Dehisced Surgical Wounds
Dehisced surgical wound is a separation of staples, sutures or glue from infection, blood clot, serous drainage and swelling. Dehisced surgical wounds can be caused by a bug or microorganism on the skin prior to surgery, in the body or organ, airborne, providers hands or surgical instruments (MedlinePlus, 2016). Patients that are more at risk for dehisced wounds: diabetics, immune suppressed, overweight, smokers, corticosteroid users and patients that have undergone surgery lasting more than 2 hours (MedlinePlus, 2016). Dehisced surgical wounds can be very serious and even life threating.
There are three stages of wound infection: superficial, deep and organ (Medline, 2016). Typically oral antibiotics are given for superficial wounds, but sometimes IV antibiotics are needed because of allergies. Sometimes a surgical procedure called incision and drainage or exploratory surgery is needed to clean and drain the wound (MedlinePlus, 2016). After the incision and drainage procedure the wound is left opened so it will heal from the inside out. During the healing time wound care will be needed and either you, family member or a health care provider will do daily wound dressings. Wound care usually consist of removing the packing, cleaning the wound and repacking followed by outer dressing. Sometimes serial debridement is needed to clean the wound for better healing. Occasionally a wound vac is used to speed up the healing process. The healing time is different for every patient so it could take days to months to completely heal. Yukon Wound Care and Rehab work closely with your physician to best meet your needs and speed up healing recovery.
Reference
Surgical wound infection – treatment: MedlinePlus Medical Encyclopedia. (2016, August 22). Retrieved from https://medlineplus.gov/ency/article/007645.htm
Knee Rehab
Knee Rehabilitation is important for daily life! Having a pain free knee joint is important to maintaining daily life tasks, exercise routines, general function and mobility. Rehabilitation can be utilized for arthritic pain, strains, sprains and weakness. Therapist will listen to your complaints and descriptions of pain while palpating the area to feel for arthritic changes and muscular inflammation.
Treatment will then include strenghtening, plyometrics, stretching, taping and manual therapies to assist with the healing process. Manual therapy can consist of dry needling, soft tissue mobilization, and joint mobilization. A combonation of each treatment will be utilized to meet the patient’s goals. As goals are met, a home exercise program and self care instructions are given for long term needs. Strong pain-free knees make work and daily routines effortless! You may contact our clinic directly to schedule an appointment at any time. Direct access allows you to be seen 30 days without a signed prescription from your physican. We do stay in constant contact with your physican during your physical therapy.
Osteoporosis – What You Need to Know
Got Calcium? May is Osteoporosis Month.
Osteoporosis is the thinning and loss of bone density over time.
Osteoporosis occurs when the bone mass decreases when bone resorption is greater than bone formation. As a result, the bone weakens and easily fractures especially in the hip and vertebrae. (Image credit: American Recall Center) #YWCR #osteoporosis #calcium #fractures
Spider Bites
Springtime in Oklahoma!
Time for Spring Cleaning and Yard Work!
Spiders hide in dark quiet areas of our home and lawns. If you are bitten by a spider medical attention could be necessary!
Contact us immediately if bite area becomes red, swollen, spreads or begins to blacken! We can help monitor, treat, and contact your Physician for possible antibiotics! 405-265-2255 (Pictures is a Brown Recluse) #woundcare #YWCR #springtime #spiders
Shoulder Pain
Many American’s suffer with shoulder pain for several different reasons. Shoulder pain can be the result of rotator cuff tear, bursitis, tendonitis, labrum tear, frozen shoulder, osteoarthritis and impingement. Physical therapy is usually the first line of care and the gold standard in treating shoulder pain. Physical therapy can restore active range of motion, reduce inflammation, pain and restore stability and strength.
Rotator cuff tear is either incomplete (partial) or complete tears (full thickness) (McKinnis, 2014). The cause of rotator cuff tear could be from traumatic injury or from progressive tendon tearing during overhead repetitive activities (McKinnis, 2014). The rotator cuff is made up of 4 muscles, subscapularis, supraspinatus, infraspinatus and teres minor. The most common tendon tear is the supraspinatus muscle. Imaging to diagnose a rotator cuff tear is MRI or US.
Shoulder bursitis is usually a gradual onset of pain caused by repetitive activities resulting in inflamed bursa. Shoulder pain is usually worse lying on affected side. The most cost effective and useful imaging modality to diagnose shoulder bursitis is US (McKinnis, 2014). Shoulder tendonitis also known as shoulder impingement is caused by repetitive overhead activities or trauma. Pain is usually gradual and worse with resistance. At initial injury (RICE) rest, ice, compression and elevation is useful in pain relief. Again US is the least expensive imaging modality to use to diagnosis shoulder tendonitis and / or impingement (McKinnis, 2014).
Labrum tear is usually from shoulder trauma injury causing pain with overhead activities, and instability. There are two types of labrum tears SLAP involving the superior labrum and Bankart involving the inferior labrum. Treatment is usually NSAID’s and RICE rest, ice, compression and elevation. If pain persist and shoulder is increasingly unstable surgery may be needed to restore stability. Imaging to diagnosis shoulder labrum tear is MRI (McKinnis, 2014). Frozen shoulder is a gradual increase in pain that cause loss of joint movement and can occur after shoulder injury or lifting something heavy. Physical therapy is the first and best treatment for pain and restoring joint mobility. Imaging for diagnosis is usually plain radiography and MRI (McKinnis,2014).
Osteoarthritis is the most common reason for shoulder pain in glenohumeral joint and acromioclavicular joint. Osteoarthritis of shoulder generally is gradual onset of pain and loss of mobility and responds to NSAID’s and physical therapy to resolve pain and immobility. Imaging to diagnosis shoulder OA is plain radiography which is the least expensive, then MRI followed by CT (McKinnis, 2014). Shoulder pain is extremely common in both men and women of all ages. Surgery is usually the last resort and should be avoided if possible. Physical therapy is the gold standard of care and most effective treatment to restore range of motion, strength, function and resolve pain.
References
McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging.
Pressure Ulcers
Pressure ulcers, also known as bed sores and decubitus ulcers, are the result of external prolonged pressure causing damage to soft tissue such as skin, fat, muscle and fascia (Godman & Fuller, 2015). Most pressure ulcers begin over bony prominent areas and can occur anywhere bone protrudes. Pressure ulcers occur for several reasons including: external pressure, friction, shearing, tissue softening from moisture, tissue weakening from dehydration, under nourishment and poor circulation (Goodman & Fuller, 2015). Additional patient related influences that can cause pressure ulcers are reduced sensation, poor mobility, incontinence, malnutrition and confusion. Unfortunately, acute care hospital admissions is the most common factor in causing pressure ulcers, because of acute illness and immobility during the hospital stay.
Pressure ulcers are identified and documented in stages I, II, III, IV and unstageable: Stage I is non-blanchable with intact skin, Stage II is non-intact skin with tissue damage to epidermis and/or dermis but superficial, Stage III is non-intact skin with tissue damage to epidermis, dermis, fat and muscle, but not past fascia. Stage IV is non-intact skin with tissue damage to epidermis, dermis, fat, muscle, fascia, bone and / or tendon. Unstageable is non-intact skin with tissue damage that is covered with eschar or necrotic tissue of 50% or more, viewing wound unstageable (Goodman & Fuller, 2015). In addition, pressure ulcers once they are staged should never be backstaged. As the wound heals documentation should be written as healing stage I, II or III and so on (Goodman & Fuller, 2015).
Preventing pressure ulcers from ever happening is difficult and challenging for the patient and caregivers, but is the best line of defense. Prevention guidelines include: patients at risk should undergo a full skin evaluation daily with close attention to bony areas, keep patients skin clean after soiling with gentle washing using gentle soaps and washing to avoid drying or shearing skin, avoid skin drying with adequate moisturizer, avoid skin friction and / or shearing using correct positioning, transferring, turning and use moisturizers, skin barriers and padding, preserve patients activity function and mobility, monitor nutrition to avoid drop in albumin levels and dehydration, reposition all patients at risk every 2 hours or more and use pillows and wedges assist in maintaining positioning and avoid pressure on knees, ankles and heels, use equipment such as trapeze bar, lifts, sliding boards, or sheets to avoid dragging movement, use pressure- redistributing mattresses on all high risk patients, patients who are wheelchair bound are at high risk and should be taught to relieve pressure every 15 to 30 minutes and use pressure- redistributing chair devices such ae Roho cushion (do not use doughnut-type devices) (Goodman & Fuller, 2015).
References
Goodman, C. C., & Fuller, K. S. (2015). Pathology: Implications for the physical therapist.