Atypical Wound Care
Integumentary Physical Therapy
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,
– malignancies and
– external causes.
Potential etiologies
• Inflammatory causes •Metabolic and genetic
– Vasculitis causes
– Pyoderma gangrenosum −Calciphylaxis
−Sickle cell anemia
• infections
•External causes
– Atypical mycobacteria
−Bites
– Deep fungal infections
−Radiation
Risk Factors
• The risk for atypical wounds is usually higher in elderly
people with weak immune systems,
• associated with pre-existing chronic medical illness,
infections, inflammations or tumours.
• Taking many prescribed medications
• Leading unhealthy lifestyle can also increase the risk
for developing atypical wounds.
Scleroderma
• A widespread connective tissue disease that involves
changes in the skin, blood vessels, muscles, and internal
organs.
• Scleroderma causes the skin to become thick, hard, and
tight due to excess collagen buildup.
• It can also affect internal organs like the lungs, heart,
kidneys, and digestive system.
• Symptoms vary, but may include Raynaud's phenomenon,
joint pain, and digestive issues.
• Affect 300,000 people in USA
• Female : Male
– 4:1
• Population
– infants and elderly both
• Average age
– 22-55
• Causes
– Unknown
– Autoimmune disease
– Not directly inherited
– Over production of collagen in the skin and other organs
• 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 beneath 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
Treatment
• Medication
– Decrease activity of immune system
• 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 of death.
Epidermolysis Bullosa (EB)
• Epidermolysis Bullosa is a group of rare genetic
skin disorders that cause the skin to be extremely
fragile.
• Even minor friction or trauma can cause blisters and
skin tearing.
• It usually appears at birth or in early childhood.
• Severe types can also affect mucous membranes,
like in the mouth or esophagus.
TYPES OF Epidermolysis Bullosa (EB)
Feature EB Simplex (EBS) Junctional EB (JEB) Dystrophic EB (DEB)
Severity Mild Moderate to severe Mild to severe
Within the epidermis At the junction of epidermis Below the basement
Blister Location
(outer skin layer) and dermis membrane (deep dermis)
Onset At birth or early infancy Usually at birth At birth or in infancy
Scarring common, may
Scarring No or minimal scarring Some scarring possible
cause deformities
Common Areas Hands, feet (due to Widespread; may involve Skin, nails, and sometimes
Affected friction) mucous membranes internal areas
Slower healing; risk of Healing with scarring and
Healing Heals well with care
complications fusion
Can be reduced (in severe Varies; severe cases may
Life Expectancy Usually normal
cases) lower lifespan
Inheritance Dominant or recessive
Autosomal dominant Autosomal recessive
Pattern (recessive more severe)
COMPLICATIONS
• Lesions heal with scarring
– result IN 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 should be encouraged to be
independent in his / her early age so as to avoid
trauma by others.
Oral Care
• Affect mucous membrane
– E.g. oral blistering, bleeding, oral sub-mucous fibrosis,
esophageal strictures
• Dental decay
– Due to fragility of oral mucosa
– Fluoride supplement
– Oral hygiene
• Constipation – supplements should be used.
Wound management
• Control pain
• Necrotic tissue
– surgical debridement is contraindicated as it
may result in even worse ulceration
• Avoidance of trauma at dressing removal
– disturbance can generate an even greater
inflammatory response and stimulate deterioration
• 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
