy’s role in wound care

3. CERTIFICATIONS
1) CERTIFIED WOUND CARE NURSE
2) WOUND CARE CERTIFICATION
3) WOUND CARE SPECIALIST

4. CERTIFICATIONS
 CWCN: Certified Wound Care Nurse
 Wound, Osteotomy, and Continence Nursing Certification Board
 WCC: Wound Care Certification
 National Alliance of Wound Care and Ostomy Certification Board
 WCS: Wound Care Specialist
 American Association of Wound Management Certification Board

5. CWCN
 Directed for nurses
 Must be a registered nurse (RN)
 Must have a minimum of bachelors degree
 Meet one of the 3 criteria:
 50 ConED hours AND 1,500 clinical experience hours all in wound care within the last 5
years
 Complete a wound, ostomy, and continence education program provided by the WOCN
board
 Complete a graduate level nursing program with proof of course work
 Renew every 5 years

6. WCC
 Meet one of the 4 criteria:
 Education through:
 Wound Management Training Course
 Active involvement of wound care full-time for 2 years or
part-time for 4 years all within last 5 years
 Certification through:
 Active certification of CWCN, CWON, CWOCN, WCS, or
WCSP
 Experiential through:
 Active involvement of wound care full-time for 4 years
within last 5 years
 60 contact hours of wound care
 Preceptor through:
 Wound Management Training Course
 120 contact hours with NAWCO clinical preceptor
 Multiple health providers eligible:
 RN, LPN, NP
 PT, PTA
 OT, OTA
 MD, DO, PA
 Renew every 5 years
 https://www.nawccb.org/library/documents/Handbo
oks/WCC_Candidate_Handbook.pdf

7. WCS (WCSA OR WCSP)
 WCS Eligibility criteria:
 Minimum of bachelors degree
 Wound experience for at least 3 years
 Or completed fellowship of at least 1 year in wound
care
 Practice as one of the professions seen on right
 Interesting requirements:
 Personal statement
 Professional resume
 Letters of recommendation
 Recommended professions:
 MD, DO, PA
 PT, OT
 DPM
 RN
 DMD or VMD
 Renew every 10 years
 http://documents.goamp.com/Publications/candidateHan
dbooks/ABWM-CWS-Handbook.pdf

8. PATIENT CASES
CASE 1: PILONIDAL CYST
CASE 2: BIPOLAR + OCD + WOUND
CASE 3: PIN FIXATION

9. CASE 1: PILONIDAL CYST
• Background: inflammatory process forms pit at
hair follicle base, hair folds below skin surface
further creating inflammatory process and
eventually cyst formation and potentially
infectious abscess
• Prevalence/Risk Factors:
• 2x Males > Females
• Ages 15 – 30
• Hairy body
• Overweight (BMI >25)
• Lack of hygiene
• Prolonged sitting

10. CASE 1: PILONIDAL CYST
 Patient match:
 Female
 15 years old
 Hairy body
 Overweight
 Sedentary lifestyle
 Patient procedure:
 3 cysts surgically removed
 Large wound down to coccyx ~4in width,
6in length
 Wound care:
 Wound-Vac changed 3x/wk

11. CASE 1: PILONIDAL CYST
What treatment can physical therapists
perform to help healing?
 Nutrition education
 Importance of exercise
 Hygiene education

12. CASE 2: OCD + BIPOLAR + WOUNDS
 Male roughly 50 years old
 Diagnosed with bipolar & OCD
 Diabetes type 2, HBA1C level 10
 Superficial stage 2 wound on posterior
neck
 Stage 1 wound on forehead

13. CASE 2: OCD + BIPOLAR + WOUNDS
 Healthcare: “I get aggressive with nurses touching me wrong”
 Nutrition: “Sometimes I sleep for 3 days at a time and I’m not hungry”
 Compulsions: “I feel there is something digging into my spinal cord and I need to
get out”
 Delusions: “I can pull a string-like thing in my wound and I feel it here [front left
skull]”

14. CASE 2: OCD + BIPOLAR + WOUNDS
How do we as healthcare providers best treat this individual?
 Support, caregiver
 Frequent check ups on mood, exercise,
nutrition
 CBT + physical activity + pharmacotherapy
 Wound education, reassurance

15. CASE 3: PIN INSERTION
 Severe burns to all extremities (60-70%
TBSA)
 2-5 phalanges with pin fixation
 Escharotomy to dorsal hand

16.  Pin fixation and Kirschner wires
 Both do the same thing
 Pins have larger diameter to wires
 Early intervention tool for traction of bone
fragment
 See in orthopedics
CASE 3: PIN INSERTION
 Patient developed osteomyelitis
 Surgical removal of digits 3-5
 Pinning prevents movement of
joint
 Stiffness
 Loss of ROM
 Contracture?

17. RESEARCH TOPICS
1) VENOUS LEG ULCER TREATMENT
2) FOOT ORTHOSES

18. CHRONIC VENOUS LEG ULCERS (VLU)
 When no arterial
involvement:
 Compression wrap
 2 layers, one elastic
 20-30mmHg of pressure
 Options with compression
wraps:
 Hydrocolloids
 Antimicrobials
 Collagen

19. Antimicrobials:
 Iodine > hydrocolloids
 Silver ≠ no silver
 Mimosa tenuiflora with hydrogel ≠ hydrogel
alone
 Manuka honey > compression alone
Other items:
 Collagen > compression alone
 Cellular allogenic > compression alone
 Cellular human equivalent inconclusive
 Autologous keratinocytes > compression
alone
VLU TREATMENT OPTIONS

20. BOOTS AND BURNS
 3 main purposes:
 Progressive stretch (Jas-splint or Dyna-
splint)
 Maintain motion (Multipodus or Rooke)
 Offload pressure areas (Technically all)

21. PHYSICAL THERAPISTS AND WOUNDS
1) DIRECT INVOLVEMENT
2) INDIRECT INVOLVEMENT

22. PHYSICAL THERAPISTS IN WOUND CARE
Practice Act:
 12-41-103. Definitions: (F) General wound care, including the assessment and management of skin
lesions, surgical incisions, open wounds, and areas of potential skin breakdown in order to maintain or
restore the integumentary system.
 12-41-113. Special practice authorities and requirements – rules: (3) Wound debridement. A physical
therapist is authorized to perform wound debridement under a physician's order or the order of a
physician assistant authorized under section 12-36-106 (5) when debridement is consistent with the
scope of physical therapy
Rules/Regulations:
 The term “wound debridement” as used in section 12-41-113(3), C.R.S., refers to sharp, enzymatic,
selective, and pharmacological wound debridement and can only be performed by a licensed Physical
Therapist unless otherwise authorized by Colorado law. Physical Therapists may not delegate such
wound debridement to unlicensed personnel, but may delegate soft or non-selective wound
debridement to Physical Therapist Assistants.

23.  Strong associations between ankle ROM and calf strength with ulcer reoccurrence, healing, and size
 Simple walking programs show improvements (gait speed correlates with life)
 Electrical modalities have been proven to improve healing of wounds, particularly VLU
 High-voltage pulsed current
 Pulsed ultrasound
 PT has low reimbursement rates, making it cost-effective
 PT is another discipline involved = company makes more money
 DRG’s
PHYSICAL THERAPISTS IN WOUND CARE

24. PT’S INDIRECT INVOLVEMENT IN WOUND CARE
 Direct access
 Primary care provider
 PREVENTION!!!
 Never too early to start
 General health questions
 Exercise
 Diet
 Hygiene

25. THOUGHTS? QUESTIONS?

26. REFERENCES
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