1、Atypical Wound Care,LEE Wai-kuen Nurse Specialist Queen Mary Hospital,Atypical Wound,Wounds due to uncommon etiologies are called atypical wounds. The most commonly encountered etiologies for an atypical wound include inflammatory causes, infections, vasculopathies, metabolic and genetic causes, mal
2、ignancies and external causes.(Baranpski & Ayello, 2004),Potential etiologies,Inflammatory causes Vasculitis Puoderma gangrenosum Infections Atypical mycobacteria Deep fungal infectionsAraujo & Kirsner, 2004,Metabolic and genetic causes Calciphylaxis Sickle cell anemia Malignancies Squamous cell car
3、cinoma Basal cell carcinoma Lymphoma Kaposis sarcomaAraujo & Kirsner, 2004,Vasculopathies Cryoglobulinemia Cryofibrinogenaemia External causes Bites RadiationAraujo & Kirsner, 2004,Scleroderma,A widespread connective tissue disease that involves changes in the skin, blood vessels, muscles, and inter
4、nal organs.,Alternative Names,CREST syndrome Progressive systemic sclerosis Systemic sclerosis Localized scleroderma,Affect 300,000 people in USA Female : Male = 4:1 Population Infant elderly Average age 22-55,Causes Unknown Not directly inherited Over production of collagen in the skin and other or
5、gans Risk factors Occupational exposure to silica dust and polyvinyl chloride,Skin symptoms,Blueness or redness of fingers and toes in response to heat and cold Ulcerations on fingertips or toes Skin hardness / thickening Skin is abnormally dark or light Shiny hands and forearm Small white lumps ben
6、eath the skin Tight and mask-like facial skin Hair loss,Other organs involvement,Bone, joint and muscle Digestive system Lung Kidney Gallbladder Heart Eye,Complications,Heart failure Kidney failure Malabsorption Pulmonary fibrosis Pulmonary hypertension,Medication Decrease activity of immune system
7、Corticosteroids Immunosuppressants (Methotrexate, Cytoxan) Nonsteroidal anti-inflammatory drugs (NSAIDs) Symptomatic control,Prognosis,In most patients, the disease slowly gets worse. Death may occur from gastrointestinal, heart, kidney, or lung involvement. Pulmonary sclerosis - most common cause o
8、f death.,Epidermolysis Bullosa (EB),A rare inherited disease The skin is very fragile and blisters formed in response to friction and to every day trauma May also affect multiple systems of the body,Epidermolysis Bullosa,Epidermolysis simplex Junctional epidermolysis bullosa Dystrophic epidermolysis
9、 bullosa,Epidermolysis simplex,Largest group Dominantly inherited disorder One copy of the gene is faulty Not life threatening Blistering mainly limited to the hands, elbows, knees and feet Reduce in severity as the child becomes older,Junctional epidermolysis bullosa,Recessively inherited disease B
10、oth copies of the gene are faulty The most serious type of EB, infants usually die during the first year of life Generalized lesions Affect mucous membrane,Dystrophic epidermolysis bullosa,Can be either dominant or recessive Dominant only mildly affected Recessive severely affected Continuing bliste
11、ring and ulceration of the skin follows everyday trauma,Lesions heal with scarring result in strictures and contractures limitation in mobility and eating Predispose to skin cancer,Handling of the children,Small infants should never lift up under arms as painful blisters may result. Older children s
12、hould be encouraged to be independent in his / her early age so as to avoid trauma by others.,Aims of wound care,Encourage wound healing Maintain daily activities Social acceptability,Dressing choice,Wound contact layer dressing eg. Mepitel, Urgotul Non adherent dressing eg. Melolin, Tricose, Meplie
13、x Alginate dressing,Clothing,Fine material clothing Can be worn inside out to avoid rough seams Remove internal labels Padded footwear,Oral care,Affect mucous membrane eg. oral blistering, bleeding, oral submucous fibrosis, oesophageal strictures Dental decay Due to fragility of oral mucosa Fluoride
14、 supplement Oral hygiene ? Tooth brushing ? Dentures,Nutrition,Dysphagia - gastrostomy feeding Constipation soluble fibre supplement,Mobility,Digital fusion Results from repeated blistering and scarring Plastic surgery Splintage,Pyoderma Gangrenosum (PG),An inflammatory process resulting in ulcerati
15、on of unknown etiology. It was an immune-mediated inflammatory condition characterized by ulcerative skin lesions. Affect about 5 percent of people with ulcerative colitisRegueiro, et al, 2003Papageprgiou, Mathew, Kaniorou-Larai, & Yiakoumetis, 2007,Systemic diseases associated with PG,Associated wi
16、th other conditions in up to 75% of patients. Inflammatory bowel disease Arthritis Hemotologic abnormalities Lymphoma Myeloma Leukemia Immunologic abnormalities SLE Araujo & Kirsner, 2005,Appear as a blister, red bump, or pustule Appear alone or in a group Pustules progress rapidly and develop into
17、the ulcer Commonly found on the extremities More frequently on the legs than on the armsNkrumah, Addo, & Tachi, 2005Papageprgiou, et al, 2007,Diagnosis,No single diagnostic test available for PG It is a clinical diagnosis of exclusion Based on excluding other causes and evaluating the patient for un
18、derlying systemic disease. Trent & Kirsner, 2001,Treatment,Treat underlying disease Corticosteroid Immunosuppressant Cyclosporine Systemic antibiotics Anaesthetic,Wound management,Control pain Necrotic tissue surgical debridement is contraindicated as it may result in even worse ulceration Avoidance
19、 of trauma at dressing removal disturbance can generate an even greater inflammatory response and stimulate deterioration Araujo, & Kirsner, 2004,Negative pressure therapy may be used to assist debridement when the disease is stable Debridement and skin grafting can be considered when condition is under controlled surgery may reactive the disease Moffatt, Martin, Smithdale, 2007,The End !,
