Burns Management & Wound Healing

• These notes are for the management of burns and integumentary integrity impairment

Factors Delaying Healing

• Intrinsic factors that hinders healing include age, medical conditions, and nutritional status
• Extrinsic factors that hinders healing include cytotoxic agents and drug-induced activity

Wound Healing

Epidermal Healing

• Retention of viable cells allows epithelialization so epithelial cells grow, proliferate, and migrate to close wound
• Protection of epithelial cells during healing is critical
• Loss of sebaceous glands dries and cracks the wound, making moisturizing creams important

Dermal Healing

• Dermal healing results in scar formation as injured tissue gets replaced by connective tissue
• Scars are initially red or purple then later turns white

Inflammatory Phase

• The first phase of dermal wound healing is characterized by redness, edema, warmth, pain, and decreased range of motion, lasting 3-5 days

Proliferative Phase

• The second phase of dermal wound healing is when fibroblasts form scar tissue in deeper tissues
• Wound contraction is characteristic and re-epithelialization may occur at the wound surface if viable cells remain

Maturation Phase

• Scar tissues remodels during the final maturation phase, lasting up to 2 years
• Hypertrophic scars and/or keloid scars may result

Pharmacological Interventions: Cleaning Agents

Sterile Saline / Normal Saline Formula

• 0. 9 grams of non-iodized table salt is needed for every 100ml of distilled water
• Formila is used in hospitals, for non-infected wounds but is non-cytotoxic to cells

Povidone Lodine (Betadine Solution)

• Can be used as an initial or first cleansing agent whether the wound is infected or not
• It is indicated for infected wounds and is its most effective cleaning agent
• Disadvantage is that it is cytotoxic to granulation tissue

Sodium Hypochlorite (House Bleach)

• Indicated for infected wounds, and is the second most effective for infected wounds

Other Cleaning Agents

Acetic Acid (Vinegar)

• Indicated and most effective as the third choice for infected wounds
• Inhibits bacteria from spreading/proliferating
• Acetic acid can be used to manage contamination with Pseudomonas aeruginosa
• Is cytotoxic to granulation tissue

Hydrogen Peroxide (Agua Oxinada)

• Functions as a non-selective debridement, loosening small debris
• Least effective as a cleaning agent, since it removes oxygen from the wound site slowing the healing process
• Contraindicated with tunneling/granulating, non-infected wounds
• Cytotoxic to granulation tissue

Antibacterials

• Includes Bacitracin/Baciguent for mild skin allergies

Neosporin/Neomycin sulfate

• An over-the-counter product
• Used for anti-reaction, allergy, and itchiness

Silvadene/Silver Sulfadiazine

• The best antibacterial ointment for burns, especially thermal injuries

Furacin/Nitrofurazone

• A cytotoxic agent to avoid, especially during animal studies

Sulfamylon/Mafenide Acetate

• Used for deep partial thickness burns d/t eschar

Bactroban/Mupirocin

• A useful ointment for all varieties of staphylococcus

Gentamycin/Geramycin

• Useful against staphylococcus and streptococcus bacteria

Aquaphor

• Provides moisture without fighting bacteria, which prevents/treats dryness on wound

Physical Therapy Intervention for Impaired Integumentary Integrity

Patient/Client Related Instructions

• Promote disease awareness and encourage healthy behaviors by educating how to avoid contamination and how to give medications
• Avoid harsh soaps

Modalities to Enhance Healing

• Electric muscle stimulation stimulation (EMS)
• Iontophoresis

High Voltage Pulsed Current (HVPC)

• Pain relief

Electrical Stimulation/Estim

• Facilitates epidermal cell proliferation
• Anodal pulse is to be used

Continuous Short Wave Diathermy

• Continuous SWD facilitates fibroblast proliferation, collagen formation, and tissue perfusion which all assists in metabolic rate
• Facilitates the progress of one phase of wound healing to the next

Whirlpool Contraindications

• Venous insufficiency, or venous ulcers
• Clean/granulating wounds
• New skin grafts
• Edema of extremity or lethargy

Ulcers

• To be surgically cleaned to resurface wound, enhance vascularity and/or prevent osteomyelitis

Patient Management

• Daily comprehensive skin inspection is carried out during treatment especially around bony prominences

Wound Management Contraindications

• Acute phlebitis
• Dry Gangrene during full body whirlpool