Wound Healing : Alternatives in Management

by Kloth, Luther; McCulloch, Joseph M.; Kloth, Luther; McCulloch, Joseph M.

• ISBN13: 9780803608337
• ISBN10: 0803608330
• Edition: 3rd
• Format: Hardcover
• Copyright: 2001-07-01
• Publisher: F a Davis Co

Summary

Marquette Univ., Milwaukee, WI. Changes for this edition include a color insert containing more than 50 color illustrations of wounds and related technologies, an integration of the principles and recommendations espoused by the APTA Guide to Physical Therapist Practice, and new chapters. Previous edition: c1995.

Table of Contents

SECTION I: The Wound-Healing Environment	1	(150)
The Normal Process of Healing	3	(32)
Robert S. Kirsner
Gabriele Bogensberger
Wound Characteristics Affecting Wound Healing	4	(2)
Wound Depth	5	(1)
Wound Creation Methods	5	(1)
Wound Closure Methods	6	(1)
Phases of Wound Healing	6	(21)
Inflammatory Phase	6	(9)
Proliferative Phase	15	(8)
Remodeling Phase	23	(4)
Factors Affecting Connective Tissue Repair	27	(1)
Measures to Accelerate Wound Healing	28	(1)
Summary	28	(1)
References	29	(6)
Nutrition and Wound Healing	35	(33)
Brynda Lewis
The Nutritional Biochemistry of Wound Healing	35	(7)
Protein and Wound Healing	36	(1)
Fats and Fatty Acids and Healing	37	(1)
Carbohydrates and Wound Healing	37	(1)
Trace Elements and Wound Healing	38	(1)
Vitamins and Wound Healing	39	(3)
Nutritional Assessment	42	(13)
Body Weight	42	(1)
Anthropometric Indices	43	(1)
Creatinine Height Index	44	(1)
Assessment of Visceral Proteins	44	(1)
Assessment of Immune Function	45	(1)
Assessment of Nitrogen Balance	45	(1)
Prognostic Indices	46	(1)
Risk Assessment Tools	47	(1)
Dietary Assessment Methods	47	(1)
Requirement Determinations	48	(2)
Nutrition, Nutritional Status, and Pressure Scores	50	(5)
Malnutrition, Other Types of Wounds, and Wound Healing	55	(5)
The Metabolic Response to Surgery	55	(1)
Nutritional Status and the Postoperative Wound Healing Response	56	(2)
Nutrition in Venous Ulceration	58	(1)
Nutrition in Burn Injury	59	(1)
Clinical Decision Making: Case Study	60	(2)
Summary	62	(1)
References	62	(6)
Factors Impeding Wound Healing	68	(29)
William J. Ennis
Patricio Meneses
Theory Associated with Wound Healing Factors	68	(2)
Overlap Theory	69	(1)
Local Factors	70	(5)
Bio-burden	70	(1)
Tissue Perfusion	71	(2)
Eschar and Dessication	73	(1)
Foreign Bodies	73	(2)
Systemic Factors	75	(10)
Stress Situations	75	(1)
Obesity	76	(1)
Nutrition	76	(1)
Temperature	77	(1)
Comorbidities	78	(4)
Age	82	(3)
Clinician-Induced Factors	85	(5)
Medications	86	(1)
Topical Agents	87	(1)
Wound Modalities	87	(2)
Dressings	89	(1)
Clinical Decision Making: Case Study 3-1	90	(1)
Clinical Decision Making: Case Study 3-2	90	(1)
Summary	91	(1)
References	91	(6)
Bacteriology and Infection Control	97	(32)
Lynda A. Britton
Nancy Harkess
The World of Microbiology	98	(2)
Overview of Bacteriology	98	(2)
Wound Infections	100	(4)
Host Defense Mechanisms	100	(1)
Pathogenic Properties of Microbes	101	(1)
Factors Predisposing to Infection	101	(1)
Sources of Organisms in Wounds	102	(1)
Clinical Signs of Infection	103	(1)
Organisms Commonly Encountered in Wound Infections	103	(1)
Infection Control	104	(10)
Sterilization, Disinfection, and Antisepsis	104	(1)
Infectious Waste Disposal	105	(1)
Health-Care Worker Protection	106	(1)
Patient Protection	107	(2)
Wound Care	109	(1)
Hand Washing	109	(1)
Antimicrobial Prophylaxis	110	(1)
Multiply Resistant Bacteria	110	(4)
The Role of the Microbiology Laboratory	114	(9)
Identification of the Agents of Infection	114	(5)
Interpretation of Culture Results	119	(1)
Antimicrobial Susceptibility Testing	119	(2)
Epidemiological Typing for Infection Control	121	(2)
Treatment of Wound Infections	123	(1)
Clinical Decision Making: Case Study 4-1	124	(1)
Summary	124	(1)
References	125	(4)
Growth Factors, Extracellular Matrix, and Wound Healing	129	(22)
Jeffrey M. Davidson
Wound Repair Terminology	129	(2)
Components and Mediators in the Skin	131	(2)
Extracellular Matrix	131	(1)
Adhesive Proteins	132	(1)
Basement Membranes	132	(1)
Cell Populations	133	(1)
Cytokines, Growth Factors, and Their Receptors	133	(4)
Epidermal Growth Factors	133	(1)
Platelet-Derived Growth Factor	134	(1)
Fibroblast Growth Factor	134	(1)
Vascular Endothelial Growth Factor	135	(1)
Connective Tissue Growth Factor	135	(1)
Transforming Growth Factor-β	136	(1)
Insulin-Like Growth Factors	136	(1)
Growth Factor Production and Regulation	137	(1)
Cellular Components of the Inflammatory System	137	(2)
Platelets	137	(1)
Neutrophils	138	(1)
Monocytes	138	(1)
Lymphocytes	138	(1)
Mast Cells	139	(1)
Sequential Events in the Wound Repair Cascade	139	(2)
Granulation Tissue	140	(1)
Re-epithelialization	140	(1)
Scar Formation	141	(1)
Pathobiology of Wound Repair	141	(2)
Nonhealing Wounds	141	(1)
Excessive Healing	142	(1)
Wound Healing Research in Animal and Experimental Models	143	(3)
Granulation Tissue and Angiogenesis	143	(1)
Irritant Injection	144	(1)
Implanted Biomaterials	144	(1)
Excisional Wounds	144	(1)
Tissue Biomechanics	145	(1)
Scarring	145	(1)
Chronic Wounds	145	(1)
Burns	146	(1)
Summary	146	(1)
Acknowledgments	146	(1)
References	147	(4)
SECTION II: Evaluation	151	(50)
Methods of Wound Evaluation	153	(48)
Katherine E. Lampe
The Guide to Physical Therapist Practice: Integument	154	(13)
History	156	(1)
Patient Demographic Information	157	(1)
Occupation or Employment	157	(1)
Social Information	157	(1)
Past Medical History	158	(1)
Current Health Status	158	(5)
Risk Assessment	163	(4)
Patient Examination	167	(24)
Wound Examination	167	(10)
Periwound Examination	177	(1)
Vascular Examination	178	(9)
Edema	187	(1)
Sensation	188	(3)
Other Tests, Measures, and Examinations	191	(1)
Wound Reassessment and Outcome Prediction	191	(4)
Clinical Decision Making: Case Study 6-1	195	(1)
Summary	196	(1)
References	197	(4)
SECTION III: Principles and Techniques	201	(182)
Wound Debridement and Irrigation	203	(29)
Harriett B. Loehne
Identification of Tissue Types	204	(2)
Skin	205	(1)
Subcutaneous Layer	205	(1)
Fascia	205	(1)
Skeletal Muscle	205	(1)
Bone	205	(1)
Cartilage	206	(1)
Blood Vessels	206	(1)
Tendon	206	(1)
Soft Tissue and Drainage	206	(1)
Surgical Debridement	207	(1)
Sharp Debridement	207	(4)
Instruments	208	(1)
Preparation	209	(1)
Technique	209	(1)
Tissue Differentiation	210	(1)
Precautions	210	(1)
Mechanical Debridement	211	(2)
Soft Debridement with Gauze or Swab	211	(1)
Wet-to-Dry Dressing	212	(1)
Dextranomer	212	(1)
Vacuum-Assisted Closure (V.A.C.)®	213	(1)
Hydrotherapy	213	(10)
Enzymatic Debridement	223	(1)
Enzyme Selection	223	(1)
Recommended Procedure	224	(1)
Frequency and Duration	224	(1)
Disadvantages and Advantages	224	(1)
Autolytic Debridement	224	(1)
Chemical Debridement	225	(1)
Topical Bactericidal Agents	225	(1)
Clinical Decision Making: Case Study 7-1	226	(3)
Summary	229	(2)
References	231	(1)
Dressings	232	(39)
Anne Myer
Dressing Selection	232	(5)
Location	233	(1)
Wound Stage	233	(1)
Cavities	233	(1)
Necrosis	233	(3)
Incontinence	236	(1)
Drainage	236	(1)
Wound Edges	237	(1)
Granulation	237	(1)
Epithelialization	237	(1)
Infection	237	(1)
Gauze (Woven and Nonwoven)	237	(2)
Description	237	(1)
Indications/Contraindications	238	(1)
Advantages/Disadvantages	239	(1)
Impregnated Gauze	239	(1)
Description	239	(1)
Indications/Contraindications	240	(1)
Advantages/Disadvantages	240	(1)
Transparent Films	240	(2)
Description	240	(1)
Indications/Contraindications	241	(1)
Advantages/Disadvantages	241	(1)
Hydrocolloids	242	(2)
Description	242	(1)
Indications/Contraindications	243	(1)
Advantages/Disadvantages	243	(1)
Amorphous Hydrogels	244	(1)
Description	244	(1)
Indications/Contraindications	244	(1)
Advantages/Disadvantages	245	(1)
Hydrogel Sheets	245	(2)
Description	245	(1)
Indications/Contraindications	246	(1)
Advantages/Disadvantages	246	(1)
Foams	247	(1)
Description	247	(1)
Indications/Contraindications	248	(1)
Advantages/Disadvantages	248	(1)
Alginates	248	(2)
Description	248	(1)
Indications/Contraindications	249	(1)
Advantages/Disadvantages	250	(1)
Absorptive Fillers	250	(2)
Description	250	(1)
Indications/Contraindications	251	(1)
Advantages/Disadvantages	251	(1)
Composite Dressings	252	(1)
Description	252	(1)
Indications/Contraindications	252	(1)
Advantages/Disadvantages	253	(1)
Collagen	253	(1)
Description	253	(1)
Indications/Contraindications	253	(1)
Advantages/Disadvantages	254	(1)
Biological Dressings	254	(1)
Description	254	(1)
Indications/Contraindications	255	(1)
Advantages/Disadvantages	255	(1)
Dressings Containing Active Agents	255	(4)
Antibacterials (Topical)	255	(1)
Silver Sulfadiazine Dressings	256	(1)
Arglaes and Acticoat Silver Dressings	257	(1)
Iodosorb Gel and Idoflex Pad	258	(1)
Biofine WDE and Biofine RE	258	(1)
Clinical Decision Making: Case Study 8-1	259	(2)
Clinical Decision Making: Case Study 8-2	261	(1)
Summary	261	(1)
References	261	(3)
Appendix 1: Wound Care Product Manufacturers	264	(7)
Electrical Stimulation for Wound Healing	271	(45)
Luther C. Kloth
Terminology of Medical Electricity	271	(2)
Polarity	271	(1)
Charge	272	(1)
Charge Density	272	(1)
Voltage	272	(1)
Current	272	(1)
Therapeutic Electrical Circuit and Electrodes	273	(1)
Theoretical Basis of Electrical Stimulation	273	(8)
Endogenous Electrical Currents	273	(4)
Endogenous Therapeutic Currents for Wound Healing	277	(4)
Literature Review	281	(21)
Basic Science Research	281	(6)
Clinical Research	287	(15)
Strength of Evidence for ES as a Wound Healing Intervention	302	(4)
Meta-analysis of ES Wound Healing Research Studies	303	(1)
Guidelines for Wound Treatment with ES	303	(1)
Precautions	303	(1)
Contraindications	304	(2)
Clinical Decision Making: Case Study 9-1	306	(5)
Summary	311	(1)
References	311	(5)
Adjunctive Interventions for Wound Healing	316	(67)
Luther C. Kloth
Normothermia	316	(6)
Literature Review	317	(2)
Strength of Evidence for Normothermia as a Wound Healing Intervention	319	(1)
Components of the Warm Up Wound Therapy System	320	(1)
Protocol for Normothermic Treatment of Chronic Wounds	321	(1)
Precautions for Warm Up Wound Therapy	322	(1)
Contraindications for Warm Up Wound Therapy	322	(1)
Clinical Decision Making: Case Study 10-1	322	(4)
Summary	326	(1)
Ultraviolet Radiation Therapy	326	(10)
Physical Properties of Ultraviolet Radiation	327	(1)
Literature Review	327	(5)
Strength of Evidence for Ultraviolet Radiation as a Wound Healing Intervention	332	(1)
Components of the Derma Wand and Handisol Ultraviolet Systems	332	(1)
Guidelines for Ultraviolet Treatment of Chronic Wounds	333	(1)
UVC Protocol for Treatment of Infected Wounds (Bactericidal Effect)	333	(1)
UVB Protocol for Inducing an Inflammatory Reaction in Chronic Wounds	334	(1)
UVB Protocol for Inducing an Inflammatory Reaction in Chronic Wounds	334	(1)
UVB Protocol for Stimulating Growth of Granulation Tissue	334	(1)
UVB Protocol to Promote Breakdown and Elimination of Necrotic Tissue	334	(1)
Precautions for Ultraviolet Radiation	335	(1)
Contraindications for Ultraviolet Radiation	335	(1)
Clinical Decision Making: Case Study 10-2	336	(3)
Summary	339	(1)
Negative-Pressure Wound Therapy	339	(7)
Literature Review	341	(2)
Strength of Evidence for Negative-Pressure Wound Therapy as a Wound-Healing Intervention	343	(1)
Components of the Vaccum-Assisted Closure System	344	(1)
Protocols for Vacuum-Assisted Closure of Acute, Subacute, and Chronic Wounds	344	(1)
Protocols for Vaccum-Assisted Closure of Wounds	344	(1)
Precautions for Vaccum-Assisted Closure of Wounds	345	(1)
Contraindications for Vaccum-Assisted Closure of Wounds	346	(1)
Clinical Decision Making: Case Study 10-3	346	(3)
Summary	349	(1)
Hyperbaric Oxygen Therapy	349	(6)
Literature Review	350	(1)
Clinical Research	351	(2)
Strength of Evidence for Hyperbaric Oxygen as a Wound Healing Intervention	353	(1)
Components of the Hyperbaric Oxygen Treatment System	353	(1)
Protocol for Hyperbaric Oxygen Treatment of Wounds	353	(1)
Precautions for Treatment of Wounds with Hyperbaric Oxygen Therapy	354	(1)
Contraindications for Treatment of Wounds for Hyperbaric Oxygen Therapy	354	(1)
Clinical Decision Making: Case Study 10-4	355	(3)
Summary	358	(1)
Ultrasound Therapy	358	(9)
Literature Review	359	(6)
Strength of Evidence for Ultrasound as a Wound Healing Intervention	365	(1)
Components of a Therapeutic Ultrasound System	365	(1)
Protocol for Ultrasound Treatment of Chronic Wounds	365	(2)
Precautions for Ultrasound Therapy	367	(-10)
Contraindications for Ultrasound Therapy	357	(10)
Clinical Decision Making: Case Study 10-5	367	(2)
Summary	369	(1)
Thermal and Nonthermal Pulsed Diathermy	369	(7)
Thermal-mode Pulsed Diathermy	370	(1)
Nonthermal-mode Pulsed Diathermy	371	(1)
Literature Review	372	(2)
Strength of Evidence for Thermal-Mode Pulsed Diathermy as a Wound Healing Intervention	374	(1)
Strength of Evidence for Nonthermal-Mode Pulsed Diathermy as a Wound Healing Intervention	375	(1)
Components of the Pulsed Diathermy System	375	(1)
Precautions for Thermal and Nonthermal Pulsed Diathermy	375	(1)
Contraindications for Thermal and Nonthermal Pulsed Diathermy	375	(1)
Clinical Decision Making: Case Study 10-6	376	(1)
Summary	376	(1)
References	376	(7)
SECTION IV: Case Management and Documentation	383	(144)
Management of the Insensate Foot	385	(24)
James A Birke
Etiology of Foot Ulcerations	385	(3)
Loss of Protective Sensation	385	(1)
Mechanical Stress	386	(1)
High Foot Pressures	387	(1)
Other Factors Contributing to Tissue Injury	387	(1)
Examination of the Foot	388	(5)
Foot Screening and Risk Identification	388	(1)
History	388	(1)
Sensory Testing	388	(2)
Skin Inspection	390	(1)
Muscle Strength Testing	391	(1)
Limitation of Motion	392	(1)
Identification of Deformities	392	(1)
Vascular Status Assessment	393	(1)
Evaluation of Footwear	393	(1)
Prevention and Treatment of Foot Ulcers	393	(7)
Wound Care	394	(2)
Devices of Off-Load Stress	396	(4)
Prevention of Reulceration	400	(1)
Wound Remodeling and Maturation	400	(1)
Footwear	401	(2)
Evaluation of Footwear	402	(1)
Clinical Decision Making: Case Study 11-1	403	(2)
Summary	405	(1)
Acknowledgments	405	(1)
References	405	(4)
Management of Wounds Secondary to Vascular Disease	409	(20)
Joseph M. McCulloch
Overview of Vascular System Anatomy and Physiology	409	(2)
Venous Insufficiency	411	(7)
Pathogenesis	411	(1)
Theories of Venous Insufficiency Ulceration	412	(2)
Clinical Features of Venous Ulcers	414	(1)
Treatment of Venous Ulcers	415	(3)
Arterial Insufficiency	418	(6)
Pathogenesis	418	(3)
Clinical Features of Arterial Ulcers	421	(1)
Treatment of Arterial Ulcers	421	(3)
Clinical Decision Making: Case Study 12-1	424	(1)
Summary	425	(1)
References	426	(3)
Prevention and Treatment of Pressure Ulcers	429	(88)
Laurie M. Rappl
Deborah D. Hagler
The Pressure Ulcer Problem	430	(8)
Incidence and Prevalence	430	(1)
Cause	430	(1)
Contributory Factors	431	(3)
Features and Locations	434	(3)
Patients at Highest Risk	437	(1)
Ideal Positions and Positioning Principles	438	(9)
Sitting	438	(4)
Recumbent Postures	442	(5)
Diagnostic Process	447	(14)
History	447	(1)
Examination and Evaluation	448	(13)
Diagnosis and Prognosis	461	(1)
Interventions	461	(18)
Treatment of the Wound Site	462	(1)
Pressure Reduction	462	(1)
Equipment for Positioning and Support	462	(17)
Clinical Decision Making: Case Study 13-1	479	(11)
Summary	490	(1)
Additional Readings on Seated Positioning	490	(1)
References	491	(3)
Appendix 13-1: Musculoskeletal System: Examples for Seated Position	494	(8)
Appendix 13-2: Musculoskeletal System: Examples for Recumbent Position	502	(8)
Appendix 13-3: Neuromuscular, Musculoskeletal, Genitourinary, Psychosocial, Gastrointestinal, and Cardiopulmonary Systems: Example for Seated Position	510	(4)
Appendix 13-4: Neuromuscular, Musculoskeletal, Genitourinary, Psychosocial, and Cardiopulmonary Systems: Example for Recumbent Position	514	(3)
Documentation for Reimbursement	517	(10)
Lisa A. Barton
Pamela Unger
Interdisciplinary Documentation	517	(4)
Risk Assessment	518	(1)
Examination	519	(1)
Evaluation	519	(2)
Prognosis	521	(1)
Intervention	521	(1)
Physical Therapy Documentation	521	(3)
Correlative Interdisciplinary Documentation	522	(1)
Billing Recommendations	522	(2)
Clinical Decision Making: Case Study 14-1	524	(1)
Acknowledgments	525	(1)
Summary	525	(1)
References	526	(1)
Appendix 1: Braden Scale for Predicating Pressure Sore Risk	527	(1)
Appendix 2: Norton Risk Assessment Scale	528	(1)
Appendix 3: History and Physical Examination	529	(2)
Appendix 4: Wound Evaluation / Assessment Tool	531	(1)
Appendix 5: Weekly Measurement Tool	532	(1)
Appendix 6: Wound Care Evaluation	533	(4)
Appendix 7: Weekly Wound Care Progress Not	537	(3)
Appendix 8: Initial Wound Assessment and Treatment Plan	540	(1)
Glossary	541	(8)
Index	549