Short Stretch Bandaging and the Chronic Venous Wound
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1 Short Stretch Bandaging and the Chronic Venous Wound A novel approach to a classic dilemma Joshua Trock, PT, DPT, CLT Director of Therapy Head Lymphedema Therapist Amistad Homecare
2 Agenda Physical Therapy? Edema and Chronic Venous Wounds Complete Decongestive Therapy Principles behind short stretch bandaging Case Studies
3 PT and Wound Care Designated practice patterns in The Guide to Physical Therapist Practice by the APTA Primary Prevention/ Risk Reduction for Integumentary Disorders Impaired Integumentary Integrity Associated with Superficial Skin Involvement Impaired Circulation and Anthropometric Dimensions Assoc c Lymphatic System Disorders
4 PT s have a long history of wound care involvement including: Debridement Dressing application Wound VAC External Compression Modalities (E-stim, Anodyne, Microcurrent)
5 Pathophysiological Conditions that can Lead to Edema 3 1. Increased capillary hydrostatic pressure 2. Decreased plasma proteins (Hypoproteinemia) 3. Increased capillary permeability 4. Blockage of lymphatic return (Lymphedema) Note: Anything which disturbs the balance of forces within or outside of the blood capillary may create edema!
6 Venous Edema 1,2 Pitting (?) Brawny Hemosiderin staining Fibrosis of subcutaneous tissue Atrophic skin
7 Venous Wounds A result of a non-functioning or inadequate functioning calf muscle and/or incompetent valves in the vein leading to venous hypertension, edema and impaired microcirculation Venous blood pools in the LE and foot Usually appear on medial aspect of LE and ankle superior to medial malleolus
8 Complete Decongestive Therapy (CDT) 1,2,6 CDT is the Most Successful Treatment for Lymphedema! 6,7 CDT Consists of: Manual Lymph Drainage Compression Bandaging Exercise Meticulous Skin and Nail Care Instruction in Self-Care
9 CDT is a Two Phase Treatment Intensive Phase Daily Treatments Daily treatments Duration depends on severity Self Care Phase Garments (Daytime) Bandaging (Night) Exercises (Daily) Skin & nail care MLD as needed Follow-up visits
10 External Compression Treatment Rigid Paste Bandage (Unna s Boot) Multilayer Compression Bandage Systems (Profore) Short Stretch Bandage (Rosidal K, Comprilan)
11 Compression Bandaging
12 Effects of Short Stretch Bandaging Compression 1,2 Reduces the effective ultrafiltration rate Accelerates venous and lymphatic drainage Improves venous pump Increases central hemodynamic flow Maintains therapeutic results Softens fibrotic tissue.
13 Laplace s Law Pressure = Tension/ Radius Short Stretch: Low Resting Pressure, High Working Pressure. High Priority is Retrograde Gradient!!! Utilize foams, cotton to decrease high pressure areas to create uniform shape.
14 Case #1 84 yo female L ant tib wound with MRSA infection Pending skin graft due to non-healing Pt had been treated with Coban 4-layer compression PMH: Cardiac Edema, Lupus
15
16 8 weeks later, full closure
17 Case #2
18 Case Example #3 54 yo male with 5 yr Hx chronic lymphedema PMH: Avascular necrosis of the hips, HTN, EtOH abuse, liver cirrhosis, chronic Hep C Admitted for care of Stg 3 pressure ulcer of buttocks and newly developed ulcers of legs secondary to worsening lymphedema
19 Case Example #3 54 yo male with 5 yr Hx chronic lymphedema PMH: Avascular necrosis of the hips, HTN, EtOH abuse, liver cirrhosis, chronic Hep C Admitted for care of Stg 3 pressure ulcer of buttocks and newly developed ulcers of legs secondary to worsening lymphedema
20 Case Example #3 Jan 2012 Kindred Hospital
21 Case Example #3 Treatment consisted of wound care, debridements PRN, manual massage, compression wraps, exercise Discharged after 4 weeks care with plans for clinic follow-up and HHC for daily treatment of his lymphedema Condition at discharge...
22 Case Example #3 Feb 2012
23 Admission to Home Health
24 After 1 st weekend with pt attempting to treat
25 8 months later
26 Conclusion/ Questions
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