wound care

epidermis

outermost layer

protective

avascular

dermis

vascularized

subcutaneous

insulation and shock absorption

superficial wound

damage to epidermis

superficial partial thickness

damage to papillary dermis

deep partial thickness wound

damage to reticular dermis

full thickness wound

damage to subcutaneous

hemostasis stage of healing

bleeding stops

inflammatory stage of healing

redness, swelling, warmth, pain

chronic wounds get stuck here

proliferation stage of healing

fibroblasts laid down to produce collagen (type 3)

maturation stage of healing

extracellular matrix formation

skin is only 80% as strong

primary intention closure

surgical closure

secondary intention closing

natural healing

tertiary intention closing

natural healing followed by surgical

maceration

excessive moisture causing soft, white fragile tissue

desquamation

dry peeling flaking skin

induration

hardened tissue due to inflammation or fibrosis

venous wound characteristics

gaiter area

edema

palpable pulses

hemosiderin staining

weeping

shallow irregular borders

little to no eschar

treatment for venous wounds

moving body

elevating leg

compression

debridement

what do you need to check before compression

rule out arterial disease

make sure pt doesnt have HF

check ABI

no infection

safe ABI

0.8-1.2

ABI for PAD dx

<0.8

ABI for noncompressible calcified or fibrotic

>1.2

arterial ulcer characteristics

pale

necrotic eschar

dry

punch out lesions

deep

painful (at rest, claudication)

distal extremities, lateral malleous, dorsal foot/toes

contraindications for arterial wounds

debridement

compression therapy

treatment for arterial wounds

ambulation program

open chain exs

diabetic ulcer characteristics

plantar surface of feet and toes

thick callouses