Physiotherapy in Skin Injuries PDF

14/02/2023 Topic 4 Physiotherapy in Skin Injuries: Pressure Ulcers, Scars and Burns. 1 2 1 14/02/2023 PRESSURE ULCERS • Pressure ulcers are areas of cellular necrosis which usually occur over bony prominences that can withstand a lot of pressure in one position • • • • • Advanced age. Neuro...

14/02/2023 Topic 4 Physiotherapy in Skin Injuries: Pressure Ulcers, Scars and Burns. 1 2 1 14/02/2023 PRESSURE ULCERS • Pressure ulcers are areas of cellular necrosis which usually occur over bony prominences that can withstand a lot of pressure in one position • • • • • Advanced age. Neurological involvement. Drugs: sedatives, Radiotherapy. Metabolic diseases: diabetes. 3 Pressure ulcers areas 4 2 14/02/2023 European Pressure Ulcer Advisory Panel Classification (EPUAP) • Stage I • Intact skin (non-blanching erythema) • Red abnormal colour 5 Stage II • Partial-thickness skin loss involving epidermis and/or dermis • The pressure ulcer is superficial and presents as a blister or abrasion A 6 3 14/02/2023 Stage III • Full thickness skin loss involving damage of subcutaneous tissue but not extending to the underlying fascia 7 Stage IV • Full thickness skin loss with extensive destruction and necrosis extending to underlying fascia and involving fat and muscles 8 4 14/02/2023 PREVENTION ▪ ▪ ▪ ▪ ▪ ▪ Risk assessment: Braden and Norton scales (+++). Frequent postural change: 2 h max. Protection of high-pressure areas. Skin Hydration products. Stabilisation of posture with pillows. Massage therapy and lymphatic drainage in pressure areas. GNEAUPP 2003, 2014. 9 9 10 5 14/02/2023 PRESSURE ULCERS Physioterapy Protocole – Ultraviolet irradiation – US: 3HZ, 0,8 – 1 W/cm2 , 5 – 10 min – Magnetoterapy: 20 – 50 Hz Y 50 – 100 Gauss. – TENS: 0.4 ms, 2Hz, 2 times/day 11 SCARS Influencing factors in healing: • • • • Blood supply. Infections, foreign bodies. Quality of tissue rest: early mobilisation. Approximation of edges and size of lost skin. Types: • • Linear.; NORMAL Vicious: hypertrophic 12 12 6 14/02/2023 SCARS Problems: • Limited ROM • Functional impotence. • Pain • Aesthetics ADHERENCES 13 13 14 7 14/02/2023 PHYSIOTHERAPY IN SCARS OBJECTIVES :make the tissue more flexible and stimulate the generation of elastic fibres. • • • • • • • Thermotherapy prior to mobilisation and massage. Massage therapy. Mobilisation of the affected joints. Capacitive radiofrequency. US and TENS: Similar to Pressure Ulcers. Hydro-thermo-kinesitherapy. Elastic and functional bandaging. 15 15 BURNS • Skin injury or other organic tissue caused by heat , radiation, radioactivity,friction electricity, or contact with chemicals products . 16 8 14/02/2023 Determination of Burn Severity ▪ Depth ▪ Size of burning area 17 DEPTH OF BURN Superficial Partial Thickness (1st degree) • Red,dry ,tender skin • • Area turns white when touched Limited to epidermis • Sunburns or tanning beds Deep Partial Thickness (2nd degree) Skin is red, some blister formation Involve epidermis and dermis Causes :hot thick liquids Physiotherapy Intervention Spontaneously recovey in 2 weeks 18 9 14/02/2023  Full Thickness (3rd degree) Skin appears “leathery” dry, brown, hardened all epidermis and dermis is destroyed may have destruction of sub-dermal layers, subcutaneous tissue and muscle as well. Wound will needs skin grafting (surgery and PT protocole) 19 Size of burning area 20 10 14/02/2023 21 Burns Physiotherapy • Continues for months and sometimes • years after the initial event • Two periods :Early Stage Later Stage • Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, 22 11 14/02/2023 Early Stages • The patient may be in Burns Units • Pain control with pharmacological support Oedeme control Stretching /Mobilization Positioning Improving cardiovascular and respiratory capacity….. 23 Oedeme control • Compression Pressure Garments Bandages • Rhytmic pumping : Mobilization + MUSCLE activation • Postural care for avoid cutaneous adherences • Positioners 24 12 14/02/2023 Stretching /mobilization • Several times /day, painfree • Active better than passive • Check : skin grafting or Epithelial autograf Biological dressing PT time start Burns Type Skin grafting < 6 days Grade II Epithelial autograf >9 days Grade III 25 Later Stage • Chronic condition • Reintegration of the patient into society • Achieve high level of function reducing impairments • Focus points : Gait Manipulation • Psychological support 26 13