MANAGEMENT OF CLIENT

WITH INTEGUMENTARY
DISORDERS
Prepared By:
Ms. Lydia C. Mactal, RN,MSN
REVIEW OF ANATOMY &
PHYSIOLOGY

A. Structure of the skin

 Four Cell types
 Keratinocytes
 Principal cells of the
epidermis
 Produces KERATIN
 Epidermis constantly
regenerates itself
providing a though
keratinized barrier
 Melanocytes
Epidermal pigment –
producing cells
 Produces
MELANOSOMES (pigment
granules) that contains
MELANIN (skin pigment)
 Four pigments that
determine skin color
 yellow – exogenously
produced carotenoids
 brown – melanin
 blue – reduced Hgb in
venules
 red – oxygenated Hgb in
capillaries
 Langerhans Cells
 Merkel cells
 The touch
 Originally located at
receptors on the bone marrow &
palms, soles, oral migrate to the
& genital epidermis
epithelium but very  Plays a role in the
scarce immune reactions of
the skin  can alert
the immune system
 Vitamin D
 activated in the epidermis
by the UV light
distributed by the blood to
the other areas of the
body.
 Darker skin tones are not
caused by increase number
of melanocytes rather the
size of the pigment
granules (melanin)
contained in each cell
determines the color.
 SKIN APPENDAGES
 HAIR
 Toughness is caused by
 Individual hairs can
hair keratin rich in sulfur
differ in both structures
& rate of growth
depending on body
location
 Hair follicles are located
in the dermal layer
Nails
 Horny scales of the epidermis
 Parts:
 LUNULA – white crescent- shaped portion at the lower end of the
nail plate
 NAIL MATRIX – source of non-keratinized cells; located at the
proximal nail bed
 CUTICLE – attaches the nail plate; layer of keratin at the nail fold
 Nail growth is a continous but a slow process
 Growth rate:
 Fingernails: 3 to 4 months
 Toe nails: 12 months
Glands
2. Sweat Glands
1. Sebaceous glands  Eccrine glands
 Found throughout the
 sweat producing glands
skin except palms & that play an important
soles
role in thermoregulation
 Directly connected at
 Numerous in palms,
the hair follicle
soles, forehead and
 Produces SEBUM – axillae
mildly bacteriostatic  Odorless, isotonic
fat containing
secretion
substance; lubricates
 Can lose up to 10 to 12
the skin & reduces
H20 loss liters of fluid/single day
 Main stimulus for
secretion is HEAT or can
be caused by exercise &
emotional stress
 Apocrine glands
 have direct contact with
the hair follicle
 Found in axillae, perineal,
areola & periumbilical
area
 odor is caused by the
interaction of skin
bacteria with the
secretions
ASSESSMENT
A. Demographic Data
▪ Age – changes could
be normal in color
adult
 Race & Nationality –
normal/abnormal with
specific race &
ethnicity
 Occupation –
chemicals, irritants,
abrasive substances &
environmental skin
problems
B. Family History &
Genetic Risk
▪ skin disorders have a
familial predisposition
▪ explore family’s
tendency for chronic
skin problems
▪ current skin status
C. Personal History E. Diet History
▪ medical history
▪ previous & current • weight, height, body
illness fluid & food
D. Medication History preferences
▪ use of prescription and
OTC  Poor nutrition, CHON
▪ time drug started, dose deficiency & vitamin
& frequency, time deficiency, obesity
dose taken
F. Socioeconomic Status
 social & economic
background
2.Skin Assessment
A. Inspection 2. Lesions
1. Color ▪ described as;
▪ can be affected by; Primary lesion – initial
 Blood flow reaction
 Oxygenation  Secondary lesion – occur
 Body temperature after the initial reaction
 Pigment ▪ describe interms of;
production Color
▪ changes can be  Size
generalized or  Location
localized  Configuration
▪ can be observed in oral
mucosa, sclera, nail
beds and palms, soles
3. Edema
▪ appear shiny, taut and
pale
 ▪ document location,
distribution and color

4. Moisture
▪ note for the thickness
and consistency of
secretion
▪ excess moisture
Cause skin breakdown
Decreased air
circulation
5. Vascular markings
▪ normal – birthmarks,
angiomas (spider &
cherry) and venous
stars
▪ abnormal – caused by
bleeding into the
tissue
▪ Petchiae
▪ Ecchymosis
6. Integrity
▪ examine actual breaks
7. Cleanliness
B. Palpation
▪ gather additional information
▪ confirm size of the lesion (flat or raised)
▪ make hands warm before palpation
▪ assess texture which differs according to body parts
 ▪ Turgor
– indicates the amount of skin elasticity
- assess for “tenting”
- older client chest at the forehead or chest
 3. Hair Assessment
 ▪ inspect and palpate
for cleanliness,
distribution, quantity
and quality
 ▪ inspect the scalp for
scaling, redness,
lesions and
tenderness
 ▪ Hirsutism -
excessive hair growth
4. Nail Assessment  Consistency
 Color ▪ described as hard, soft or
▪ inspect for thickness brittle
and transparency, ▪ soft nail plate – caused by
amount of RBC, arterial malnutrition, chronic
blood flow & pigment arthritis, myxedema
deposits ▪ brittle nails –
onychomycosis or advanced
psoriasis
 Lesions
▪ oncholysis – common with
fungal infections and after
trauma
▪ inspect for soft tissue
folds around nail plate for
redness, heat, swelling and
tenderness
 Other Diagnostic Tests
Diagnostic Assessment a. Skin Biopsy
 Laboratory Tests
▪ a small piece of skin
1. Culture tissue for pathologic
study
▪ types:
 Punch Biopsy
- uses punch (a small
circular cutting
instrument)
 Shave Biopsy- removes a
portion of the skin is
elevated
- scalpel or razor is moved
parallel to the skin
 Excisional Biopsy – larger
or deeper specimens
c. Wood’s Light
examination
▪ a handheld, long-wave
UV light
 ▪ infected skin produces
blue-green or red
d. Diascopy
▪ a glass slide or lens is
pressed down over the
area to be examined,
blanching the skin to
reveal the shape of the
lesions
e. Skin Testing
MINOR SKIN PROBLEMS
A. DRYNESS
 ▪ Xerosis
 ▪ common in older adult
 ▪ flaking of the stratum
corneum
 ▪ generalized pruritus
 ▪ Causes:
central heating or
airconditioning
 wind, cold & sunlight
 frequent bathing with
harsh soap & hot water
 ▪ Management
1) Bathing with moisturizing
soap, oils and lotions.
2) Encourage application of
skin creams or lotions.
3) Avoid constricting
clothing.
4) Rinse thoroughly after
bath.
5) Maintain daily fluid intake
of 1-3 liters/day unless
contraindicated
6) Do not apply rubbing
alcohol, astringents or
other drying agents.
MINOR SKIN PROBLEMS
B. PRURITUS
 ▪ itching, a distressing
symptom that may or
may not occur with skin
disease
 ▪ subjective symptom as
pain; varies among
client in location &
severity
 ▪ usually worse during
the night
 ▪ poor skin hydration,
increase temperature,
perspiration & emotional
stress
 ▪ Management
 Plan is to provide comfort
& maintain skin integrity.
 proper bathing &
skin lubrication
 fingernails should
be kept short
 wearing of mittens
during the night
 use of therapeutic
bath
 antihistamines &
anti-inflammatory
drugs are
administered
MINOR SKIN PROBLEMS
C. SUNBURN
 ▪ a first-degree or superficial
burn
 ▪ common skin injury
 ▪ excessive exposure to UV
injures the dermis
 ▪ S/S : tenderness, edema,
occasional blister formation
 ▪ redness (erythema) & pain
begin within few hours
 ▪ treatment towards comfort
cool baths
soothing lotions
antibiotics ointment for
blisters
corticosteroids for severe pain
MINOR SKIN PROBLEMS
D. URTICARIA
 ▪ hives
 ▪ presence of white or red edematous
papules or plaques of various size
 ▪ factors:
drugs
 foods
 infection
 autoimmune disease
 ▪ Treatment removal of triggering
substances
 antihistamine
 avoid overexertion
 alcohol consumption
 warm environment
PRESSURE ULCERS
 ▪ tissue damage caused
when the skin and
underlying soft tissue are
compressed between
bony prominences and
external surface for a
extended period of time
 ▪ referred as decubitus
ulcer, pressure ulcer
 ▪ commonly occur over
the sacrum, hips and
ankles
 ▪ commonly occur in
people limited mobility
and sensory impairment
PRESSURE ULCERS
 Stages
1. Stage I
changes in color (red,
blue, purple),
temperature (warm or
cold)
2. Stage II
partial-thickness loss
of skin involving
Epidermis & part of
Dermis
PRESSURE ULCERS
3. Stage III
full-thickness skin loss
involving subcutaneous
damage or necrosis
4. Stage IV
full-thickness skin loss
with severe
destruction, necrosis or
damage to muscle,
bone or supporting
structures
PRESSURE ULCERS
▪ causes:
 pressure
▪ can compress blood vessel
that may lead to ischemia,
inflammation & tissue
necrosis
 friction
▪ surfaces rub the skin and
initiate or directly pull off
epithelial tissue
 shear
▪ generated when the
skin itself is stationary
and the tissue below
the skin shift or move
▪ occur when the client
in a semi-sitting
position and gradually
slides
PRESSURE ULCERS
Incidence/Prevalence
 In acute care setting
 Long term care facility
 Home care setting
 Prevention/Health
Promotion
“ An ounce of prevention may
be worth tons rather than
pounds of cure”.
PRESSURE ULCERS
A. Identification of High
Risk Clients
1. Activity/ Mobility
▪ level of client’s
independent mobility
2. Nutritional Status
▪ includes laboratory
studies
▪ evaluation of weight
& weight change
3. Incontinence
B. Implementation of
pressure relief or
reduction devices
 Pressure-relief Devices
▪ consistently reduce
pressure
 Pressure-reduction
Devices
▪ lower pressure than that
of the standard hospital
devices
 Positioning
 ▪ 30-degree rule
 ▪ turning & positioning
every 2 hours
 Wound Assessment
▪ assess
wound location
 size, color & extent
of wound involvement,
cell types
presence exudates
condition of
surrounding tissue
presence of foreign
body
• record location, size of
wound
• Psychological Assessment
▪ client may have altered
body image
▪ client and family
knowledge of treatment
goals
▪ strict adherence to
pressure ulcer care
• Laboratory Assessment
▪ culture & sensitivity
▪ swab culture
▪ blood examination
PRESSURE ULCERS
 Management
1. Positioning
▪ keep the head of the bed
elevated at 30 degrees angle
▪ use a lift sheet to move
client in bed
▪ change position every 2
hours
▪ place pillows or foam
wedges between 2 bony
prominences
▪keep the client’s skin
directly off plastic surfaces
▪ keep the client’s heel off
the bed surface
2. Nutrition
▪ maintain adequate intake
of CHO and calories
▪ adequate fluid intake
3. Skin Care
▪ keep areas where two skin
surfaces touch (breast,
axillae)
▪ clean the skin ASAP after
soiling and at routine
interval
▪ Use mild soap & apply
lotions
▪ Use tepid water instead of
hot water
▪ gently pat the skin rather
than rub when drying.
CUTANEOUS ANTHRAX
 ▪ caused by Bacillus Anthracis
 ▪ may be confined to skin or
systemic
 ▪ vesicles appears, itchy and
resembles as an insect bite
 ▪ the vesicles become
hemorrhagic & sinks inward
 ▪ necrosis & ulceration begins
 ▪ usually painless
 ▪ Diagnosis
Appearance of the lesion
Culture
Anthrax antibodies
Biopsy
 ▪ Treatment
Oral Antibiotics for 60 days
 no edema, systemic
symptoms, lesions not on the
head & neck
Intravenous injections & 60
days oral antibiotics
 pregnant, fever, lesions on
the head & neck, excessive
edema
 Drug of choice
Ciprofloxacin (Ciprobay)
Doxocycline (Doxin,
Vibramycin)
PARASITIC DISORDERS
A. Pediculosis
▪ infestation of human lice
▪ oval, 2 to 4mm long
▪ types
1. Pediculosis Capitis
▪ head lice
2. Pediculosis Corporis
▪ body lice
▪ sign: excoriation on the trunk,
abdomen or extremities
3. Pediculosis Pubis
▪ pubic, crab, lice
▪ causes intense itching on the
vulvar or perirectal region
▪ contracted with infested bed
linens or sexual intercourse
PARASITIC DISORDERS
 Interventions
▪ chemical killing with
Lindane (Kwell) or
topical malathion
(Ovide, Prioderm)
▪ clothing and linens
should be washed
with hot water or dry
cleaned
▪ use of fine toothed
comb
▪ social contacts
PARASITIC DISORDERS
2. Scabies
 ▪ contagious disease
caused by mite infection
 ▪ can be transmitted by
close & prolonged
contacts
 ▪ common with poor
hygiene & crowded
living conditions
 ▪ can be carried by pets
& among school
children
SCABIES
 ▪ itching is more
intense and more
during the night
 ▪ occur in the curved
or linear ridges of the
skin
 ▪ mites & eggs can be
seen under the
microscope
 ▪ treatment:
Scabicides (lindane)
or sulfur preparation
PSORIASIS
 ▪ scaling disorder with underlying
inflammation
 ▪ there is abnormality in the
growth of epidermal cells
(usually shed every 4 to 5 days)
 ▪ No cure but can actively control
symptoms
 Etiology and Genetic Risk
 ▪ autoimmune reaction resulting
from the over stimulation of the
immune system
PSORIASIS
 Types
1. Psoriasis
Vulgaris
▪ most common
▪ presents as thick
reddened papules or
plaques covered by
silvery white scales
▪ sites: scalp, elbows,
trunk, knees, sacrum,
surfaces of the limb
PSORIASIS
2. Exfoliative Psoriasis
▪ erythrodermic
psoriasis
▪ an explosively
eruptive and
inflammatory form
with generalized
erythema and scaling
▪ do not form obvious
lesions
PSORIASIS
 Interventions
1. Topical Therapy
▪ Corticosteroids suppresses
cell division
▪ effectiveness is based on
potency and ability to be
absorbed
2. Tar preparations
▪ applied in the skin
▪ suppresses cell division
and reduces inflammation
3. Ultraviolet Light Therapy
▪ physical agent that is used
as a topical treatment
PSORIASIS
3. Systemic therapy
▪ methotrexate (Folex, Mexate)
Has effect on the liver
A cytotoxic drug
▪ Clyosporine (Sandimmune) &
Azathioprine (Immuran) –
immunosuppressant
▪ Biologic Agents
Alefacept (Amevive) – given IM
weekly in 12 weeks
Efalizumab (Raptiva) – given SQ
once per week
4. Emotional Therapy
▪ low self esteem due to lesions &
treatment
▪ touch communicates acceptance
BURNS
BURNS
 attributed to extreme
heat sources and from
exposure to cold,
chemicals, electricity or
radiation
 Etiology of Burn Injury
1. Dry Heat
▪ injuries caused by open
flame
▪ house fire and
explosions
2. Moist Heat
▪ contact with hot fluids
or steam
BURNS
3. Contact Burns
▪ hot metal, tar & grease
when in contact with the
skin
4. Chemical Injury
▪ severity depends on the
duration of contact,
concentration of the
chemicals, amount and
action of the chemical
▪ can be Alkali’s or Acids
BURNS
5. Electrical Injury
▪ occur when an electrical
current enters the body
▪ called “grand masqueder”
– small surface may cause
devastating internal injuries
▪ extent of injury depend on
the type of current, pathway
of flow, tissue resistance and
duration or contact
BURNS
6. Radiation Injury
▪ large doses of
radioactive material
▪ injury is usually
minor & rarely cause
extensive skin
damage
BURNS
 There are 4 major goals related to
burns:
1. Prevention
2. Institution of lifesaving measures for
the severely burned person
3. Prevention of disability and
disfigurement through, early,
specialized, individualized treatment
4. Rehabilitation through reconstructive
surgery and rehabilitative programs
Classification of Burns

 Superficial/ First
Degree Burn
 pink to red
 mild edema
 no blisters, eschar
 healing time 3-5
days
 no grafts required
Classification of Burns
 Partial-Thickness/Second
Degree Burn
 pink to red
 mild to moderate
edema
 painful
 presence of blisters
 < 2 weeks healing
time
 scalds, flames, brief
contact with hot objects
Classification of Burns

 Full-Thickness/Third
Degree Burn
 Black, brown,
yellow, red
 with moderate
edema
 blisters – rare
 healing time 2-6
weeks
 grafts required
Classification of Burns

 Deep Full-
Thickness/Fourth
Degree Burn
 black
 absent edema &
pain
 hard & ineslactic
eschar
 weeks 2 months
 grafts needed
BURNS
PATHOPHYSIOLOGY
CHANGES
A. Vascular Changes
1. Fluid Shift
 ▪ also known as third spacing or
capillary leak syndrome
 ▪ a continuous leak of plasma
from the vascular space to the
interstitial space
 ▪ causes loss of plasma fluids &
CHO decreases blood volume &
blood pressure
 ▪ extensive edema and weight
gain occurs in the 1st 12 hours
up to 24-36 hours
 ▪ Hemoconcentration develops
BURNS
2. Fluid Remobilization
 ▪ after 24 hours, capillary leaks
stops & restores capillary
integrity
 ▪ edema fluid shift from
interstitial space to vascular
space
 ▪ blood volume increases thus
increasing renal flow & diuresis
 ▪ Hyponatremia – increased
renal excretion & lost of Na in
wounds
 ▪ Hypokalemia – K moving back
into the cells & excreted into the
urine
BURNS
B. Cardiac Changes
 ▪ 18 to 36 hours – heart
rate increases & decreases
cardiac output
C. Pulmonary Changes
▪ results from airway edema
during fluid resuscitation,
pulmonary capillary leak,
chest burns & carbon
monoxide poisoning
BURNS
D. Gastrointestinal Changes
 ▪ lesser blood flow thus
decreased perfusion
 ▪ Peristalsis decreases
from the stimulation of
SNS as a stress response
 ▪ Curling’s ulcer develops
in 24 hours due to
reduced GI flow &
mucosal drainage
BURNS
E. Metabolic Changes
 ▪ Hypermetabolism –
increase secretion of
cathecolamines, ADH,
aldosterone & cortisol
F. Immunologic Changes
 ▪ injury activates
inflammatory response that
suppresses immune function
 ▪ protective barrier is
damaged, increasing the
risk of infection
BURNS
ESTIMATING BODY
SURFACE AREA
INJURED
1. Rule of Nine
 ▪ introduced in the
1940’s, a quick
assessment tool in
estimating burn size
 ▪ the body is divided in
anatomical sections,
each represents 9 or a
multiple of 9
3. Palm Method
 ▪ It is used if the client
suffered from
scattered burn. The
size of the patient’s
palm is approximately
1% of BSA.
 ▪ The size of the palm
can be used to
estimate the extent of
the burn injury
PHASES OF BURN INJURY
A. EMERGENT PHASE
 ▪ first phase
 ▪ begins at the onset of
injury up to the 1st 48
hours
1. Pre-hospital care
 ▪ Guidelines:
a) Remove the victim from
the source of the burn.
 ▪ Extinguish burning
clothes.
 ▪ Remove saturated clothing
(chemical or scald burn)
BURNS
 ▪ Irrigate a chemical burn.
 ▪ Turn off electricity or remove electrical
source using dry nonconductive object.
b) Assess the ABC’s.
 ▪ Establish airway
 ▪ Ensure adequate breathing.
 ▪ Assess circulation.
c) Assess for associated trauma.
d) Conserve body heat.
e) Consider need for IV administration
f) Transport
 Emergency
Department
 Minor Burns
▪ pain management
▪ tetanus prophylaxis
▪ initial wound care
▪ teaching
 Major Burns
1) evaluation or reevaluation
of ABC’s
2) Assessment
History – directly from the
patient; if not to the witness
- demographic data (age,
weight (preburn), height)
Laboratory
Blood Exam
 - WBC, HGB, HCT,
BUN, K, Cl
 - Na, Total CHON,
Albumin
2) Initiation of Fluid Resuscitation
▪ maintain vital organ perfusion
▪ signs of adequate fluid resuscitation – stable vital
signs, adequate urine output, palpable pulses, clear
sensorium
FLUID REPLACEMENT FORMULAS ARE
CALCULATED FROM THE TIME OF
INJURY NOT ON THE TIME OF
ARRIVAL.
Most commonly used:
Parkland Formula
4mg x TBSA burn x 24
½ given in 8 hours
½ given in 16 hours
IVF used: Lactated Ringer’s
solution
ex. Mr. A burned at about
50% TBSA
4 x 50 x 24 = 4800
2400 cc LR given in 8 hours
2400 cc LR given in 16 hours
3. Placement of IFC
 ▪ measurement of hourly
urine output
 ▪ urine output reliable
indicator for adequacy of
fluid resuscitation
4. Placement of NGT
 ▪ prevention of emesis and
decrease risk for aspiration
5. Vital signs/ Baseline
laboratory studies
 ▪ blood glucose, BUN,
Creatinine, serum
electrolytes, hematocrit
level
B. ACUTE PHASE
 ▪ begins 39 to 48 hours
after injury and lasts
until wound closure is
complete
 Management
1. Infection Control
2. Wound Care
 ▪ aimed to promote
wound healing
Hydrotherapy
TOPICAL ANTIBIOTIC THERAPY
 Topical antibiotics does not sterilize the burn wound
they reduce the number of bacteria so that the
overall microbial population is controlled.
 Criteria for choosing include the following:
 It is effective against gram negative organisms
 It is clinically effective
 It is cost-effective, available and acceptable
 It is easy to apply, minimizing nursing care time.
 The 3 most commonly used are: Silver sulfadiazine,
silver nitrate and mafenide acetate. Before a topical
agent is re-applied, the previously applied should be
removed
WOUND DRESSING
 When the wound is clean, the burned
area are patted dry and the prescribed
topical agent is applied; the wound is
then covered with several layers of
dressings.
 A light dressing is used over joint to
allow for movement and over areas
which a splint has been designed to
conform to the body contour for proper
positioning.
EXPOSURE METHOD
 Wound is treated by exposing to air
 The success of the exposure method depends on keeping the
immediate environment free from organisms.
 Everything that comes in contact with the patient should be
clean or sterile
 The patient’s room must be maintained at a comfortably
warm temperature with 40% to 50% humidity to prevent
evaporation of fluid as well as to maintain body temperature.
 A cradle may be placed over the patient to prevent sheets
from coming in contact with the burn area, to minimize air
currents, and to provide some covering
OCCLUSIVE METHOD
 An occlusive dressing is a thin gauze
that is either impregnated with a
topical antimicrobial or that is applied
after topical antimicrobial application.
 Occlusive dressings are most often
used over areas with new skin grafts.
 Their purpose is to protect the graft,
promoting an optimal condition for its
adherence to the recipient site.
 This dressings remain in place for 3 to
5 days.
 Functional body alignment positions
are maintained by using splints or by
careful positioning of the patient.
DRESSING CHANGES
 Dressings are changed in the patient’s unit, in the
hydrotherapy room, or treatment room area approximately
20 minutes after the administration of analgesics
 Dressings that adhere to the wound can be removed more
comfortably if they are moistened with saline solution or if
the patient is allowed to soak for a few moments in the tub.
 The remaining dressings are carefully removed with forceps
or gloved hands.
 The wound is then clean and debride to remove debris, or
remaining topical antibiotics
 Inspect the skin for color, odor, size, exudates, signs of
reepethelialization, and other characteristics of the wound
and the eschar and any changes from previous change of
dressings.
WOUND DEBRIDEMENT
 GOALS: To remove tissue
contaminated by bacteria
and foreign bodies,
thereby protecting the
patient from invasion of
bacteria
 To remove devitalized
tissue or burn eschar in
preparation for grafting
and wound healing
 3. SURGICAL
 TYPES OF DEBRIDEMENT – Is an
DEBRIDEMENT operative procedure
 1. NATURAL involving either primary
DEBRIDEMENT- The excision of the full thickness
dead tissue separates of the skin down to the
from the underlying fascia or shaving the burned
viable tissue, skin layers gradually down to
spontaneously freely bleeding.
 2. MECHANICAL  Surgical excision is initiated
DEBRIDEMENT – early in the burn wound
Involves using surgical management
and forceps to separate  The use of surgical excision
and remove the eschar carries with it risks and
and usually done with the complications, especially with
daily dressing change and large burns. The procedure
wound cleaning creates a high risk of
procedures extensive blood loss and
lengthy operating and
anesthesia time
GRAFTING THE BURN WOUND
 1. Autograft
 Purpose: To decrease the risk for
infection, prevent further loss of
protein, fluid and electrolytes
and minimize heat loss.
 The main areas of skin grafting
include the g=face, for cosmetic
and psychological reasons; the
hands and other functional areas
such as the feet; and the areas
that involve the joints
 Grafting permits earlier
functional ability and to reduce
contractures.
BILOGIC DRESSINGS (Homografts and Heterografts)
 Biological grafts is lifesaving by providing temporary
wound closure and protecting the granulation tissue until
autograft is possible.
 It may also be used to debride untidy wounds after
eschar separation.
 Biological dressings also provide immediate coverage for
clean, superBiologic dressings consist of homografts
(allograft) and heterograft (xenograft)
 Homograft are skin obtained from living or recently
deceased humans. Tends to more expensive and they are
available from skin banks.
 Heterografts consist of skin taken from animals. It
thought to provide the best infection control of all biologic
or biosynthetic dressings available
BIOSYNTHETIC
AND SYNTHETIC
DRESSINGS
 The most widely
used synthetic
dressing is
Biobrane, which is
composed of a
nylon, silastic
membrane
combined with
collagen derivative.
 Artificial skin
(Integra) is the
newest type of
synthetic dressing.
 AUTOGRAFTS Are
the ideal means of
covering the burn
wounds because they
come from the
patient’s own skin and
thus are not rejected
by the patient’s
immune system.
CARE OF PATIENT WITH
AUTOGRAFT
 Occlusive dressings are
commonly used initially
after grafting to
immobilize the graft.
 The first dressing change
is usually done by the
surgeon 3 to 5 days after
surgery
 The patient is positioned
and turned carefully to
avoid disturbing the graft,
it is elevated to minimize
edema.
 The patient begins
exercising the grafted
area after 5 to 7 days
DISORDERS OF
WOUND HEALING
1. SCAR – Healing of
such deep wounds
results in the
replacement of normal
integument with highly
metabolically active
tissues that lack the
normal architecture of
the skin.
2. KELOIDS – A large-
heaped-up mass of
scar tissue, a keloid
may develop and
extend beyond the
wound surface.
Keloids tends to be
found in darkly
pigmented people,
tend to grow outside
wound margins and
are more likely to
recur after surgical
excision.
3. FAILURE TO HEAL

4. CONTRACTURES – The
burn wound tissue shortens
because of the force
exerted by the fibroblasts
and the flexion of muscles
in natural wound healing
 An opposing force provided
by traction, splints, and
purposeful movement and
positioning must be used to
counteract deformity in
burns affecting joints.
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