Burns and Test Strategies Test Strategies Warning Collagen

Burns and Test Strategies

Test Strategies

Warning!

Collagen • What is Collagen • Protein that are the primary structural component of connective tissue • What are the two types of connective tissue? • Loose connective tissue vs. dense connective tissue examples? • LCT: skin, blood vessels, and muscle • DCT: bone, capsule, ligament and tendon

Collagen types and tissue (look more into this) • • • Type 1: All hyaline and basement membrane Type 2: Hyaline cartilage and vitreous humor Type 3: Blood vessels Type 4: Basement membrane Type 5: All tissues? ? Type 6: All tissues? ?

What is the largest organ on the body? • Skin is composed of which two basic layers? • Epidermis » Avascular, outermost layer • Dermis » Contain blood vessels, nerves, hair follicles, and sweat glands.

Question? • Which side of the hand is the skin much thinner? • Dorsal skin

Superficial partial thickness burn • What degree of burn is it? • First and second degree burns • What skin layer is involved with it? • Epidermis and possibility of the upper dermis layer • Sensation is intact • Can we get spontaneous recovery and healing timeline? • Recover in 2 weeks or earlier, no skin graft needed

Deep partial thickness burn • What degree of burn is it? • Deep second degree burn • Hair follicles and sebaceous glands remain intact • What skin layer is involved with this? • Epidermis and deeper portion of the dermis • Can we get spontaneous recovery and healing timeline? • Spontaneous recovery 3 -6 weeks, but skin grafting may occur to expedite wound closure • Precaution: a deep partial thickness burn may convert to a full thickness burn

Full Thickness Burn • What degree of burn is this? • Third-degree burn • What skin layer is involved • Epidermis and entire dermis • Includes hair follicles, nerve endings • What can you expect to treat during therapy sessions? • Can we get spontaneous recovery and healing timeline? • Spontaneous recovery is impossible, skin grafting is required.

A full thickness burn with subdermal injury • What degree of burn is this? • Fourth-degree burn • What skin layer is involved • Involves deep tissue damage to fat, muscle, or even possibly bone • Can we get spontaneous recovery and healing timeline? • Spontaneous recovery impossible and skin grafting is required

Wallace Rule of Nines • • • Head and Neck = 9% Each upper extremity= 9% Each Lower extremity= 18% Front of the trunk=18% Back of the trunk= 18% Genitals=1%

Question? • Somebody burns their entire UE • 63% • Somebody burns entire LE • 37%

Wound Healing Phase 1 • Inflammatory • Characterized by inflammation • Presence of neutrophils and macrophages, which is responsible for clearing debris and preparing for wound repair • This phase begins when the wound occurs, then will last between 3 to 5 days.

Wound Healing Phase 2 • Fibroplastic/proliferation • Characterized by the presence of fibroblasts • Lay down collage and myofibroblasts that in turn cause wound contractures. • Collagen is deposited in a random and disorganized fashion

Wound Healing Phase 3 • Maturation/modeling phase • Collagen continues to cross-link and tensile strength increases • Maturation stage can last for years • Typically 50% of strength is regained at 6 weeks • Strength will most likely return to 80% when compared to normal skin

Question • After the wound is closed in skin grafting, what becomes the main therapy focus? • Scar contractions

Phases of Burn Recovery • Phase 1: Emergent • Occurs 2 -3 days after injury • Phase 2: Acute • Day 2 -3 till wound is closed • Phase 3: Skin grafting • Phase 4: Rehabilitation • Last from wound closure to scar maturity

Classic Burn Deformity • • • Wrist flexion MP hyperextension IP flexion Thumb adduction Flattened palmar arch

Question • The position of comfort is the position of deformity is something we want?

Question • What are three best ways to decreased edema • Compression, elevation and movement

Question • The best method for evaluating hand edema in a patient who has an infected open wound of the palm is by: A. )drawing sequential hand outlines B. )measuring hand circumference at the level of the MCP joints C. )performing volumetric measurements D. )recording the distance from the fingertip to the distal palmer crease

Question • A patient who had a distal radius fracture reports excessive pain and a burning sensation in the hand during PROM. The OTR also notes that the patent has moderate hand edema, shiny skin, and sweaty palms. These symptoms are most likely indicative of: A. )complete regional pain syndrome (reflexive sympathetic dystrophy) B. )brachial plexus lesion C. )an undetached fracture D. )neuroma in the hand

Question • Can a deep partial thickness burn convert to a full burn? • Yes, why

Question • How do you want to position the hand for an orthotic after a burn? • Wrist extension • MP flexion • IP extension • Thumb abduction

Question • A patient who has deep partial-thickness burns on both thighs develops increased lower extremity edema when standing. To minimize edema, the OTR should recommend that the patient: a. ) wear knee-high compression garments b. )apply compression wraps to entire lower extremities c. )perform activities while seated on a barstool d. )massage both legs prior to standing

Question • A patient who has a full-thickness burn to the dorsum of the entire hand is referred to OT for ROM exercises. There is questionable tendon involvement. The best method of performing the exercises is to: A. )simultaneously flex the PIP and DIP joints while maintaining the MCP joints in extension B. )passively move the fingers into simultaneous maximum flexion C. )flex one joint at a time while maintaining the remaining joints in extension D. )encourage the patient to actively make a full fist

Question • During the acute phase of treatment for partial thickness burns to the trunk and upper extremities, a patient would benefit most from: A. )maximizing self-care skills B. )being fitted for pressure garments C. )preventing contractures D. )strengthening exercises

Question • Name some ways to decrease edema

Question • Should you wear an orthosis at night? And why

Resource • Fundamental of Hand Therapy, Cynthia Cooper