This document provides information on wound management. It defines different types of wounds such as incised wounds, abrasions, punctured wounds, and burns. Wounds are classified as clean, contaminated, or infected. The stages of wound healing are hemostasis, proliferation, and remodeling. Factors that can affect healing include ischemia, infection, and patient health issues. Proper wound management includes irrigation, debridement, closure methods like sutures, and dressing. Complications to watch for are infection, scarring, and tissue necrosis.
This document provides an overview of wound management. It discusses wound classification, the wound healing process, factors affecting wound healing, wound assessment, types of wound drainage, complications of wound healing, and various wound dressing techniques. The three main phases of wound healing are the inflammatory phase, proliferative phase, and maturation phase. Wound classification includes factors like the mechanism of injury, degree of contamination, and wound depth. Proper wound management requires assessing these classifications and factors to determine the appropriate treatment approach.
This document provides an overview of wound assessment techniques. It discusses assessing the patient's history, examining the wound itself using techniques like TIME (tissue, infection, moisture, epithelial edges) and PQRST (provocation, quality, radiation, severity, time) for pain. The document outlines investigating further with tests and making a diagnosis. It also discusses implementing a treatment plan using wound bed preparation principles to manage tissue, infection, moisture and epithelial edges. The goal of wound care is a healed wound through this assessment and treatment cycle approach.
The document discusses various types of soft tissue injuries including abrasions, lacerations, contusions, avulsions, punctures, sprains, and strains. It notes four factors to consider in assessing the mechanism of injury: traveling 50 mph, falling from standing, falling from a height of 15 feet, and landing on concrete. Key terms defined include abrasion as damage to the superficial skin layer from rubbing or scraping, and compartment syndrome as elevated pressure within a muscle compartment containing nerves and vessels.
1) The document discusses current trends in wound management, outlining the phases of wound healing and factors that affect it.
2) Key aspects of wound management covered include wound bed preparation through debridement and dressing, as well as various closure methods and the use of negative pressure wound therapy.
3) Emerging treatments like hyperbaric oxygen therapy and various wound covers including skin substitutes are also summarized.
The presentation is for the use of Physiotherapy students. It covers a brief introduction, classification, clinical features and general principles of management.
This document discusses wound management and healing. It covers the goals of wound care including facilitating hemostasis, decreasing tissue loss, promoting healing, and minimizing scarring. The three main types of wound healing - primary, secondary, and tertiary intention - are described. Factors that affect wound healing like diabetes, infection, drugs, nutrition, tissue necrosis and hypoxia are summarized. The basics of wound evaluation, preparation, closure, and aftercare are outlined, including debridement, reducing bioburden, optimizing blood flow and oxygen supply, and using dressings appropriately.
This document provides information on wound management. It defines different types of wounds such as incised wounds, abrasions, punctured wounds, and burns. Wounds are classified as clean, contaminated, or infected. The stages of wound healing are hemostasis, proliferation, and remodeling. Factors that can affect healing include ischemia, infection, and patient health issues. Proper wound management includes irrigation, debridement, closure methods like sutures, and dressing. Complications to watch for are infection, scarring, and tissue necrosis.
This document provides an overview of wound management. It discusses wound classification, the wound healing process, factors affecting wound healing, wound assessment, types of wound drainage, complications of wound healing, and various wound dressing techniques. The three main phases of wound healing are the inflammatory phase, proliferative phase, and maturation phase. Wound classification includes factors like the mechanism of injury, degree of contamination, and wound depth. Proper wound management requires assessing these classifications and factors to determine the appropriate treatment approach.
This document provides an overview of wound assessment techniques. It discusses assessing the patient's history, examining the wound itself using techniques like TIME (tissue, infection, moisture, epithelial edges) and PQRST (provocation, quality, radiation, severity, time) for pain. The document outlines investigating further with tests and making a diagnosis. It also discusses implementing a treatment plan using wound bed preparation principles to manage tissue, infection, moisture and epithelial edges. The goal of wound care is a healed wound through this assessment and treatment cycle approach.
The document discusses various types of soft tissue injuries including abrasions, lacerations, contusions, avulsions, punctures, sprains, and strains. It notes four factors to consider in assessing the mechanism of injury: traveling 50 mph, falling from standing, falling from a height of 15 feet, and landing on concrete. Key terms defined include abrasion as damage to the superficial skin layer from rubbing or scraping, and compartment syndrome as elevated pressure within a muscle compartment containing nerves and vessels.
1) The document discusses current trends in wound management, outlining the phases of wound healing and factors that affect it.
2) Key aspects of wound management covered include wound bed preparation through debridement and dressing, as well as various closure methods and the use of negative pressure wound therapy.
3) Emerging treatments like hyperbaric oxygen therapy and various wound covers including skin substitutes are also summarized.
The presentation is for the use of Physiotherapy students. It covers a brief introduction, classification, clinical features and general principles of management.
This document discusses wound management and healing. It covers the goals of wound care including facilitating hemostasis, decreasing tissue loss, promoting healing, and minimizing scarring. The three main types of wound healing - primary, secondary, and tertiary intention - are described. Factors that affect wound healing like diabetes, infection, drugs, nutrition, tissue necrosis and hypoxia are summarized. The basics of wound evaluation, preparation, closure, and aftercare are outlined, including debridement, reducing bioburden, optimizing blood flow and oxygen supply, and using dressings appropriately.
Proper wound care is necessary to prevent infection, assure there are no other associated injuries, and to promote healing of the skin. An additional goal, if possible, is to have a good cosmetic result after the wound has completely healed. This wound care article is designed to present information on wounds involving mainly the skin; it is not meant to cover all wounds (for example, gunshot, degloving wounds, tendon lacerations, and others).
This document discusses the management of non-healing wounds, which requires a multidisciplinary approach involving thorough assessment and wound bed preparation. It outlines the key factors in assessment including patient history, wound characteristics, and factors affecting healing. Wound bed preparation principles of debridement, control of inflammation and infection, and maintenance of moisture balance are explained. Various debridement methods and appropriate dressings to promote healing are also described.
This document provides information on wound management and wound care. It discusses the different types of wounds including acute and chronic wounds. The goals of wound care are to identify any wounds or complications, prescribe preventative measures to promote skin integrity, and treat any wounds. There are four phases of wound healing: hemostasis, inflammation, proliferation and remodeling. The three types of wound healing and closure are primary, secondary and tertiary. Various wound dressings are also described like hydrocolloid, hydrogel and alginate. The wound care market is large and growing, dominated by major players. Pricing for common wound dressings is also listed.
This document provides an overview of skin anatomy, wound classification, and wound management. It discusses the objectives of understanding wound care, outlines different topics to be covered including wound healing process and complications. The document defines wounds and classifies them by mechanism of injury, depth and degree of contamination. It describes the three phases of wound healing and different types of healing. Key steps of wound assessment and factors affecting healing are highlighted. Common wound dressings and their properties/indications are also summarized.
This document discusses wound healing and management of both acute and chronic wounds. It begins by introducing the normal phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. It then discusses factors that can influence wound healing and describes the normal healing process in tissues like bone, nerve and tendon. The document also covers classification of wound closure, managing acute wounds, and issues related to chronic wounds like leg ulcers and pressure sores. Specific topics like bites, puncture wounds, hematomas, degloving injuries, and necrotizing soft tissue infections are also summarized. Throughout the phases and management of both acute and chronic wounds are discussed in detail in this comprehensive overview of wound healing.
Pressure ulcers, also known as decubitus ulcers or bed sores, are localized areas of soft tissue damage that result from prolonged pressure. They are staged from 1 to 4 based on depth of tissue damage. Risk factors include older age, immobility, moisture, and poor nutrition. Treatment focuses on relieving pressure, cleaning and debridement of wounds, dressing changes, and surgery if needed to prevent complications like infection.
This document discusses pressure sores (also known as decubitus ulcers or bed sores), which are areas of damaged skin and underlying tissue that typically form over bony prominences of the body due to prolonged pressure. The document covers the definition, risk factors, pathogenesis, staging, clinical features, complications, and treatment of pressure sores. Common sites for pressure sores include the occiput, scapula, ischium, sacrum, and heel. Prevention is important through good skin care, use of an alpha bed, and management of incontinence. Treatment involves frequent repositioning, wound debridement, dressings, and sometimes skin grafts or flaps.
1) Trophic ulcers occur due to impaired nutrition or damage to an area of the body, often caused by diabetes, vascular disease, or nerve damage.
2) Evaluation of trophic ulcers involves assessing neuropathy, arterial blood flow, and identifying contributing local or systemic factors like high blood sugar levels.
3) Management requires aggressive debridement, wound bed preparation, offloading pressure on the affected area, and potentially surgical reconstruction. Patient education aimed at lifestyle changes and self-care is also important.
This document summarizes the use of negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC). It discusses how VAC works by applying subatmospheric pressure to open wounds to promote healing. Key points include that VAC helps remove dead tissue, improves blood flow to the wound, and pulls wound edges together. The document reviews appropriate applications of VAC, such as soft tissue trauma and skin grafts, and contraindications like non-debrided wounds. Installation and maintenance of the VAC system is also outlined.
Plastic surgery principles aim to optimize wound healing through adequate debridement and resection while ensuring good blood supply. Scars should be placed carefully along lines of minimal tension and defects replaced with similar tissue. Meticulous surgical technique and consideration of donor site costs are important. The skin has two layers - the epidermis which acts as a protective barrier and the dermis which provides strength and sensation. Grafts do not maintain their original blood supply while flaps do, allowing flaps to bring their own vascularity to the recipient site. Careful technique and consideration of various factors influence graft and flap survival.
This document provides tips and instructions for using a PowerPoint presentation on wound healing and scar formation:
1. The presentation can be freely downloaded, edited, and modified. Students are encouraged to add their names.
2. Many slides are intentionally blank except for the title to facilitate active learning discussions. The instructor will show blank slides and ask students what they know about the topic before presenting information on the next slide.
3. This approach will be repeated for three revisions to reinforce learning. The presentation can also be used for self-study with notes providing references.
This document discusses protocols for wound debridement. It defines debridement as removing dead, contaminated, or adherent tissue from a wound to facilitate healing. The main types of debridement covered are mechanical, enzymatic, sharp, autolytic, and biologic. Characteristics of necrotic tissue like color, consistency, and adherence are reviewed. Protocols for sharp debridement emphasize preparing the patient, thoroughly removing necrotic tissue from the wound base outward until bleeding edges are seen, and irrigating and dressing the wound. The goal of debridement is to remove barriers to healing and reduce the bacterial burden.
The document discusses the anatomy and types of skin grafts and skin flaps. It describes that skin has two layers, the epidermis and dermis. There are two types of skin grafts - partial thickness grafts which remove some dermis and full thickness grafts which remove the full dermis. Skin flaps differ in that they maintain the blood supply of the transferred tissue. Local flaps use nearby tissue while distant flaps require long pedicles. The techniques, indications, and advantages/disadvantages of various skin grafts and flaps are outlined.
Wound healing is a complex, dynamic process involving several phases: inflammatory, proliferative, and remodeling. The inflammatory phase involves hemostasis and inflammation to limit blood loss and seal the wound. The proliferative phase fills the wound gap with granulation tissue through fibroplasia, angiogenesis, and re-epithelialization. The remodeling phase involves regression of vessels and granulation tissue, wound contraction, and collagen remodeling to strengthen the scar. Successful wound healing depends on factors like adequate blood supply, infection control, and avoiding risks such as smoking, which can impair healing.
1. A wound is a break in the skin or tissue integrity often disrupting structure and function. Wounds are classified based on factors like cause, depth, and healing process.
2. Wound healing involves three phases - inflammatory, proliferative, and remodeling. The inflammatory phase begins immediately after injury. Then proliferation and tissue repair occurs over 3 weeks. Remodeling lasts from 3 weeks to 2 years.
3. Factors like wound site, contamination, and underlying health conditions can affect healing. Complications include hypertrophic scars and keloids. Proper wound management includes cleaning, debridement if needed, and closure through various suturing techniques depending
This document provides information on the pathophysiology and treatment of burns. It discusses the local and systemic effects of burns including cardiovascular, renal, pulmonary, gastrointestinal and immune responses. It describes methods of assessing burn severity including depth of burn and percentage of total body surface area burned. Treatment involves fluid resuscitation according to the Parkland formula, wound care, infection control, nutrition and management of complications like multiorgan failure.
This document summarizes treatment for various soft tissue injuries including open and closed wounds, amputations, impaled objects, neck wounds, chest injuries, and burns. It describes assessing the injuries, providing emergency care such as controlling bleeding and preventing infection, dressing wounds, and guidelines for transporting patients.
The document discusses soft tissue injuries and wound care. It defines the normal healing process, risks for abnormal wound healing, and treatments. Soft tissue injuries can occur in the skin, subcutaneous tissues, muscles, and nerves. Proper wound management requires understanding wound anatomy, the healing process, and factors that impact healing like infection, nutrition, smoking, and comorbidities. Treatment depends on the extent of injury and time since injury, and may include cleaning, debridement, closure or leaving open to heal.
Wound Management in Domiciliary Palliative Care wan zuraini
Basic teaching on wound management seen in home care / domiciliary palliative care in Malaysia. Spesifically describe management of pressure ulcer at home.
Proper wound care is necessary to prevent infection, assure there are no other associated injuries, and to promote healing of the skin. An additional goal, if possible, is to have a good cosmetic result after the wound has completely healed. This wound care article is designed to present information on wounds involving mainly the skin; it is not meant to cover all wounds (for example, gunshot, degloving wounds, tendon lacerations, and others).
This document discusses the management of non-healing wounds, which requires a multidisciplinary approach involving thorough assessment and wound bed preparation. It outlines the key factors in assessment including patient history, wound characteristics, and factors affecting healing. Wound bed preparation principles of debridement, control of inflammation and infection, and maintenance of moisture balance are explained. Various debridement methods and appropriate dressings to promote healing are also described.
This document provides information on wound management and wound care. It discusses the different types of wounds including acute and chronic wounds. The goals of wound care are to identify any wounds or complications, prescribe preventative measures to promote skin integrity, and treat any wounds. There are four phases of wound healing: hemostasis, inflammation, proliferation and remodeling. The three types of wound healing and closure are primary, secondary and tertiary. Various wound dressings are also described like hydrocolloid, hydrogel and alginate. The wound care market is large and growing, dominated by major players. Pricing for common wound dressings is also listed.
This document provides an overview of skin anatomy, wound classification, and wound management. It discusses the objectives of understanding wound care, outlines different topics to be covered including wound healing process and complications. The document defines wounds and classifies them by mechanism of injury, depth and degree of contamination. It describes the three phases of wound healing and different types of healing. Key steps of wound assessment and factors affecting healing are highlighted. Common wound dressings and their properties/indications are also summarized.
This document discusses wound healing and management of both acute and chronic wounds. It begins by introducing the normal phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. It then discusses factors that can influence wound healing and describes the normal healing process in tissues like bone, nerve and tendon. The document also covers classification of wound closure, managing acute wounds, and issues related to chronic wounds like leg ulcers and pressure sores. Specific topics like bites, puncture wounds, hematomas, degloving injuries, and necrotizing soft tissue infections are also summarized. Throughout the phases and management of both acute and chronic wounds are discussed in detail in this comprehensive overview of wound healing.
Pressure ulcers, also known as decubitus ulcers or bed sores, are localized areas of soft tissue damage that result from prolonged pressure. They are staged from 1 to 4 based on depth of tissue damage. Risk factors include older age, immobility, moisture, and poor nutrition. Treatment focuses on relieving pressure, cleaning and debridement of wounds, dressing changes, and surgery if needed to prevent complications like infection.
This document discusses pressure sores (also known as decubitus ulcers or bed sores), which are areas of damaged skin and underlying tissue that typically form over bony prominences of the body due to prolonged pressure. The document covers the definition, risk factors, pathogenesis, staging, clinical features, complications, and treatment of pressure sores. Common sites for pressure sores include the occiput, scapula, ischium, sacrum, and heel. Prevention is important through good skin care, use of an alpha bed, and management of incontinence. Treatment involves frequent repositioning, wound debridement, dressings, and sometimes skin grafts or flaps.
1) Trophic ulcers occur due to impaired nutrition or damage to an area of the body, often caused by diabetes, vascular disease, or nerve damage.
2) Evaluation of trophic ulcers involves assessing neuropathy, arterial blood flow, and identifying contributing local or systemic factors like high blood sugar levels.
3) Management requires aggressive debridement, wound bed preparation, offloading pressure on the affected area, and potentially surgical reconstruction. Patient education aimed at lifestyle changes and self-care is also important.
This document summarizes the use of negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC). It discusses how VAC works by applying subatmospheric pressure to open wounds to promote healing. Key points include that VAC helps remove dead tissue, improves blood flow to the wound, and pulls wound edges together. The document reviews appropriate applications of VAC, such as soft tissue trauma and skin grafts, and contraindications like non-debrided wounds. Installation and maintenance of the VAC system is also outlined.
Plastic surgery principles aim to optimize wound healing through adequate debridement and resection while ensuring good blood supply. Scars should be placed carefully along lines of minimal tension and defects replaced with similar tissue. Meticulous surgical technique and consideration of donor site costs are important. The skin has two layers - the epidermis which acts as a protective barrier and the dermis which provides strength and sensation. Grafts do not maintain their original blood supply while flaps do, allowing flaps to bring their own vascularity to the recipient site. Careful technique and consideration of various factors influence graft and flap survival.
This document provides tips and instructions for using a PowerPoint presentation on wound healing and scar formation:
1. The presentation can be freely downloaded, edited, and modified. Students are encouraged to add their names.
2. Many slides are intentionally blank except for the title to facilitate active learning discussions. The instructor will show blank slides and ask students what they know about the topic before presenting information on the next slide.
3. This approach will be repeated for three revisions to reinforce learning. The presentation can also be used for self-study with notes providing references.
This document discusses protocols for wound debridement. It defines debridement as removing dead, contaminated, or adherent tissue from a wound to facilitate healing. The main types of debridement covered are mechanical, enzymatic, sharp, autolytic, and biologic. Characteristics of necrotic tissue like color, consistency, and adherence are reviewed. Protocols for sharp debridement emphasize preparing the patient, thoroughly removing necrotic tissue from the wound base outward until bleeding edges are seen, and irrigating and dressing the wound. The goal of debridement is to remove barriers to healing and reduce the bacterial burden.
The document discusses the anatomy and types of skin grafts and skin flaps. It describes that skin has two layers, the epidermis and dermis. There are two types of skin grafts - partial thickness grafts which remove some dermis and full thickness grafts which remove the full dermis. Skin flaps differ in that they maintain the blood supply of the transferred tissue. Local flaps use nearby tissue while distant flaps require long pedicles. The techniques, indications, and advantages/disadvantages of various skin grafts and flaps are outlined.
Wound healing is a complex, dynamic process involving several phases: inflammatory, proliferative, and remodeling. The inflammatory phase involves hemostasis and inflammation to limit blood loss and seal the wound. The proliferative phase fills the wound gap with granulation tissue through fibroplasia, angiogenesis, and re-epithelialization. The remodeling phase involves regression of vessels and granulation tissue, wound contraction, and collagen remodeling to strengthen the scar. Successful wound healing depends on factors like adequate blood supply, infection control, and avoiding risks such as smoking, which can impair healing.
1. A wound is a break in the skin or tissue integrity often disrupting structure and function. Wounds are classified based on factors like cause, depth, and healing process.
2. Wound healing involves three phases - inflammatory, proliferative, and remodeling. The inflammatory phase begins immediately after injury. Then proliferation and tissue repair occurs over 3 weeks. Remodeling lasts from 3 weeks to 2 years.
3. Factors like wound site, contamination, and underlying health conditions can affect healing. Complications include hypertrophic scars and keloids. Proper wound management includes cleaning, debridement if needed, and closure through various suturing techniques depending
This document provides information on the pathophysiology and treatment of burns. It discusses the local and systemic effects of burns including cardiovascular, renal, pulmonary, gastrointestinal and immune responses. It describes methods of assessing burn severity including depth of burn and percentage of total body surface area burned. Treatment involves fluid resuscitation according to the Parkland formula, wound care, infection control, nutrition and management of complications like multiorgan failure.
This document summarizes treatment for various soft tissue injuries including open and closed wounds, amputations, impaled objects, neck wounds, chest injuries, and burns. It describes assessing the injuries, providing emergency care such as controlling bleeding and preventing infection, dressing wounds, and guidelines for transporting patients.
The document discusses soft tissue injuries and wound care. It defines the normal healing process, risks for abnormal wound healing, and treatments. Soft tissue injuries can occur in the skin, subcutaneous tissues, muscles, and nerves. Proper wound management requires understanding wound anatomy, the healing process, and factors that impact healing like infection, nutrition, smoking, and comorbidities. Treatment depends on the extent of injury and time since injury, and may include cleaning, debridement, closure or leaving open to heal.
Wound Management in Domiciliary Palliative Care wan zuraini
Basic teaching on wound management seen in home care / domiciliary palliative care in Malaysia. Spesifically describe management of pressure ulcer at home.
This document defines pressure ulcers, discusses their pathogenesis and risk factors, and outlines their classification and management. Key points:
- Pressure ulcers are localized skin injuries caused by pressure that disrupts blood flow, often over bony prominences. The elderly are especially at risk.
- Risk factors include immobility, sensory impairment, malnutrition, moisture, shear and friction forces on the skin. Common sites are the sacrum and heels.
- Pressure ulcers are classified in stages from I to IV based on tissue damage depth. Prevention focuses on pressure reduction through repositioning, support surfaces, and skin care. Treatment involves dressing, debridement and wound healing promotion.
This document outlines an overview of pressure ulcers including their definition, risk factors, classification, diagnosis, treatment and prevention. Pressure ulcers are localized injuries to the skin and underlying tissue that are usually over bony prominences due to pressure or pressure in combination with shear and friction. They are caused by both extrinsic factors like pressure, friction and shear as well as intrinsic factors like advanced age, malnutrition and altered mental status. Treatment involves controlling risk factors, dressing wounds, and sometimes surgery for advanced cases. Prevention focuses on proper positioning, pressure dispersion and skin care.
Compartment syndrome is a serious condition caused by increased pressure within the fascial compartments of the body that can compromise blood flow. It requires immediate medical attention to prevent permanent muscle and nerve damage. The condition is diagnosed based on severe pain out of proportion to the injury that is worsened with stretching of the affected muscles. Treatment involves surgical fasciotomy to release the pressure within the compartments. Early diagnosis and treatment are essential to avoid long-term complications.
Prevention of Bed Sore Injuries in ICU patients.pptxanjalatchi
What is meant by bed sore?
Bedsores — also called pressure ulcers and decubitus ulcers — are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone.
Trophic ulcers develop due to impaired wound healing caused by issues like poor circulation, neuropathy or prolonged pressure. They are classified based on their underlying cause such as diabetic ulcers, pressure sores or venous stasis ulcers. Treatment involves identifying the cause, wound debridement, dressing, offloading pressure, and correcting nutritional deficiencies or vascular issues. For non-healing ulcers, surgical reconstruction with flaps may be needed along with patient education on self-care. A multidisciplinary team approach is required for managing trophic ulcers.
Pressure ulcers, also known as decubitus ulcers or bedsores, are localized injuries to the skin and underlying tissue that are usually caused by pressure over bony prominences. They are commonly seen in immobilized or bedridden patients and are associated with increased costs of care and risk of litigation. The Braden Scale is commonly used to assess pressure ulcer risk based on factors like mobility, sensation, moisture, activity, nutrition, and friction/shear. Treatment focuses on pressure redistribution through support surfaces, wound care including debridement and moist dressings, and managing pain and infection. Staging systems classify ulcers by depth of tissue damage from non-blanchable erythema to full thickness tissue loss.
A patient with severe limb infection in whom the amputation was the first option.
Dr Majd Alhaddadin, Consultant General and Laparoscopic Surgeon, performed a transmetatrsal amputation with extensive tissue debridement and falp creation, followed by vacuum therapy and 2 stages wound closure. Fortunately xth limb was saved and the patient returned to his normal job.
This document summarizes a seminar on Dupuytren's contracture, which is a progressive disease causing thickening and fibrosis of the palmar fascia and fingers to be pulled into flexion. It discusses the anatomy, pathological process, clinical presentation, diagnostic procedures including physical exam and staging scales, management including surgery and non-surgical options, post-op management protocols, differential diagnosis, and outcomes measures. The pathological process is unknown but risk factors include northern European descent, older age, male sex, genetics, and trauma. Surgical options range from fasciotomy to dermofasciectomy and recurrence is common requiring consideration of individual patient factors in treatment planning.
Pressure ulcers, also known as bedsores or decubitus ulcers, are areas of skin breakdown that occur when soft tissue is compressed between a bony prominence and an external surface. They develop primarily in elderly patients in healthcare settings. The four main forces that contribute to pressure ulcer development are pressure, friction, shear, and strain. Treatment involves identifying risk factors, debriding necrotic tissue, moist wound care, controlling infection, redistributing pressure, and choosing appropriate dressings. More advanced pressure ulcers may require surgery to address complications like bone and joint infections.
1) Systemic sclerosis is a disorder of connective tissue that causes hardening and tightening of the skin. It occurs more often in females and peaks between ages 40-50.
2) There are two main types: limited cutaneous which mainly affects the skin, and diffuse cutaneous which has more severe internal organ involvement.
3) Symptoms include thickened skin, especially on the hands, as well as Raynaud's phenomenon and potential lung, heart, kidney, or gastrointestinal complications. Management focuses on treating specific organ involvement and symptoms.
MDR and bed sores injuries - Read-Only.pptxIbnSaad1
MDR injuries, medical devices related injuries are a common happening issues affecting, elderly, bed ridden patients...etc
In this data show we are discussing the definition, causes, degrees and management of this medical problem
This document discusses different types of leg ulcers including venous, arterial, diabetic neuropathic, and hypertensive ulcers. It provides information on:
1. The causes, risk factors, signs and symptoms, investigations and management for each type of ulcer.
2. Venous ulcers are the most common type, caused by venous insufficiency and reflux, and are typically treated with compression therapy and dressings.
3. Arterial ulcers are caused by peripheral arterial disease and present with dry necrotic wounds, often over bony prominences of the feet. Revascularization may be required for healing.
4. Diabetic and neuropathic ulcers occur due to loss of sensation from
A 60-year-old woman presented with painful, sclerotic hands and fingers due to progressive cutaneous scleroderma. She was started on a compounded topical cream containing ketamine, baclofen, gabapentin, verapamil, and pentoxifylline, which provided significant pain relief and improved sensation within a month. At a 6-month follow up, she had been largely weaned off opioid pain medications. The customized treatment targeted the pathophysiology of the condition and helped manage her debilitating symptoms.
Maxillofacial Trauma and Its Emergency Management - ATLS
Presented by Dr Sabrina and group as a part of Dhaka Dental College OMS Department weekly presentation program
This document provides an overview of the management of open fractures. It defines an open fracture as a soft tissue injury complicated by a broken bone with communication to the external environment. The history of open fracture treatment is discussed, from ancient practices like debridement to modern advances with antibiotics and fixation methods. Classification systems for open fractures are presented, including the Gustilo-Anderson classification which correlates the degree of soft tissue injury with infection risk. Key steps in managing open fractures are described, including thorough debridement and irrigation, antibiotic administration, fracture stabilization options like external or internal fixation depending on the injury, and wound management. Overall infection rates and healing times are correlated with the classification of the soft tissue injury.
This document provides information on pressure ulcers/sores, including their definition, stages, risk factors, prevention, and treatment. It discusses how pressure ulcers develop from prolonged pressure on soft tissue over bony prominences, and outlines 4 stages based on tissue depth involvement. Key risk factors include immobility, incontinence, and nutritional status. Prevention focuses on pressure relief through repositioning and support surfaces. Treatment involves wound cleaning, debridement of necrotic tissue, and dressings to promote healing.
This document defines pressure ulcers, also known as bedsores or decubitus ulcers, as localized skin injuries that occur over bony prominences due to pressure or pressure combined with shear and friction forces. Pressure ulcers develop when external pressure compresses blood vessels, obstructing blood flow and depriving tissues of oxygen and nutrients. Risk factors include limited mobility, incontinence, poor nutrition, and comorbidities like diabetes. Treatment involves repositioning, special mattresses and dressings, wound cleaning and debridement, nutritional support, and sometimes surgery.
Tumor markers are substances produced by tumors or the body's response to tumors that can help detect and monitor cancer. Alpha-fetoprotein (AFP) is elevated in hepatocellular carcinoma and germ cell tumors. It is useful for diagnosis, staging, prognosis, and monitoring treatment response in HCC and germ cell tumors. Carcinoembryonic antigen (CEA) is elevated in various cancers including colorectal cancer. CEA levels correlate with tumor stage and burden and can help monitor treatment response and detect recurrence, though it lacks sensitivity and specificity for screening and diagnosis.
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, cutting off blood supply to the testicle. It most commonly affects adolescent boys and young men under age 25. Without prompt surgical intervention to untwist the cord within 6-12 hours, the testicle will become necrotic. Diagnosis involves physical exam findings like a high-riding, swollen testicle with absent cremasteric reflex as well as Doppler ultrasound showing reduced or absent blood flow. Immediate orchiopexy is needed to save the testicle from necrosis and allow for potential future fertility.
approach to urosepsis/sepsis/septic shock.
general approach to sepsis, severe sepsis, septic shock according to the latest guidelines. SCG2016/ EGDT2018/EUA2020
Carcinoma of the prostate is the most commonly diagnosed cancer and second leading cause of cancer death in men. Risk increases with age and family history. It often metastasizes to bones and lymph nodes. Diagnosis involves elevated PSA levels, abnormal digital rectal exam, biopsy. Staging uses the TNM system - early stages are limited to the prostate while advanced stages have spread outside the prostate. Gleason scoring evaluates microscopic patterns to determine tumor grade and aggressiveness. Treatment depends on tumor stage, grade and patient health.
The document discusses the management of choledocholithiasis or common bile duct stones. It covers the clinical features, investigations like ultrasound, CT, ERCP and MRCP. It discusses the diagnostic approach and various management options including endoscopic procedures like ERCP with sphincterotomy and plastic stent placement. It also discusses open CBD exploration techniques like choledochotomy and T-tube placement. Laparoscopic CBD exploration is mentioned as a minimally invasive method. Guidelines recommend ERCP as first-line treatment for CBD stones with timing based on severity of cholangitis. Sphincterotomy with balloon dilation and cholangioscopy-assisted lithotripsy are suggested for difficult stones.
Hematuria refers to the presence of blood in the urine. A diagnosis requires red blood cells to be present in urine samples obtained at least a week apart. Hematuria can be classified as microscopic or macroscopic, intermittent or persistent, and by its location in the urinary tract. Potential causes include glomerular disease, tumors, infections, vascular abnormalities, stones and trauma. Evaluation involves urinalysis, urine culture, imaging tests like ultrasound and CT urography, and cystoscopy depending on risk factors. Treatment focuses on the underlying cause if identified, while asymptomatic microscopic hematuria often requires monitoring without intervention.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
2. Introduction
● Pressure ulcer is an area of localised damage to the skin and
underlying tissue caused by pressure, shear, friction or a
combination of these factors
● Decubitus ulcer (from Latin decumbere, “to lie down”),
pressure sore, and pressure ulcer have often been
used interchangeably
● In April 2016, the National Pressure Ulcer Advisory Panel (NPUAP) changed pressure ulcer to
pressure injury, on the grounds that the latter term better described this injury process in both
intact and ulcerated skin.
2
3. ● Currently, the NPIAP defines a pressure injury as localized damage to the skin and underlying
soft tissue, usually over a bony prominence or related to a medical or other device.
● present either as intact skin or an open ulcer and may be painful.
● It results from intense or prolonged pressure or pressure
combined with shear.
● Age, immobility, inadequate nutrition, excess moisture, sensory deficiency(neurological
problem), multiple comorbidities (DM), reduced activity, immobility, circulatory
abnormalities (Vascular disease), and dehydration have been identified as some of the risk
factors.
● In patients with normal sensitivity, mobility, and mental faculty, pressure injuries do not occur.
3
4. ● Critically ill patients in intensive care units (ICU)
are at high risk of developing HAPU due to their
characteristics such as multiple comorbidities,
unstable haemodynamics, bedridden, increased
use of medical devices and special medications.
● Estimates suggest that up to 49% of the ICU
patients developed HAPUs.
Du Y et al..(China, 2019) Efficacy of pressure ulcer prevention
interventions in adult intensive care units: a protocol for a systematic
review and network meta-analysis. BMJ Open
4
SN Country Incidence
1 Norway (2016) 7-15%
2 Ethipoia 16%
3 Netherland 27%
4 Finland 4.5%
5 Germany 11.7%
6 Brazil 12.7%
5. Anatomy
Pressure injuries are typically described in terms of location
and depth of involvement.
The hip and buttock regions( up to 70% ), with Sacral, ischial
tuberosity and trochanteric locations being most common.
The lower extremities (additional 15-25%) with malleolar,
heel, patellar, and pretibial locations being most common
The nose, chin, forehead, occiput, chest, back, and elbow are
less frequent areas
Pressure injuries can involve different levels of tissue. Muscle
has been proved to be most susceptible to pressure.
5
6. Pathophysiology
● In 1873, Sir James Paget described the production of pressure ulcers
● Many factors contribute to the development of pressure injuries, but
pressure leading to ischemia and necrosis is the final common pathway.
● Pressure injuries result from constant pressure sufficient to impair local blood flow to soft
tissue for an extended period. This external pressure must be greater than the arterial
capillary pressure (32 mm Hg) to impair inflow and greater than the venous capillary closing
pressure (8-12 mm Hg) to impede the return of flow for an extended time.
● Tissues are capable withstanding enormous pressures for brief periods, but prolonged
exposure to pressures just slightly above capillary filling pressure initiates a downward spiral
toward tissue necrosis and ulceration. [19, 20]
● The inciting event is compression of the tissues against an external object such as a mattress,
wheelchair pad, bed rail, or other surface.
6
7. ● Lindan et al (1965) documented ranges of pressure applied to various anatomic points in
certain positions.
● The points of highest pressure with the patient supine included the sacrum, heel, and occiput
(40-60 mm Hg).
● With the patient prone, the chest and knees absorbed the highest pressure (50 mm Hg).
● When the patient is sitting, the ischial tuberosities were under the most pressure (100 mm Hg).
● Obviously, these pressures are greater than the end capillary pressure, which is why these are
the areas where pressure injuries are most common.
7
8. Mechanism of injury
● Of the various tissues at risk
for death due to pressure,
muscle tissue is damaged first,
before skin and subcutaneous
tissue, probably because of its
increased need for oxygen
and higher metabolic
requirements
● Generally, muscle is the least
resistant and will become
necrotic before skin breaks
down.
8
Pressure, Shear force and friction
Microcirculation occlusion and
Ischemia
Inflammation and tissue Anoxia
Cell death, Necrosis, Ulceration
Risk
factors
9. ● Irreversible changes may occur as ealry as 2 hours of uninterrupted pressure.
● Skin can withstand ischemia from direct pressure for up to 12 hours.
● By the time ulceration is present through the skin level, significant damage of underlying muscle may
already have occurred, making the overall shape of the ulcer an inverted cone.
● Reperfusion has been suggested as a cause of additional damage to the ulcerated area, inducing an ulcer
to enlarge or become more chronic, the exact mechanism of ischemia-reperfusion injury is yet to be fully
understood. Continued production of inflammatory mediators and reactive oxygen species during
ischemia-reperfusion may contribute to the chronicity of pressure ulcers.
9
10. Etiology and Risk factors
● Impaired mobility- neurologically impaired, heavily sedated or anesthetized, restrained, demented, or
recovering from a traumatic injury.
● Contractures and spasticity - contribute to ulcer formation by repeatedly exposing tissues to trauma
through flexion of a joint. Contractures rigidly hold a joint in flexion, whereas spasticity subjects tissues
to repeated friction and shear forces.
● Inability to perceive pain- neurological or medications
● Quality of the skin : Paralysis, insensibility, and aging lead to atrophy of the skin with thinning of this
protective barrier.
● Incontinence or the presence of a fistula: moisture, maceration
● Malnutrition, hypoproteinemia, and anemia :overall status
10
12. Presentation: History
● Overall physical and mental health
● Previous hospitalizations/ operations
● Cause of pressure sore, duration
● Associated medical cause for the injury (eg, paraplegia, quadriplegia, spina bifida, immobilization in
hospital, or multiple sclerosis)
● Diet and recent weight changes
● Bowel habits and continence status
● Presence of spasticity or flexion contractures
● Medications
● Tobacco, alcohol, and Smoking
● Place of residence and the support surface used in bed or while sitting
● level of independence, mobility, and ability to comprehend and cooperate with care
● Underlying social and financial support structure
12
13. Examination
● Evaluate the patient’s overall state of health, comorbidities, nutritional status, and mental status.
● Patients cooperation : nursing care
● Wound: NPIAP system consists of four main stages of pressure injury but is not intended to imply that
all pressure injuries follow a standard progression from stage 1 to stage 4 or that healing pressure
injuries follow a standard regression from stage 4 to stage 1 to a healed wound.
13
14. ● Stage 1 pressure injury – Epidermis :Intact
skin with a nonblanchable erythema, which
may appear differently in darkly pigmented
skin
● Stage 2 pressure injury – Epidermis and
dermis: Partial-thickness skin loss with
exposed dermis but not through it; the
wound bed is viable, pink or red, moist, and
may also present as an intact or ruptured
serum-filled blister;
14
15. ● Stage 3 pressure injury - Full-thickness skin
loss, subcutaneous tissue is visible in the
ulcer and granulation tissue are often
present; slough or eschar may be visible;
● Stage 4 pressure injury - Full-thickness skin
and tissue loss with exposed or directly
palpable fascia, muscle, tendon, ligament,
cartilage or bone in the ulcer; slough or
eschar may be visible), undermining, and
tunneling often occur; depth varies by
anatomic location
15
16. Unstageable pressure injury - Full-thickness
skin and tissue loss in which the extent of
tissue damage within the ulcer cannot be
confirmed because it is obscured by slough or
eschar; if slough or eschar is removed, a stage
3 or 4 pressure injury will be revealed
16
17. Complications
Complications of chronic injury include the following:
● Malignant transformation (Marjolin ulcer)
● Autonomic dysreflexia (sweating and flushing proximal to the injury, nasal congestion,
headache, intermittent hypertension, piloerection, and bradytachycardia.)
● Osteomyelitis
● Pyarthrosis
● Sepsis (UTI)
● Urethral fistula
● Amyloidosis
● Anemia
17
18. Workup
● CBC, RFT, ESR, Albumin, Serum protein
● Urine analysis and culture
● Imaging: Plain Xrays: ostemyelitis.
MRI
● Tissue biopsy of chronic wounds is indicated to rule out the presence of an underlying
malignancy (ie, Marjolin ulceration).
18
19. Treatment
A small area of skin breakdown may represent only
the tip of the iceberg, with a large cavity and
extensive undermining of skin edges beneath.
19
21. Successful medical management of pressure ulcers relies on the following key
principles:
● Reduction of pressure
● Adequate débridement of necrotic and devitalized tissue
● Control of infection
● Meticulous wound care
21
22. ● Before surgical correction: spasticity must be controlled, nutritional status must be optimized, and the
wound must be clean and free of infection.
● Requires an interdisciplinary approach.
● Chronically ill/Terminally ill pt: the wishes of the patient or the patient’s family should be weighed carefully.
● Poor surgical candidates in general should not undergo reconstruction procedure.
22
23. Multidisciplinary Approach
● Neurosurgery, urology, plastic surgery, orthopedic surgery, and general surgery consultations
● Rehabilitation medicine specialists, social workers, and psychologists or psychiatrists may work with
geriatricians and internists to improve the patient’s health, attitude, support structure, and living
environment.
● Plastic surgeons perform most pressure injury reconstructions;
23
24. General Measures for Optimizing Medical Status
● Spasticity : medications such as diazepam, baclofen, or dantrolene sodium. Patients with spasticity
refractory to medication may be candidates for neurosurgical ablation. Flexion contractures may also be
relieved surgically.
● Nutrirional build up : adequate protein intake and the establishment of a positive nitrogen balance, with
1.0-2.0 g/kg/day being recommended for patients with pressure injuries.
● Smoking cessation, adequate pain control, maintenance of adequate blood volume, and correction of
anemia, the primary aims of which are to prevent vasoconstriction in the wound and to optimizing the
oxygen-carrying capacity of the blood.
● Treatment of UTI, fecal or stool incontinence: antibiotics, catheterizations, frequent diaper changes,
optimize for surgical diversions.
24
25. Wound assessment
General principles of wound assessment and treatment are as follows:
● Wound care may be broadly divided into nonoperative and operative methods
● For stage 1 and 2 pressure injuries, wound care is usually conservative (ie,
nonoperative: Dressings/Nursing care)
● For stage 3 and 4 lesions, surgical intervention (eg, flap reconstruction) may be
required, though some of these lesions must be treated conservatively because of
coexisting medical problems.
● Approximately 70-90% of pressure injuries are superficial and heal by second
intention
25
26. Pressure reduction
● Turning and repositioning the patient remains the cornerstone
of prevention and treatment through pressure relief.
● Patients who are capable of shifting their weight every 10
minutes should be encouraged to do so.
● Repositioning should be performed every 2 hours, even in the
presence of a specialty surface or bed.
● Pressure mattress
26
27. Wound management
Wound débridement :remove all materials that promote infection, delay granulation, and impede healing,
including necrotic tissue, eschar, and slough
● Povidone-iodine solution, Sodium hypochlorite, H2O2 (no longer recommended)
● Enzymatic debridement (proteolytic agents) -Papain-urea (debridace), Purilone
● Mechanical or Surgical removal
Wound cleansing: decrease its bioburden and facilitate healing.
● Povidone-iodine is useful against bacteria, spores, fungi, and viruses. Dilution is recommended, and this
agent should be discontinued when granulation occurs
● Acetic acid (0.5%) is specifically effective against Pseudomonas aeruginosa, a particularly difficult and
common organism in fungating lesions. Acetic acid can change the color of tissue and can mask potential
superinfection
27
28. ● Sodium hypochlorite (2.5%) has some germicidal activity but is primarily used to debride necrotic tissue.
● When no germicidal action is required, normal saline is used.
● Saline solution should also be used as a rinse after other solutions are used to irrigate the wound and
minimize fluid shifts within newly forming tissue. Normal saline solution can reduce the drying effects of
other irritants used.
28
29. Dressings
The choice of wound dressings varies with the state of the wound, the goal being to achieve a clean,
healing wound with granulation tissue.
● Guaze peices/pads/Foams:: Obliteration of dead space; retention of moisture; exudate
absorption;
● Alginates: Exudate absorption; obliteration of dead space; autolytic débridement
● Hydrocolloids: Occlusion; retention of moisture; obliteration of dead space; autolytic
débridement eg COMFEEL
● Hydrogels
Care should be taken to keep the wound dressing within the boundaries of the wound to prevent
maceration of the surrounding skin
Antibiotics: may be used to reduce infection; eg Silver sufladiazine. Mafenide acetate, Neomycin,
Mupirocin
29
31. Other treatment
additional therapeutic methods :
● NPWT (VAC),
● application of growth factors
( recombinant human platelet-derived growth factor becaplermin )
NPWT enhances wound healing by
● reducing edema,
● increasing the rate of granulation tissue formation,
● and stimulating circulation.
Increased blood flow translates into a reduction in the bacterial load (removal of interstitial tissue) and delivery
of infection-fighting leukocytes.[
31
32. NPWT
General indications for NPWT :
● Chronic wounds
● Acute wounds
● Traumatic wounds
● Partial-thickness wounds
● Dehisced wounds
● Diabetic ulcers
● Pressure injuries
● Flaps
● Grafts
General contraindications for NPWT [148] :
● Malignancy of the wound
● Untreated osteomyelitis
● Nonenteric or unexplored fistulas
● Known allergies or sensitivity to
acrylic adhesives
● Placement of negative-pressure
dressings directly in contact with
exposed blood vessels, organs, or
nerves
32
33. Surgical interventions
Wound closure
33
include the following:
● Surgical débridement
● Diversion of the urinary or fecal stream
● Release of flexion contractures
● Wound closure
● Amputation
● Direct closure (rarely usable for pressure injuries being considered for surgical treatment)
● Skin grafts
● Skin flaps
● Myocutaneous (musculocutaneous) flaps
● Free flaps
34. Extensive débridement: adequate excision of the injury, including the bursa or lining, surrounding scar tissue,
and any heterotopic calcification found. Underlying bone must be adequately debrided to ensure that there is
no retained nidus of osteomyelitis.
Débridement of a pressure injury that will be reconstructed is different from débridement of a pressure injury that will be treated
conservatively (ie, allowed to heal by secondary intention).
Pressure injuries that are treated conservatively are not radically debrided; they need only be debrided of obvious necrotic tissue.
Urinary or fecal diversion may be necessary to optimize wound healing. Many of these patients are
incontinent and their wounds are contaminated with urine and feces daily.
Release of flexion contractures resulting from spasticity may assist with positioning problems, and
amputation may be necessary for a nonhealing wound in a patient who is not a candidate for reconstructive
surgery.
34
35. Reconstruction
Reconstruction of a pressure injury is aimed at improvement of patient hygiene and appearance, prevention
or resolution of osteomyelitis and sepsis, reduction of fluid and protein loss through the wound, and
prevention of future malignancy (Marjolin ulcer).
In general, stage 3 and 4 pressure injuries tend to require flap reconstruction.
For pressure injuries that will be reconstructed, a radical bursectomy is performed to prevent the development
of infection or seroma under the flap. This radical bursectomy is technically achieved by placing a methylene
blue–moistened sponge in the bursa and excising the pressure injury circumferentially, removing all
granulation tissue, even from the wound base
radically removing underlying necrotic bone, padding of the bone stump, filling the dead space with muscle,
using a large flap, achieving adequate flap mobilization to avoid tension, and avoiding adjacent flap territories
to preserve options to reconstruct other locations.
35
36. Wound Closure
● direct closure, skin grafting, skin flaps, and musculocutaneous flaps.
● medically stable and able to benefit from the procedure
1).Direct closure
simplest approach nt appropiate for large defects. Because these wounds are tense as a result of large soft-tissue
defects, direct closure can lead to wound defects, excessive wound tension, and a paucity of soft-tissue
coverage. Tissue expanders have been used to provide more skin surface and to facilitate closure.
2). Skin grafts
SSG used to repair shallow defects and pressure injuries, but their main disadvantage is that they provide only a
skin barrier. When applied directly to granulating bone, skin grafts quickly erode, thus precluding healing. They
also cause scars in the area from which the skin is harvested, and the transplanted skin is never as tough as the
original skin.
36
37. 3). Myocutaneous flaps
● Myocutaneous (musculocutaneous) flaps are usually the best choice for patients with spinal cord injuries
(SCIs) and for those who have a loss of muscle function that does not contribute to a comorbidity.
● For patients who are ambulatory, the choice is less clear, in that the improved blood supply and reliability of
the muscle flap must be balanced against the need to sacrifice functional muscle units.
● Myocutaneous flaps can help heal osteomyelitis and limit the damage caused by shearing, friction, and
pressure. [159, 160, 161] They bring muscle and skin to the area of the defect and are probably as resistant to
future pressure injuries as the original skin.
4). Free flaps
Free flaps are muscle-type flaps in which the vein and artery are disconnected at the donor site and subsequently
reconnected to the vessels at the recipient site with the aid of a microscope. In paraplegic patients dependent on
their upper body for mobility, the latissimus dorsi would typically be an unacceptable donor for free tissue transfer;
however, a portion of the muscle may be used with limited donor site morbidity.
37
38. Ischial pressure injury
● ischial location is the most common site of pressure injury in individuals with paraplegia.
● Recurrence of the pressure injury is common in the ischial location.
● the first option for reconstruction is the gluteal thigh rotation flap ( axial flap based on the inferior
gluteal artery) which does not preclude the future use of the inferior portion of the gluteus maximus
muscle
inferior gluteus maximus myocutaneous flap
hamstring myocutaneous flap,
the biceps femoris myocutaneous flap,
the tensor fasciae latae (TFL) flap,
the gracilis myocutaneous flap,
and the medially based posterior thigh skin flap with or without
the biceps femoris.
38
39. Sacral Pressure sore
● Sacral pressure injuries :common in patients who have been on prolonged bed rest.
● Small sacral pressure injuries can be reconstructed with an inferiorly based skin rotation flap, with or
without a superior gluteus maximus myocutaneous flap.
● With a superior gluteal myocutaneous flap, a wide skin rotation flap is elevated with the superior portion of
the gluteus maximus. Landmarks for the superior gluteal artery on which this flap is based include the posterior superior iliac
spine (PSIS) and the ischial tuberosity.
39
40. The superior and inferior gluteal arteries branch from the
internal iliac artery superior and inferior to the piriformis
approximately 5 cm from the medial edge of the origin of
the gluteus maximus from the sacrococcygeal line (from
PSIS to coccyx)
40
41. Larger sacral pressure injuries require the use of bilateral flaps such as bilateral V-Y myocutaneous
advancement flaps .
V-Y flaps can be based on the superior, inferior, or entire gluteus maximus, depending on the location of the
pressure injury .
41
42. Trochanteric pressure injury
Excisional debridement: preparation for flap repair involves resection of the entire bursa and greater trochanter of
the femur.
TFL flap, a myocutaneous flap based on the lateral femoral circumflex artery.
● The TFL is 13 cm long, 3 cm wide, and 2 cm thick, and it originates from the anterior superior iliac spine
(ASIS) and the iliac crest and inserts into the iliotibial tract.
● The skin paddle is harvested in a width of 10 cm and designed over the muscle along an axis from the ASIS
to the lateral tibial condyle
42
modifications of the TFL flap
include the retroposition V-Y
flap and the bipedicled TFL
flap.
Others : the vastus lateralis
myocutaneous flap, the gluteal
thigh flap, and the anterior
thigh flap.
43. Postoperative Care
● POC encourage wound healing and to reduce the risk of complications such as recurrence.
● Prevent shearing and tension across the flap repair.
● Patients are positioned flat( prone) in the air-fluid bed for 4 weeks. After 4 weeks, the patient can be
placed carefully into a semisitting position
● Skin care must be performed daily. the flap should be evaluated for discoloration and wound edge
separation
● Complications: Hematoma, Seroma, Wound dehiscence, Wound infection, Recurrence
● Activity usually as soon as possible- after 6 weeks.
43
44. Prevention
○ Two main components: identification of patients at risk and interventions designed to reduce the
risk.
● Identification of patients at risk
● General physical and mental condition, nutritional status, activity level, mobility, and degree of bowel
and bladder control are all known to affect this risk
● A systematic assessment of pressure injury risk can be accomplished by using a assessment tool such
as the Braden scale or the Norton scale
44
45. Norton: tested on elderly persons in hospital settings
Braden: Evaluated in diverse sites (eg, medical-surgical, intensive care units, nursing homes)
45
46. According to the Agency for Healthcare Research and Quality (AHRQ), prevention guidelines, risk
assessment should include the following :
● Complete medical history taking
● Determination of Norton (or Braden) score
● Skin examination
● Identification of previous pressure ulcer sites
46
Prime candidates for pressure ulcers :
● Elderly persons
● chronically ill (eg, those with cancer,
stroke, or diabetes)
● immobile (eg, as a consequence of
fracture, arthritis, or pain)
● weak or debilitated
● altered mental status (eg, from the effects
of narcotics, anesthesia, or coma)
● decreased sensation or paralysis
Secondary factors include the following [15] :
● Illness or debilitation increases
pressure ulcer formation
● Fever increases metabolic demands
● Predisposing ischemia
● Diaphoresis promotes skin maceration
● Incontinence causes skin irritation and
contamination
● Other factors, such as edema,
jaundice, pruritus, and xerosis (dry
skin)
In November 2019, the NPUAP changed its name to the National Pressure Injury Advisory Panel (NPIAP).Decubitus ulcer occurs at sites overlying bony structures that are prominent when a person is recumbent. Hence, it is not an accurate term for ulcers occurring in other positions, such as prolonged sitting (eg, ischial tuberosity ulcer).
National Pressure Injury Advisory Panel (NPIAP; formerly the National Pressure Ulcer Advisory Panel [NPUAP]
The tolerance of soft tissue for pressure and shear may be affected by microclimate, nutrition, perfusion, comorbid conditions, and the condition of the soft tissue.
Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath.
These pressures often exceed capillary filling pressure (~32 mm Hg).
NorwegiAN STUDY 7-15% INCIDENCE in inpatients ( 2016, systematic review, including 7 studies) Ethiopia (16%) , Netherland (27%) Finland (4.5%), Germany 11.7%, Brazil (12.7%), Turkey (11.7%)
Maceration may occur in a patient who has incontinence, predisposing the skin to injury
Prolonged immobility may lead to muscle and soft tissue atrophy, decreasing the bulk over which bony prominences are supported.
Stage 1 : presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes; color changes do not include purple or maroon discoloration, which may indicate deep tissue pressure injury
Stage 2 : adipose (fat) and deeper tissues are not visible, and granulation tissue, slough and eschar are not present; these injuries commonly result from adverse microclimate and shear in the skin over the pelvis and shear in the heel
Stage 3 : the depth of tissue damage varies by anatomic location; areas of significant adiposity can develop deep wounds; undermining and tunneling may occur; fascia, muscle, tendon, ligament, cartilage, and bone are not exposed
Although Marjolin initially described malignant transformation of a chronic scar from a burn wound, the term Marjolin ulcer has been commonly applied to the malignant transformation of any chronic wound, including pressure injuries, osteomyelitis, venous stasis ulcers, urethral fistulas, anal fistulas, and other traumatic wounds.
patients often have anemia of chronic disease, suggested by a low mean corpuscular volume, and can be considered for a transfusion in order to achieve a preoperative hemoglobin level higher than 12 g/dL.
Bone biopsy is the criterion standard for the diagnosis of osteomyelitis within a pressure injury.
With thorough and comprehensive medical management, many pressure injuries may heal completely without the need for surgical intervention
The presence or absence of foul odors, wound drainage, and soiling from urinary or fecal incontinence provides information about bacterial contamination and the need for debridement or diversionary procedures.
Hyperbaric oxygen also
With the gluteal thigh flap, a superiorly based flap is elevated, with its axis being the inferior gluteal artery located between the greater trochanter and the ischial tuberosity. Both the biceps femoris flap and the hamstring myocutaneous flap transect the inferior gluteal artery
Superior and inferior gluteal arteries branch from internal iliac superior and inferior arteries to piriformis approximately 5 cm from medial edge of origin of gluteus maximus from sacrococcygeal line.