15/16-Feb PT in wound ulcers or healing

 

Contents

• Definition
• Types of wound
• Stages of wound healing
• Clinical presentation
• Before PT intervention
1. history
2. subjective
3. objective
4. aim of treatment
• PT treatment (Modalities)

• Definition
  1. A wound is an injury to a tissue
  2. A wound ulcer is caused by pressure on the derma and underlying vascular structure
• Types of wound
  1. Closed wound: the surface of the skin is intact, but the underlying tissue may be damaged
  2. Open wound: the skin is split or cracked and the underlying tissue is exposed to the outside environment
• Stages of wound healing

• Inflammatory phase:

  1. it's characterized by the vasodilation released of histamine and stimulation of nacioreceptor
  2. This can be present with redness, heat, swelling, pain

• Proliferation phase

  1. It's characterized by the formation of granulation tissue
  2. The wound contracture starts in this phase
  3. The fibroblasts in the wound develop into collagen Matrix

• Maturation or remodeling phase

  1. Remodeling of epithelial Starts
  2. it's an ongoing process even after wound closure takes months to years
  3. PT intervention starts in this stage

• Clinical presentation

  1. Redness, change in skin temperature, swelling loss of skin thickness, and bleeding in an open wound

• Before PT intervention (wound examination)

  • History
    1. History is taken to determine the primary problem
    2. History should start from the mechanism of injury, date of onset, progression
    3. Treatment history to date
    4. History of the previous wound
    5. Co-morbidities: vascular disorder, diabetes, cancer
  • Subjective examination
    1. To gather information on current symptoms
    2. Patients should be questioned about behavior and characteristics of symptoms
  • Objective examination
    1. Here observation is the most important component of data collection, it includes the type of lesions
    2. It includes stages of wounds

• Aim of treatment

1. enhance clotting time and bleeding time
2. Teach the patient self-care for wounds and identification of signs of infection
3. Reduce the necrosis tissue at the normal site
4. Decrease the pain associated with the wounds and risk of infection
5. Improve the physical function of the wound site

How do modalities help in wound healing (PT treatment)

• Ultrasound therapy

  1. When ultrasound is applied in the inflammatory stage.
  2. It enhances the degranulation of mast cells, releasing histamine and other mediators that attract fibroblasts and endothelial Cells to the injured area.
  3. Early intervention with ultrasound should result in an accelerated acute inflammatory phase moving to a more quick entry into the proliferative phase and improving the wound.
  4. In the Proliferative stage, ultrasound stimulates fibroblast migration and proliferation to secrets Collagen, improving the tensile strength of the healing Connective tissue
  5. In the remodeling phase, Collagen extensibility and ultrasound increase enzyme activity and also improve the tensile strength of the healing tissue
  6. Doses- 3-4 times a week.
  7. For superficial wound: 3MHz
  8. Deep wound: 1MHz

• LASER

  1. Laser light stimulates fibroblast development and accelerates collagen synthesis in damaged tissue for faster recovery
  2. Laser light accelerates cellular reproduction and growth to improve the speed of healing time. Laser light induces vasodilation increasing blood flow to damaged areas.

• UVR

  1. Increase the amount of fibronecting present in the wound environment, Potentially improving the microenvironment for cell migration,
  2. And also Stimulates contraction thus decreasing the size of the wound It stimulates cell hyperplasia.
  3. Improve Skin Condition by increasing blood Supply Destroy and remove infected material.

• Whirlpool bath

  1. Treat wounds with loosely adherent necrotic tissue or thick exudates. facilitates debridement in infected wound
  2. Decrease wound pain
  3. The warmth of water increases blood circulation to the Wound surface.
  4. Doses - daily for 20 minutes at 33-35°C. Once daily

• Electrical Stimulation

  1. Electrical Stimulation has effectiveness in facilitating healing in both acute and chronic wounds.
  2. It is used to eliminate bacterial load, Promote granulation, reduce inflammation, and edema, and reduce wound-related pain.
  3. Using high voltage Pulse current directly in the wound can create these changes - attraction of neutrophils, macrophages, and epidermal cells which facilitate debridement and re-epithelialization.
  4. Electrical stimulation has a galvanotaxic effect on the Cells needed for healing

• Infrared radiation

  1. It increases local wound and skin temperature facilitating metabolic rate and improving circulation to the wound site.
  2. Increases local circulation in nitric oxide leading to vasodilation Indications venous ulcers, diabetic ulcers

• Compression therapy.

  1. It is a goal standard treatment for venous ulcers it decreases Chronic oedema and lymph edema.
  2. Compression bandaging needs to be applied by skilled Practitioners and experts.
  3. It tackles symptoms of assisting venous insufficiency by assisting venous blood flow back to the heart.
  4. Greater pressure is applied at the ankle and gradually increases Circulation and prevents edema in the veins of the lower limb.

• Prevention of wound ulcer

  1. Air mattress- It Presents infection since dirt and dead skin can't Penetrate water. Healing is 3 times faster in those who already have an ulcer