ASHT Test Prep Book Chapter 3
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Epidermis | show 🗑
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Epidermal Layers (from superficial to deep) | show 🗑
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show | -Outermost layer of the epidermis
-Consists of dead, tightly packed keratinocytes
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Stratum Lucidum | show 🗑
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show | -Granular, compressed, multi-layered cells
-aide in keratin formation
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show | -Several layers of more mature, flattening keratinocytes
-aides in keratin production
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show | -Single row of keratinocytes which undergoes mitosis to produce keratin
-Forms the junction between epidermis and dermis
-Role is to increase surface area, provide nutrient transfer, and resist shearing forces
-Function decreases with age
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Epidermis Cell Types | show 🗑
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Keratinocyte | show 🗑
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show | -Binds adjacent Keratinocytes and provides cohesion during keratinocyte migration through epidermal cell layers
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Melanocyte | show 🗑
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show | - Specialized mechanoreceptor that provides information on light touch
-function= constant touch pressure; slow adapting
STUDY TIPS:
MerKONSTANT & MerKONSLOW
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Langerhan's Cells | show 🗑
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Functions of the Epidermis | show 🗑
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Dermis | show 🗑
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Two Layers of the Dermis | show 🗑
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Papillary Dermis | show 🗑
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show | -Deeper, thicker layer of the dermis that provides structural support to the skin
-Full of thick fibrous connective tissue
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Dermis Cell Types | show 🗑
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show | -Produces collagen and elastin, giving the dermis its strength and flexibility
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show | -Scavenger cells that ingest dead tissue, repair injured tissue, secrete growth factor to stimulate the cascade of healing, and assist white blood cells in defending against infection
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Mast Cells | show 🗑
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show | -Provide information for touch, pressure, vibration, and temperature
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Types of Specialized Sensory Receptors | show 🗑
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show | -256 Hz; movement and vibration
-Rapidly adapting
-Tested with tuning fork
-STUDY: P56 CoRAPID
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show | -30 Hz; movement and vibration
-Tested with tuning fork/moving 2 point discrim
-STUDY: MeisneR (R=rapid) MoVement (V=vibration)
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show | -MOVEMENT
-Rapid adapt and vibration
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Cells/Organs are consistent with what function? | show 🗑
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show | -Constant pressure, lateral stretch
-Slow adapting
-Tested with steady pressure, stretching of the skin, joint movement
-STUDY: Stretch skin to END with CONSTANT pressure from hands
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show | 1. Deep Pressure/Pinprick (Most pressure/time)
2. Moving Touch (more time on skin)
3. Static Light Touch (One single spot with longer pressure)
4. Discriminative Touch (able to locate more specific quicker touch)
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show | -Supports and provides nutrition to Epidermis
-Houses epidermal appendages
-Infection control against microorganisms
-Thermoregulation
-Deeper sensation
-Protection against mechanical injury
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show | -Hypodermis cells are found in loose connective tissue under the dermis.
-This includes adipose tissue, fascia, major blood vessels. nerves, and lymphatic vessels
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show | -Energy through storage of calories
-Thermal insulation to deeper tissues
-Cushioning or a mechanical "shock absorber" to deeper tissues
-Supports blood vessels
-Controls body shape
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Types of Blood Components | show 🗑
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Red Blood Cells (RBCs) | show 🗑
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show | -Part of the immune system and help the body fight infection
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Lymphocytes | show 🗑
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Neutrophil | show 🗑
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Platelets | show 🗑
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Partial Thickness Wound | show 🗑
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show | -Through re-epithelialization, no granulation tissue is present
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show | -Skin loss through the epidermis, dermis, and into the subcutaneous tissue
-Can extend into bone, muscle, and tendon
-Wound closure achieved by 4 overlapping phases that begin at the time of injury
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show | -Through granulation tissue and angiogenesis
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Phases of Wound Healing | show 🗑
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Hemostasis (Phase I) | show 🗑
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Fibrinolysis | show 🗑
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show | -Lasts from onset of injury to 4-6 days
-Vascular and cellular response is designed to defend the body from further injury and remove dead tissue to prepare for the repair process
-Epithelialization and Vasodilation
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show | -Platelets: close off lymphatic channels to increase edema
-Neutrophils: enter the wound to destroy bacteria through phagocytosis for 24-48 hours
-Macrophages: arrive 2-3 days post injury to remove bacteria and debris. If absent, delayed healing
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Cardinal Signs of Inflammation | show 🗑
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Chronic Inflammation | show 🗑
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Proliferative Phase (Phase III) | show 🗑
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show | -Endothelial Cells (angioblasts) form budding capillaries for nutrition to the fibroblasts
-Prominent feature of granulating tissue that fills a full thickness wound
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show | -Tissue is formed with fibroblasts beginning collagen synthesis by manufacturing collagen, ground substance, various proteins, & peptide chains.
-Collagen synthesis gives tensile strength & structure to the healing wound so keratinocyte can be produced
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show | -Myofibroblasts contracting and pulling the wound margins together towards the center of the defect
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show | -Regeneration of the epithelial layer that covers the wound surface
-Begins in the inflammatory phase but continues through the proliferative phase.
-Epidermis eventually thickens and layers are re-established and the surface becomes keratinized
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Remodeling/Maturation Phase (Phase IV) | show 🗑
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The healed would will only gain _______% of normal tensile strength of non-injured skin. | show 🗑
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show | -Local Wound Environment
-Mechanical Influences
-Systemic Factors
-Clinician-Influenced Factors
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Scab | show 🗑
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Chronic Inflammation | show 🗑
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Dead Tissue can... | show 🗑
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Hematoma can... | show 🗑
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Systemic factors of wound healing include: | show 🗑
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show | -Physical location
-Partial/Full thickness depth
-LengthxWidthxDepth in cm
-Wound bed characteristics
-Draining/exudate
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show | - Epithelial
-Necrotic
-Drainage/Exudate
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Epithelial Tissue | show 🗑
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Types of Necrotic Tissue | show 🗑
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show | -Dry, desiccated necrotic tissue that feels firm, dry, and leathery.
-Brown-Black in color
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Slough | show 🗑
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show | -Slough & Eschar
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show | -Presents as beefy, red granular tissue. It grows from base of wound to replace dead tissue in healing full thickness wounds
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show | -Tissue that forms and projects above the skin surface and delays epithelialization
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show | -Identified by how much of the dressing is covered in exudate
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Descriptions of Exudate | show 🗑
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Types of Exudate | show 🗑
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Serous Exudate | show 🗑
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Sanguineous Exudate | show 🗑
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Serosanguineous Exudate | show 🗑
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show | -Thin, watery, cloudy, yellow-tan
-Consider the possibility of infection
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show | -Thick, opaque, yellow, tan, green or brown
-Not normal in the wound, not always an indicator of infection
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show | -Healthy, good blood flow
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show | -Poor blood flow, ischemia
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White Wound | show 🗑
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show | -Slough, non-viable necrotic tissue
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show | -Eschar, non-viable necrotic tissue
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show | -Trauma, may indicate high bacteria count
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show | -Non-viable tissue, associated with pseudomonas infection
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Heat, redness, swelling (and discomfort) during the inflammatory phase is ____________________ | show 🗑
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show | -INFECTION
-if past the inflammatory phase
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Vascularity is determined by... | show 🗑
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show | -Hydrocolloid (occlusive) Dressing
-A saturated dressing
-Necrotic tissue in the wound bed
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Erythema | show 🗑
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Induration | show 🗑
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Colors Found in Peri-Wound Tissue: | show 🗑
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show | -Wrinkled white skin from excess moisture
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show | T= Tissue management
I= Infection control and inflammation
M=Moisture Balance
E=Topical wound management
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show | -Uses the body's own cells and enzymes to break down and liquefy necrotic tissue.
-Slow and painless natural physiologic process
-Not appropriate for wounds with large amounts of eschar, infections, or with immunocompromised patients
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show | -Applies an exogenous enzyme ointment to the wound to expedite debridement
-Selectively degrades denatured collagen anchored to the wound
-Not compatible with silver
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show | -Uses medicinal sterile maggots to remove devitalized tissue.
-Maggots liquify necrotic tissue to ingest and remove bacteria from the wound
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Types of Selective Debridement | show 🗑
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show | -Removes only non-viable tissues
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show | -Removes viable tissue in the process of removing non-viable tissue
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show | -Mechanical Debridement
-Sharp Debridement
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show | -When an external force separates necrotic tissue from the wound base.
-This includes scrubbing, irrigation, and whirlpool
-It is not used on wounds with granulation or epithelial tissue present (red/bloody looking)
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Sharp Debridement | show 🗑
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show | -The presence of bacteria in a wound
-Bacteria is not multiplying, do not elicit a host reaction, and od not impair wound healing
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Colonization | show 🗑
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show | -Replicating bacteria in a wound that begins to cause local tissue damage
-One or two signs and symptoms of bacteria in the wound may be present
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Signs and Symptoms of Bacteria in the Wound | show 🗑
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Infection | show 🗑
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Local infection is described using the acronym NERDS: | show 🗑
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show | -Includes 3+ signs/symptoms plus an elevated WBC count, elevated body temperature, confusion and/or agitation, and red streaks extending away from the wound
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show | S= Size of wound increasing
T=Temperature increased
O=Exposed or probing bone
N= New areas of breakdown
E= Exudate/Erythema/Edema
S=Smell or foul odor
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Conditions that limit the expression of inflammation include: | show 🗑
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Moisture Balance | show 🗑
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show | -Alginate and hydrofiber dressings are used to absorb excess moisture
-Should be changed when a "strikethrough" occurs (exudate observed on outermost dressing layer)
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Epithelial or Edge Advancement | show 🗑
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Wound Packing | show 🗑
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Topical Wound Management | show 🗑
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Topical antiseptics/antibiotics should not be used longer than _____ weeks. | show 🗑
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show | -Anticeptic
-A bactericidal effective against pseudomonas
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Betadine | show 🗑
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Hydrogen Peroxide | show 🗑
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Types of Topical Antiseptics | show 🗑
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Types of Topical Antibiotics | show 🗑
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show | -Active against Methicillin-resistant Staphylococcus Aureus (MRSA)
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show | -Wide spectrum, commercially available over the counter as a triple antibiotic ointment
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Silvadene (Silver Sulfadiazine) | show 🗑
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Impregnated Gauze | show 🗑
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Transparent Film | show 🗑
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Contact Layer | show 🗑
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Hydrocolloids | show 🗑
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Hydrogel | show 🗑
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Foams | show 🗑
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Active Leptospermum | show 🗑
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Alginates | show 🗑
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Hydrofibers | show 🗑
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show | -Mechanical treatment that applies suction to the wound bed
-Uses negative pressure to eliminate fluid collection, increases oxygen tension, and decreases contamination
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show | -Increases perfusion & maintains moist wound environment
-Prevents hematoma
-Improves graft take in burns
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show | -Wound edges are brought together and held in place by mechanical means like suture, staple, tape, etc.
-Reliance on artificial means to hold the wound together stops at 10-14 days
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show | -When a wound is not closed mechanically, but allowed to remain open and closes by the biological process of tissue granulation, wound contraction, and epithelialization.
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When is Secondary Intention appropriate? | show 🗑
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show | -When crossing a joint
-Requires more time and therapeutic management due to more scar tissue, scar contracture, and fixed/rigid scars
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show | -A wound allowed to heal for a short time by secondary intention and then closed surgically via primary closure
-Appropriate for untidy and/or infected wounds
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Split Thickness Skin Graft (STSG) | show 🗑
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show | -Consists of the entire Epidermis and Dermis
-Donor site requires primary closure or STSG to heal
-Typically viable in 5-7 days but greater risk of nonadherence compared to STSG
-Often harvested from hypothenar eminence, medial arm, or groin
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show | -For wound beds with limited blood supply or where gliding structures are exposed (i.e. blood vessels and tendons)
-The pedicle refers to the local blood supply of the flap that is preserved
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Random Flap | show 🗑
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Axial Flap | show 🗑
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Local Flap | show 🗑
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show | -Generally used for defect on the volar surface of the hand and is useful in reducing scar contractures that cross the normal skin creases
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show | -Indicated for transverse and/or dorsal oblique fingertip amputations with exposed bone and intact nail bed.
-Provides excellent sensation and soft tissue coverage
-Contraindicated in volar oblique tip amputations
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show | -Used to maintain length in distal thumb amputation
-May require positioning for tension as it may cause a secondary thumb IP flexion contracture, but places the thumb in a functional position.
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show | -Requires vascular dissection and microvascular anastomosis to blood supply.
-The defect is attached to the recipient site and approximately 3 weeks later is separated with another surgical procedure
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Free Tissue Transfer | show 🗑
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show | -Cellular and acellular tissue products engineered to prepare the wound bed for autograft application or designed as a substitute for human skin.
-Can be temporary or permanent solutions
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show | -Synthetic, permanent, acellular bilayer matrix dressing consisting of epithelial and silicone layers comprised of bovine tendon collagen and glycosaminoglycan
-Promotes revascularization and neodermis formation
-Appropriate for clean, noninfected wound
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show | -Bioengineered cellular skin substitute created from bovine collagen and foreskin derived neonatal keratinocytes and fibroblasts
-Appropriate for clean, noninfected wounds
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Cultured Epidermal Autograft (CEA) | show 🗑
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Thermal Burn | show 🗑
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Chemical Burn | show 🗑
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Electrical Burn | show 🗑
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show | -Caused by a mechanical force rubbing against the skin surface
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Radiation Burn | show 🗑
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show | -The total body surface area (TBSA) as a percentage
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Palmar Method | show 🗑
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Lund Browder Method | show 🗑
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Rule of Nine | show 🗑
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show | -Involve only the epidermis
-Erythematous and painful
-Cell damage occurs without cell death, allowing complete scarless healing in 3-5 days via re-epithelialization
-Not included in TBSA %
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show | -Involve the epidermis and the superficial dermal layer (papillary dermis)
-Red, shiny, blistering, weepy, and wet & extremely painful
-Tissue blanches upon palpation with quick capillary refill
-Can heal o their own in 14-21 days
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Deep Partial Thickness Burns | show 🗑
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show | -Extend through the epidermis, dermis, subcutaneous tissue, and into muscle, tendon, and bone.
-Deep red, white, or black with a dry, leathery appearance with total loss of sensibility and no pain
-No capillary refill and not capable of healing
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show | -Burn cleaning solution made from bleach that has been diluted and treated to decrease irritation
-Effective against microorganisms known to infect burn wounds
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show | -Removal of necrotic tissue to lower infection risk, prevent impaired blood flow, and ischemia.
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Dorsal Hand Burn Orthotic Positioning | show 🗑
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Palmar Hand Burn Orthotic Positioning | show 🗑
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show | -Modified resting pan orthosis
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show | -Moisturizers, creams, and petrolatum topicals
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show | -Petrolatum topicals, petrolatum gauze, hydrogels, contact layers, foams
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show | -Foams, hydrofibers, alginates, antimicrobials, active leptospermum (medical grade honey)
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Biologic Dressing Options for Full Thickness Burns | show 🗑
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Which type of cell produces histamine? | show 🗑
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show | -Occurs when the upper edge of the epidermis rolls under the basement membrane and prevents epithelial migration
-Prolongs wound healing
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show | -Involves a portion of the wound edge and proceeds as tissue destruction under intact skin
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Scar | show 🗑
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Abnormal Scars Occur... | show 🗑
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show | -Extend beyond the original wound border and lack regression
-Higher incidence in darker pigmented skin, trauma, delayed healing, and after burns
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show | -Bulky scars that are elevated above the skin and stay within the boundaries of the wound & are more common than keloid scars
-Improves with therapy and eventually flattens in 1-2 years
-Can be found across joints and in areas of motion
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