![[libribook.com] Traumatic Scar Tissue Management 1st Edition](https://documents.yumpu.com/000/063/506/600/df9a14f39008e2ef6fb6257fe1995653691c6175/78495942476d415367326b574a577143792b587756513d3d/69376a73536453453351314e794e66733072425855773d3d.jpg?AWSAccessKeyId=AKIAICNEWSPSEKTJ5M3Q&Expires=1726218000&Signature=%2FLxH14S2VzWAywrc0nSSrz7JmOI%3D)
[libribook.com] Traumatic Scar Tissue Management 1st Edition
from the tissues and taken up by the lymphatic system. The rate of lymph flowfrom burn-injured tissue directly correlates with the amount of fluid crossing thecapillary membrane into the interstitial space during the edema process. Thefluid is protein-rich, as evidenced by the high content of lymph albumin andglobulin relative to the plasma protein value. The continued increase in lymphflow for more than 36 hours after burn injury indicates that the increasedcapillary permeability to protein persists for several days (Shankar et al. 2007).Lymph flow rate and lymph protein content have been used frequently tomonitor microvascular fluid filtration rate and protein permeabilitycharacteristics. Lymph flow rate reflects the degree of either fluid fluctuation ortransport across the capillary at any given moment, as the lymph channels openvery close to the capillary interstitium.Several researchers have used various lymph preparations for the study of burnedema. The concentration of large molecules in lymph, such as protein ordextrans, has been used to determine the permeability characteristics of themicrocirculation. Because lymph is derived from interstitial fluid, variousvasoactive substances released from the burn may appear in high concentrationin the regional lymph areas that are injured (Demling 2005).Lymph flow appears to be a valid means of accurately monitoring partialthicknessburns, or non-burned tissue, where capillaries and lymphatics remainintact.With deeper burns, capillary or microvascular occlusion decreases the perfusion(delivery of blood) to the burn tissue. Therefore, less fluid is likely to enter theinterstitium and local lymphatics. In addition, subsequent lymphatic damagedecreases the efficiency of the lymphatic network.The concentration of larger molecules in the lymph fluid, such as proteins, hasbeen used to study the permeability of microcirculation. The microcirculation ishighly responsive to, and a vital participant in, the inflammatory response.Because a burn patient receives high volumes of fluid in the early stages ofinjury, the measured lymph flow rate in deep burns is likely to underestimate theactual degree of injury and the actual edema formation in deeper burns (Demling2005).Neuropathic Pain and Pruritus
As noted in Chapter 4, neuropathic pain is defined as pain initiated or caused bya primary lesion or dysfunction in the peripheral or central nervous system.Neuropathic-like pain symptoms consisting of a ‘pins and needles’, burning,stabbing, shooting or electric sensation is a common occurrence in burn injuriesafter the open wound has healed (Schneider et al. 2006). Researchers havedocumented neuropathy in up to 29% of patients with burn injuries.Neuropathy is a common complication of a severe burn injury in the oldersurvivor, the critically ill, an injury caused by electricity, or in those with ahistory of alcohol abuse. Peripheral neuropathy is a well-known disablingcomplication after major burn injury.Determining why this occurs proves difficult due to the complex metabolicnature of burn trauma; the high incidence of sepsis; the use of neurotoxicantibiotics and potential iatrogenic (inadvertent medically induced) causes ofneuropathy. However, some studies have shown the presence of neuropathycorrelates with the TBSA that has been injured, the percentage of full-thicknessburn and other severe illnesses (Kowalske & Holavanahalli 2001).PruritusIn addition to pain, burn trauma can also result in pruritus (itching) as a result ofthe burn trauma or as part of the wound healing process. As well as itching, scarshave also been reported to exhibit burning and crawling sensations (Crandall etal. 2009).Pruritus during wound healing is typically a short-lived, non-invasivepresentation that decreases in frequency and intensity as the scar forms.However, with some pathophysiological scars, pruritus can be persistent andpresent as ‘unbearable’.In a Texas study (Ganio et al. 2013), 87% of post-burn patients reported dailyepisodes of pruritus. Fifty-two per cent reported experiencing itch for up to 30minutes, some experiencing a single episode while others experiencing multipleepisodes daily.Management is particularly challenging due to elusive etiology. The exactmechanism and pathophysiology remain unclear and therefore effective
- Page 469 and 470: Clinical ConsiderationHere we see t
- Page 471 and 472: Pathophysiological ConsiderationAcc
- Page 473 and 474: Pathophysiological ConsiderationNeu
- Page 475 and 476: The diverse biological effects of N
- Page 477 and 478: Clinical ConsiderationCareful appli
- Page 479 and 480: Clinical ConsiderationSome patholog
- Page 481 and 482: Pathophysiological ConsiderationSom
- Page 483 and 484: compressive effect in the keloidal
- Page 485 and 486: alterations in the mechanical envir
- Page 487 and 488: Clinical ConsiderationMechanical fo
- Page 489 and 490: Table 5.4Role of neuropeptides (NP)
- Page 491 and 492: Fitch P (2005) Scars of life. Journ
- Page 493 and 494: Langevin HM (2006) Connective tissu
- Page 495 and 496: active scars. Journal of Bodywork a
- Page 497 and 498: trauma.
- Page 499 and 500: Clinical ConsiderationPostsurgical
- Page 501 and 502: following burn injury,bacterial col
- Page 503 and 504: Table 6.1Comparison of scars (Ogawa
- Page 505 and 506: Pathophysiological ConsiderationAcc
- Page 507 and 508: BurnsA burn injury to the skin or o
- Page 510 and 511: Figure 6.1Depth of burn trauma and
- Page 512 and 513: • Stimulate ECM formation• Regu
- Page 514 and 515: Clinical ConsiderationIt has been i
- Page 516 and 517: Clinical ConsiderationMT may be a v
- Page 518 and 519: ThermoregulationThermoregulation (t
- Page 522 and 523: treatment strategies are difficult
- Page 524 and 525: Clinical ConsiderationSkin rolling
- Page 526 and 527: Sequelae and ComplicationsAdvances
- Page 528 and 529: • Paresthesia - 47%• Arm/should
- Page 530 and 531: breast or around the edge of the ar
- Page 532 and 533: Radiation scarringScar tissue as a
- Page 534 and 535: Implants and painPain of fluctuatin
- Page 536 and 537: LymphedemaBreast cancer treatment o
- Page 538 and 539: volume of fluid that accumulates or
- Page 540 and 541: OneTwoThreeCommonly referred to as
- Page 542 and 543: myokinetic chain/myofascial meridia
- Page 544: • Loss of touch sensation• Clum
- Page 548 and 549: Figure 6.3Distribution of nerves in
- Page 550 and 551: include preservation of as much of
- Page 552 and 553: complication is present there is de
- Page 554 and 555: Clinical ConsiderationScar complica
- Page 556 and 557: BreastCancer.org (2015c) Side Effec
- Page 558 and 559: 323-9.Kania A (2012) Scars. In: Dry
- Page 560 and 561: Slemp AE, Kirschner RE (2006) Keloi
- Page 562 and 563: scar tissue, while being mindful of
- Page 564 and 565: Physiological ResponseAs discussed
- Page 566 and 567: • The realization that one is abo
- Page 568 and 569: Stress Response and Stress Hormones
As noted in Chapter 4, neuropathic pain is defined as pain initiated or caused by
a primary lesion or dysfunction in the peripheral or central nervous system.
Neuropathic-like pain symptoms consisting of a ‘pins and needles’, burning,
stabbing, shooting or electric sensation is a common occurrence in burn injuries
after the open wound has healed (Schneider et al. 2006). Researchers have
documented neuropathy in up to 29% of patients with burn injuries.
Neuropathy is a common complication of a severe burn injury in the older
survivor, the critically ill, an injury caused by electricity, or in those with a
history of alcohol abuse. Peripheral neuropathy is a well-known disabling
complication after major burn injury.
Determining why this occurs proves difficult due to the complex metabolic
nature of burn trauma; the high incidence of sepsis; the use of neurotoxic
antibiotics and potential iatrogenic (inadvertent medically induced) causes of
neuropathy. However, some studies have shown the presence of neuropathy
correlates with the TBSA that has been injured, the percentage of full-thickness
burn and other severe illnesses (Kowalske & Holavanahalli 2001).
Pruritus
In addition to pain, burn trauma can also result in pruritus (itching) as a result of
the burn trauma or as part of the wound healing process. As well as itching, scars
have also been reported to exhibit burning and crawling sensations (Crandall et
al. 2009).
Pruritus during wound healing is typically a short-lived, non-invasive
presentation that decreases in frequency and intensity as the scar forms.
However, with some pathophysiological scars, pruritus can be persistent and
present as ‘unbearable’.
In a Texas study (Ganio et al. 2013), 87% of post-burn patients reported daily
episodes of pruritus. Fifty-two per cent reported experiencing itch for up to 30
minutes, some experiencing a single episode while others experiencing multiple
episodes daily.
Management is particularly challenging due to elusive etiology. The exact
mechanism and pathophysiology remain unclear and therefore effective
Change language