wound care

Pilonidal Cyst

Pilonidal CystPilonidal cyst is a fluid filled pus pocket formed around hair follicles between the butt cheeks. Pilonidal cyst usually become infected requiring surgery to drain and debride the abscess.  Antibiotics and outpatient wound care may be needed to heal the wound if delayed healing occurs.

Risks involved in pilonidal cystectomies include bleeding, delayed healing, infection and reoccurrence. Pilonidal cysts are extremely difficult to heal because of many factors. Factors include: wet moist environment, hair, heat, friction and stool. Our clinic has exceptional healing success rate with pilonidal cyst and we work closely with physicians and the patient to ensure the best care.

References

Google Search. (n.d.). Retrieved from https:////medlineplus.gov/ency/article/007591.htm

 

Pilonidal Cyst2020-03-04T20:37:45+00:00

What is a wound culture

wound care oklahoma cityWound culture on children and adults is a test that looks for germs like bacteria, fungi or viruses.

If the wound is infected the culture can help determine what kind of germ produced the infection. This helps your provider determine which antibiotic to use. There is nothing to prepare for except telling your child or adult that a q-tip will swab inside the wound and it will sting or burn. In some cases there may be wound bleeding after the culture.

The culture is taken to a lab and tested and if there is infection the culture will be positive and if it does not it is negative.  The results will be called to your provider and he or she will decide what antibiotic treatment should be used.

References

Wound Drainage Culture. (n.d.). Retrieved from https://kidshealth.org/en/parents/wound-culture.html?view=ptr&WT.ac=p-ptr

What is a wound culture2019-09-23T21:19:17+00:00

Non-Healing Wound

Non-healing wound is a delay in the natural healing process from either an outside or inside source. Inside sources could be and infection, bleeding, drainage, clots, fatty necrosis, unexpected debris, tracks, and underlying health issues such as diabetes and  poor circulation. Outside sources could be pressure, friction, moisture, trauma, burn, radiation and insects (roaches or maggots).  All of these sources make each patient and circumstance unique and different and should be treated with individual care.

As a wound practitioner my responsibility is to find the delay or non- healing source quickly for every patient. Early detection will reduce pain, suffering and return patients to their lifestyle.

Our wound care clinic is unique because our staff is physical therapist and assistances that specialize in wound care and debridement. We have successful wound healing because of our outstanding experience, skill and consistent staff. Our small staff of professionals allows us to have better consistency and patient compliance. Most wound care facilities operate with large changing staff that causes inconsistent care and delayed healing.

Sherri Boos, DPT, PT

Yukon Wound Care & Rehab

Non-Healing Wound2019-01-15T16:56:35+00:00

Lymphedema

The Function of a Physical Therapist Treating Lymphedema

Lymphedema is progressive chronic swelling usually in extremities, but can occur in the chest, stomach and groin regions. Currently there is no cure for lymphedema, but treatment from a physical therapist is extremely helpful to prevent immobilizing side effects and possible dangerous complications (APTA.org, 2009).

Prompt discovery of limb and / breast lymphedema is key to managing and preventing complication (APTA.org, 2009). In our practice we work closely with physicians and patients to treat lymphedema quickly with minimal to no pain. We use manual lymphatic drainage therapy and begin immediate compression for long term management.  Other physical therapy terms used to describe lymphedema treatment are decompression therapy, complete decongestive therapy and complex physical therapy (APTA, org,2009). Complex physical therapy for lymphedema is the gold standard of care and includes: manual lymphatic drainage, compression garments, exercise and education about skin and nail care (APTA.org, 2009). In most cases patients who receive lymphedema therapy see an 80% improvement in just one to two weeks.

Evidence based research has proven success in lymphedema treatment and management using patient education, exercise, compression and lymphedema therapy can stop lymphedema from returning (APTA.org, 2009). Early onset of lymphedema improves outcomes and reduces complications. Patients with breast cancer should be aware of the risk factors and warning signs that include:

Risks

  • Overweight or increasing weight during and throughout cancer treatment.
  • Lymph node removal
  • Radiation therapy
  • Infection or blood clot in affected extremity.

Warnings

  • Pain and fullness in affected limb
  • Tightness in affected limb
  • Noticeable swelling in affected limb
  • Numbness and tingling in affected limb (APTA.org, 2009).

In conclusion, the role of physical therapist treating patients with lymphedema is to help patients identify lymphedema early to prevent lasting side effects and possible dangerous complications. Currently there is no cure for lymphedema. However, treatment from a physical therapist is highly successful in eliminating lymphedema and preventing reoccurrences.

Sincerely, Sherri Boos, PT, DPT

References
Physical Therapist Play Integral Role in Lymyphedema Prevention, Treatment. (2009). Retrieved from APTA.org, 2009
Role of Physical Therapist in the treatment of Lymphedema. (2009). Retrieved from http://APTA.org

 

 

Lymphedema2019-01-22T19:42:32+00:00

Oklahoma Wound Care Services

Oklahoma Wound Care Services

Yukon Wound Care and Rehabilitation opened in 2014 to serve Yukon and Oklahoma rural residents with excellent affordable wound care services.  We currently serve Yukon, Mustang, El Reno, Piedmont, Chickasha and many other rural areas in Oklahoma. Our patients receive up to date compassionate wound care so they don’t have to travel to the metro area for care. Many patients cannot or don’t want to travel to the Oklahoma City, Midwest City or Norman for wound care.

Several of our patients have shared stories of not being able to wear shoes for 5 years due large draining wounds causing restricted walking and difficult adult daily activities. Furthermore, we have patients that come to us for successful healing after years of failed wound care at other facilities.

Our facility strives to reduce pain, restore function and heal wounds as quick as possible and affordable.  We are committed to serve not only Yukon, but all metro and surrounding Oklahoma Cities with the latest wound care assessment, skills and products.

In addition to wound care services we also specialize in women’s health, orthopedic, cardio conditioning, vestibular rehab, and pre-habilitation. Our mission is to provide all patients with the results they want and the care they deserve.

Oklahoma Wound Care Services2019-01-22T19:42:33+00:00

Burns

Burns can be extremely painful for the patient and difficult to manage for the clinician. Over the years I treated many burns including babies, children and older adults. Understanding burns is the basic requirement that is absolutely necessary in the healing process. During the initial assessment staging the wound is vital and is done by sensation tests throughout the involved tissue because the entire burn will vary in depth causing sensation changes over the peri wound and wound itself.

First degree wounds are the most painful because nerve endings are inflamed and fully exposed encompassing the epidermis layer causing redness and swelling (MedlinePlus, 2014). First degree burns usually heal in 7 to 10 days with topical medication and light debridement. Second degree burns involve the epidermis and dermal layers and remain painful because the nerves are exposed causing redness, swelling and blisters (MedlinePlus, 2014).

Second degree burns heal in 10 to 21 days requiring topical medication and moderate firm debridement timely to avoid scaring. Third degree burns involve the epidermis, dermis and hypodermis layers with much less pain because the nerves are fully damaged causing numbness, redness, swelling, blisters and thick eschar (MedlinePlus, 2014). Third degree burns heal in 21 days to months and usually require surgical debridement, skin grafting resulting in severe scaring and soft tissue restrictions.

Burns are devided into 4 categories of depth: epidermial, superficial partial thickness, deep partial thickness and full-thickess (Devgan et al. 2006). Epidermal and superficial partial thickness are considered 1st and 2nd degree requiring non-operative wound treatment, but deep partial thickness and full-thickness are considered 3rd degree burns and often require operative more invasive care (Devgan et al. 2006).

Clinical understanding of these categories is vital in the wound healing process because burn wounds undergo a conversion process that imped healing (Devgan et al. 2006). The conversion process is described as 3 complicated zones: viable zone of coagulation, continued viable stasis zone and edematous zone of hyperemia (obstruction of blood flow) (Devgan et al. 2006). Wound healing is interrupted in these 3 zones requiring timely assessment and intervention, which is why this research article looked at various modalities to improve depth assessment (Devgan et al. 2006). The most used and cost effective method is bedside clinical exam with an accuracy of two thirds of burns assessing appearance, staging of capillary refill, capillary staining and sensation testing with light touch and pin prick (Devgan et al. 2006).

However, bedside assessment limitations are consistent clinical knowledge of burns leading to error of overestimation of burn depth and validity of diagnosis (Devgan et al. 2006). The available modalities that are listed in this article are: biopsy and histology, thermography, vial dyes, indocyanine green video angiography and laser doppler flowmetry (Devgan et al. 2006).

Biopsy and histology is 100% accurate but has drawbacks of invasiveness and added tissue damage and scarring, increased cost of experienced pathologist and subjective interpretation (Devgan et al. 2006). Thermography is a modality that measures tissue temperature to diagnose burn depth with an accuracy of 90%, but has disadvantages of false positive depth secondary to loss of heat within the tissue after 3 days of the burn (Devgan et al. 2006).

Vital dyes is a modality rarely used that employs intravenous injection of fluorescein dye surveyed by illumination of 360 to 400 ultraviolet light over damaged tissue looking for depth but cannot differentiate between superficial and deep partial-thickness wounds or recognize healthy tissue covered with eschar (Devgan et al. 2006).

Indocyanine green video angiography (ICG) is a modality that uses videography that pictures changes in tissue perfusion with intravenous injection of IGC looking for dye uptake within the damaged tissue (Devgan et al. 2006). This modality has the potential to gain popularity but has disadvantages of cost and large infrastructure requirements as well as interference with topical medication used for burn intervention (Devgan et al. 2006).

Laser doppler flowmetry monitors perfusion using mono frequency light waves with an accuracy of 90 to 97% (Devgan et al. 2006).

However, this modality has limitations as well because it involves using a probe and pressure directly on the burned tissue subjecting the tissue to infection and additional wound trauma (Devgan et al. 2006). In addition to the above modalities there is considerable research that is underway using advance modalities of: Optic measurements, nuclear imaging, and non-contact high frequency US to improve burn depth assessment (Devgan et al. 2006).

All of the mentioned modalities sound very promising in assessing burn depth to aide in diagnosing and timely intervention in burn victims. However, in my opinion improvement in consistent clinician assessment is necessary followed by a referral as soon as possible to the next level of care for the best outcome.

Respectfully,
Sherri Boos, PT, DPT

Figure 1 (MedlinePlus Medical Encyclopedia Image, 2014).

References
Burns: MedlinePlus Medical Encyclopedia Image. (n.d.). Retrieved August 3, 2014, from
http://www.nlm.nih.gov/medlineplus/ency/imagepages/1078.htm
Devgan, L., Bhat, S., Aylward, S., & Spence, R. J. (2006). Modalities for the assessment of burn
wound depth. Journal of Burns and Wounds, 5, 7-15. Retrieved from Utica College.

Burns2020-03-04T20:29:26+00:00

Soft Tissue Injuries

physical therapist yukonFalls, trauma and sport related injuries cause problems to bones and soft tissue structures. Because soft tissue structures can be strained or even ruptured a grading scale is used to determine damage and proper treatment (Boissonnault, 2011). Grade I soft tissue strain is an over stretch of tissue without rupture. Grade II soft tissue strain is a partial tear in the tissue without disruption to the fascia. Grade I and II injuries cause local tenderness, edema, muscle spasm, bruising and pain with movement (Boissonnault, 2011).

Early treatment for grades I and II consist of rest, ice, compression and elevation. Once the acute swelling and pain subsides approximately 7 to 10 days a referral to physical therapy to restore motion, weight bearing, reduce swelling and pain and restore soft tissue function is necessary.

However, grade III soft tissue injury is more involved resulting in compete tear of soft tissue (muscle) and fasciaresulting in total loss of movement and possible surgical repair. Grade III injuries cause edema, blisters, pain, superficial and deep bruising, and palpable soft tissue defect. Referral to a wound care specialist for debridement and wound healing may be required along with a referral to orthopedic specialist for joint repair. Once the grade III injury is repaired and healing has occurred a referral to physical therapy is protocol to restore motion, reduce swelling and pain, regain weight bearing and normal function.

References

Boissonnault, W. G. (2011). Primary care for the physical therapist (2nd ed.). St, Louis, Missouri: Saunders.

Soft Tissue Injuries2019-01-22T19:42:34+00:00