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Although all wounds follow roughly the same healing process, there are many different causes of wounds. Partial-thickness wounds penetrate the outer layers of the skin (the epidermis and the superficial dermis) and heal by regeneration of epithelial tissue (skin). Full-thickness wounds involve a loss of dermis (deeper layers of skin and fat) and of deep tissue, as well as disruption of the blood vessels; they heal by producing a scar. Wounds are classified by stage. Stage I wounds are characterized by redness or discoloration, warmth, and swelling or hardness. Stage II wounds partially penetrate the skin. Stage III describes full-thickness wounds that do not penetrate the tough white membrane (fascia) separating the skin and fat from the deeper tissues. Stage IV wounds involve damage to muscle or bone and undermining of adjacent tissue. They may also involve the sinus tracts (red streaks indicating infected lymph vessels). laptop battery

One medical term for a wound is an ulcer. An ulcer is an open sore on the skin (or a mucous membrane) that causes destruction of surface tissue. An ulcer can be shallow or deep and crater-shaped. Ulcers are usually inflamed and painful. thinkpad

Traumatic Ulcers An injury caused by any kind of accident (or trauma) can result in a wound that affects the skin, blood vessels, bones, muscles, soft tissue, or organs that may result in development of an ulcer. microsoft

Arterial Ulcers The arteries supply blood, which carries vital oxygen required by cells to live. If arterial circulation is partially or completely blocked, the tissue will begin to die, resulting in a painful wound. Impaired circulation of this type usually occurs in the extremities (arms and legs), especially on the top of the foot. Impaired circulation is signaled by lack of pulse; cool or cold skin; skin that appears shiny, thin, and dry; loss of skin hair; and delayed capillary return time. (To test capillary return time, briefly push on a skin area and then release: normal color should return in 3 seconds or less.) Treatment of arterial ulcers has two goals: re-establishing circulation with medical treatment and healing the wound(s). laptop computers

Venous Ulcers Veins carry deoxygenated blood back to the lungs. Veins contain valves that prevent backflow, but when these valves become incompetent, too much blood remains in the tissues. This condition is called congestion. Venous congestion commonly affects the legs, causing swelling (edema) and a brownish discoloration from the hemoglobin of the immobile red blood cells that leak out. Venous ulcers are the most common wounds affecting the legs and are frequently found on the ankles. Venous ulcers are shallow and not too painful. They may have a weeping discharge. Although venous valves cannot be repaired, the return of blood through the veins can be improved by physical activity and by compression which can be supplied by compression stockings, dressings, or mechanical pumping devices. laptop computer

Diabetic Foot Ulcers Diabetes results in a narrowing of the small arteries which can cause ulcers. This narrowing cannot be resolved, but it can be prevented by careful glucose control. Diabetes also causes peripheral neuropathy and the loss of sensation, especially sharp/dull discrimination, in the legs and feet. For this reason, injuries to the feet may go unnoticed and can progress into serious wounds. In addition, peripheral neuropathy can cause deformity of the foot (Charcot foot deformity) because of inappropriate stresses being placed on the bones, resulting in microfractures; this deformity in turn results in bony prominences and swelling that contribute to ulceration. Neuropathy also cannot be cured, but careful glucose control slows its progress. Diabetics must be extremely vigilant about foot care and should seek immediate medical attention for any wounds. Special shoes can help relieve pressure on the feet. desktop computer

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Pressure Ulcers Also known as bedsores, pressure ulcers are very common in older and immobile persons. When too much pressure is placed on them, cells do not get enough oxygen. Pressure of this type occurs when cells are sandwiched between a bony prominence (elbow, hip, heel, or tailbone) and a hard surface (bed or wheelchair). Those cells closest to the bone begin to die, and the wound spreads toward the skin surface. Thus, a pressure ulcer indicates not only a surface wound, but also a deep tissue wound. The risk of pressure ulcers can be reduced by enhancing mobility, maintaining skin and general health, ensuring good nutrition, and monitoring weight (patients should be neither too heavy nor too light). lenovo

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Burns Most burns occur in the home, particularly from accidents. Burns can be caused by scalding hot liquids, grease fires, car accidents, chemical explosions, frayed electrical cords, house fires, hot objects (stoves, irons, grills, tailpipes), or even the sun. A first-degree burn results in a superficial reddened area on the top layer of the skin (epidermis) like that caused by a mild sunburn. A second-degree burn involves the epidermis and second layer of the skin. It results in a blistered injury that heals spontaneously after the blister fluid has been removed. A third-degree burn penetrates all layers of the skin and will usually require surgical intervention in order to heal. Superficial burns usually heal on their own within 2 weeks with routine wound care and protection from infection. Deeper burns (second and third degree) require medical attention, including nutritional support and assessment of lung function, and may require skin grafts and vascular or reconstructive surgery. Immediate care of a burn consists of cooling the affected area with ice or ice water. travelstar

Stages of Wound HealiNG gateway

• Inflammatory
• Proliferative
• Maturation and Remodeling

Wounds with even edges that come together spontaneously (minor cuts) or can be brought together with sutures usually heal well with routine wound care. Wounds with rough edges and tissue deficit (a crater) may take longer to heal. When there is a crater and the edges of a wound are not brought together (left open intentionally), bumpy granulation tissue grows from the exposed tissue. The granulation tissue is eventually covered by skin that grows over the wound from the cut edges to the center. When healing is complete, the granulation tissue develops into tough scar tissue. All wounds heal in three stages. laptop parts

Inflammatory Stage This stage occurs during the first few days. The wounded area attempts to restore its normal state (homeostasis) by constricting blood vessels to control bleeding. Platelets and thromboplastin make a clot. Inflammation (redness, heat, swelling) also occurs and is a visible indicator of the immune response. White blood cells clean the wound of debris and bacteria. software

Proliferative Stage hard drives

After the inflammatory stage, the proliferative stage lasts about 3 weeks (or longer, depending on the severity of the wound). Granulation occurs, which means that special cells called fibroblasts make collagen to fill in the wound. New blood vessels form. The wound gradually contracts and is covered by a layer of skin. electronics

Maturation and Remodeling Stage This stage may last up to 2 years. New collagen forms, changing the shape of the wound and increasing strength of tissue in the area. Scar tissue, however, is only about 80% as strong as the original tissue. The body s ability to heal during this stage is diminished in the elderly. canon

Wound CaRE desktop pc

• Debride and Cleanse
• Maintain a Moist Environment
• Prevent Further Injury
• Provide Materials for Healing

There are four basic steps to follow in caring for any wound. Perhaps the most important factor in wound healing is compliance: in other words, caring for the wound consistently and correctly. desktop computers

Debride and Cleanse Debridement means the removal of dead tissue. Debridement can be accomplished in an autolytic manner, meaning the wound itself is encouraged to do this task by the use of dressings. A medical professional may also use biochemical enzymes; wet-to-dry dressings (in which a wet dressing is allowed to dry, trapping material in it, and is then carefully removed); or mechanical implements such as scalpel or scissors to remove dead tissue from more serious wounds. Cleansing refers to the removal of any foreign debris from the wound (such as residuum from previous dressings) and any bacteria. Cleansing is usually accomplished by irrigating the wound with fluid from a disposable syringe. think pad

Many previously accepted wound-cleansing solutions have been found to be toxic to fibroblasts and lymphocytes, the cells required to heal wounds. These solutions include povidone-iodine, acetic acid, iodophor, hydrogen peroxide, and Dakin s solution (sodium hypochlorite). Commercially prepared solutions are not regulated by the FDA, and many have been found to be cytotoxic. The only acceptable wound-cleansing solution is normal saline solution (0.9% sodium chloride, or salt, in water). Normal saline solution effectively removes contaminants and has the same salt concentration as the fluid in cells, so it does not damage cells by pulling water out of them. Normal saline is also inexpensive and readily available. repair

Maintain a Moist Environment During wound healing, cells and fluid are slowly exuded (or discharged). The exudate provides an environment that stimulates healing because it contains white blood cells, growth factors, and other special enzymes and hormones. A moist environment preserves this exudate, speeding wound healing and promoting skin growth. It also prevents dressings from adhering to the wound and damaging the fragile tissue when the dressing is removed. A moist environment can easily be maintained using gauze moistened with normal saline solution (or with a Vaseline-based prescribed ointment obtained from a physician). data recovery

Normal saline solution will support autolytic debridement, absorb discharge, and trap bacteria. For partial-thickness wounds with no infection, polyvinyl dressings, which are semipermeable to oxygen and impermeable to bacteria, can also be used. Polyvinyl dressings have the advantage of concentrating the cells responsible for healing in the wound bed, but the disadvantage is that they are adhesive and may therefore damage the fragile skin surrounding the wound. Hydrocolloid dressings are not adhesive and are impermeable to oxygen and bacteria, but may leave a residue in the wound, which must then be removed. Absorptive dressings are used on wounds with a lot of discharge. cisco

It is critical that the first two steps of wound care be performed regularly and gently. Dislodging the fragile granulation tissue or skin that is forming in the wound bed will delay healing. For most wounds, the first two steps can be accomplished easily and effectively by using gauze that is kept moist with normal saline solution. keyboard

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Prevent Further Injury In order to prevent further injury, the initial cause of the wound must be determined and addressed as described above and the area must be protected from additional trauma. desktop

Provide Materials for Healing Proteins, made up of amino acids, are necessary for all phases of wound healing, including angiogenesis, fibroblast proliferation, collagen synthesis, and scar remodeling. Proteins also support the immune system, helping to prevent infection. One study found that protein depletion before surgery is a risk factor in wound infection (McPhee et al. 1998). Fats and carbohydrates are also needed to supply the extra energy used in healing and to prevent proteins from being used for energy. Water is necessary to replace losses through vomiting, bleeding, wound discharge, and fever. Vitamins and minerals also play key roles in the healing process, as will be discussed later. infosys

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Myofascial Syndrome Updated: 06/10/2003 wipro

• Description
• Distinguishing Myofascial Syndrome from Fibromyalgia
• Summary of Treatment Modalities
• Summary

Myofascial: from the Greek myelos, meaning marrow (muscle) and from the Latin fascia meaning bandage or band lap top

Myofascial #include virtual="/newshop/cgi-shop/LEFAdvisor2.cgi" syndrome (MFS) is a painful musculoskeletal condition characterized by painful foci of muscle called trigger points (TrPs). MFS became better known based on the work of a well-known Washington, D.C. physician, the late Dr. Janet Travell. Dr. Travell was the White House physician for a number of presidents. refurbished

MFS has often been confused with fibromyalgia because they both involve muscle pain. The trigger points of MFS are different from the tender points of fibromyalgia in that they may be just about anywhere, whereas the tender points of fibromyalgia are in a specified pattern. When a physician presses on a tender point in patients with fibromyalgia, the patient describes exactly that--tenderness. When a physician pushes a trigger point in MFS, the trigger point elicits an involuntary twitch response. Additionally, the patient may report pain that radiates to an area away from the trigger point itself. This is what is considered referred pain. The painful trigger point area is in the muscle or the junction of the muscle and fascia. Hence, myofascial pain is usually associated with a taut band, indicating a ropey thickening of the muscle tissue. memory

The fascia is a tough connective tissue that spreads throughout the body in a three-dimensional web from head to foot without interruption. The fascia surrounds every muscle, bone, nerve, blood vessel, and organ of the body, all the way down to the cellular level. Therefore, malfunction of the fascial system due to trauma, posture, or inflammation can create a binding down of the fascia, resulting in abnormal pressure on nerves, muscles, bones, or organs. intel

Much of the pain that accompanies MFS is due to inadequate blood flow to the trigger point area (ischemia) that inhibits the ability of the muscle to eliminate metabolic wastes, such as lactic acid and potassium. These accumulated metabolic byproducts combined with inadequate oxygen flow to the affected area then build up, stimulating nearby nerve endings that lead to trigger point pain. as400

Distinguishing Myofascial Syndrome from FibromyalGIA averatec

• Causative Factors
• Treatment
• Depression and Anxiety
• Pain and Associated Depression
• Dietary Changes
• Amino Acid Supplementation
• Exercise

What distinguishes MFS from fibromyalgia (FM) is that MFS is not usually associated with poor sleep or chronic fatigue, although some patients may have a little bit of both. The trigger points of MFS do not go away by getting the patient to sleep better. Since a patient can have both FM and MFS, treating the FM may improve things. However, persistent painful areas may be the result of MFS. For example, a patient may experience headaches and have classic FM. Following the FM protocol makes the patient feel much better, but the headache persists. Upon reexamination, the patient s physician finds the same mid-trapezoidal trigger points described above, greater on the right than the left. It turns out that the patient carries a heavy laptop every day on the right shoulder. When the trigger point is pressed upon very firmly, the patient develops neck pain that evolves into a migraine. Treating the trigger point and having the patient stop carrying the laptop for a while will result in resolution of the headaches. What has been described is, of course, the ideal diagnostic situation. Some patients may not develop the migraine right there in the office. However, any person who has unexplained headaches should have an evaluation for the presence of trigger points. The same is true for any persistent muscular pain that appears to be nondermatomal in origin. hardware

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Causative Factors storage

• Repetitive motions; excessive exercise; muscle strain due to overactivity seagate

• Lack of activity (leg or arm in a sling) computer sales

• Nutritional deficiencies computer hardware

• Nervous tension or stress printers

• Generalized fatigue technology

• Sudden trauma to muscles, ligaments, or tendons mainframe

• Hormonal changes (PMS or menopause) samsung

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Treatment Mapping out the myofascial pain regions and their associated trigger points was attributed to the work of Dr. Travell. She developed a technique which is used to either inject a local anesthetic with a mild anti-inflammatory steroid solution into the trigger point or to break up the trigger point with a needle. The exact pathology of the trigger point is not entirely understood. What is clear is that treating the trigger point is responsible for resolving many types of pain patterns. used computers

Janet Travell s work coincides with acupuncture points. The trigger points and associated pain radiation areas have been co-related by an acupuncture researcher. As it turns out, 87% of Dr. Travell s trigger points and their associated pain areas lie on acupuncture meridians and correlate with known acupuncture points. Additionally, acupuncturists describe a certain grabbing of the needle which is called taking Chi. This correlates with the twitch response described by Dr. Travell. When a trigger point is properly needled, there is a visible grab observed by the practitioner and a feeling of a grabbing or slight contraction around the needle experienced by the patient. Although new to Western medicine, Dr. Travell s work had already been discovered and utilized thousands of years before by the Chinese (Travell et al. 1983)! network

The acupuncture points He Gu (the point near the wrist where the thumb and forefinger join) and Yin Men (on the back of the thigh) were found to increase blood flow and reduce MFS-related pain (Wang et al. 1998). Most studies, however, seem to indicate that although acupuncture is an effective short-term treatment of chronic pain due to MFS, there is only limited evidence that acupuncture will be effective in the long-term, and further human studies need to be conducted (Fargas-Babjak 2001; Irnich et al. 2001). One study on the use of amitriptyline in people with temporomandibular joint (TMJ) pain and MFS seemed to show that the beneficial effects of these pain treatments reduced over time, but the muscular pain was still manageable more than 1 year after treatment (Plesh et al. 2000). Amitriptyline is a tricyclic antidepressant drug with many side effects that preclude long-term use in most people. digital cameras

For refractive cases of MFS, a homeopathic solution of traumeel and/or a mild narcotic called buprinorphine injected into the trigger point(s) may be employed. Dr. Travell s technique of injecting corticosteroids and/or local anesthetics into the trigger points appears to be effective in reducing muscle pain. Dr. Iwama and his colleagues at the Central Aizu General Hospital, Aizu, Japan conducted studies on 40 women with chronic lumbar, shoulder, or neck myofascial pain. Using Dr. Travell s technique each woman was given an injection of diluted anesthetic or a saline placebo and their pain levels were measured. In another portion of the study, 21 outpatient volunteers were given different dilutions of different anesthetics in each shoulder. Dr. Iwama concluded that the most suitable type of local anesthetic is lidocaine or mepivacaine and the most effective water-diluted concentration is 0.2-0.25% (Iwama et al. 2001). desktops

Trigger points may require multiple treatments that necessitate excessive amounts of steroids over time. Some physicians feel that local anesthetics may irritate the muscle tissue, and multiple injections into the same trigger point may aggravate the problem. cognos

Buprinorphine, when diluted and injected into the trigger points, may have a local pain-reducing action or in some way help to directly break up the trigger point. Additionally, buprinorphine is a mild narcotic analgesic that makes repetitive injections more tolerable for the patient. The dosage of traumeel is not critical since it is homeopathic. One to 2 ampules a session may be adequate, depending upon the number of trigger points and the volume of the solution. The proportion works out to 1 ampule per 10 cc of saline. Since buprinorphine has a systemic action and may produce drowsiness, no more than 2 ampules are usually used a session, again depending upon the volume used. Some patients, especially those who are obese, may tolerate more than 2 ampules a session. The dilution is 1/2-2 ampules (0.15-0.6 mg) per 20 cc of saline depending upon patient response and the number of trigger points treated per session. It is advised to begin with the lower concentrations. hosting

The injections are usually only 2-4 cc per trigger point. Someone must drive the patient home after treatment because of the potential for sedation. For really difficult-to-treat trigger points, the Edegawa technique involves taking a 60-cc syringe filled with saline (salt water) and injecting it rapidly through an 18-gauge (large) needle. Anywhere from 20 cc up to the full 60 cc may be used for a particularly recalcitrant trigger point. It is believed that the rapid influx of saline pulls the muscle fibers apart where they cross the trigger point, resulting in a breakup of the trigger point itself. netfinity

If saline injections fail, traumeel and buprinorphine may be added to the saline. This combination is recommended at the outset due to the safety of the two preparations: the possible direct actions of both agents on the trigger point, and the systemic pain-killing properties of buprinorphine. After all, multiple injections of large volumes of fluids into the muscle tissue are painful. The dilution is 6 ampules of traumeel and 1-2 ampules of buprinorphine per 60 cc of saline. Each trigger point may require anywhere from 10-60 cc of fluid as previously described. The amount must be found empirically. No matter how many trigger points are treated, it is suggested that no more than 3 ampules a session of buprinorphine be used because of the potential for sedation. However, some patients, especially those who are obese, may require and tolerate more. There is no need to worry about addiction (see the Pain protocol for more information). internet

A Link to Depression and Anxiety Many painful conditions, including headaches, migraines, TMJ pain, and muscle pain improve when the trigger points associated with myofascial syndrome are identified and treated. However, chronic pain may affect people emotionally, and many people with MFS experience depression or anxiety disorders. It may be beneficial to consult a mental health professional in addition to a regular physician (Glaros 2000) (see the Depression and Anxiety and Stress protocols for additional information). cheap computer

Antidepressants are often prescribed for the treatment of MFS. At low doses, medications, such as tricyclic antidepressants relax muscles, improve sleep, and help in regulating neurotransmitter activity that contributes to the associated pain. At higher doses, they will help relieve depression, but have side effects that often preclude long-term use. digital camera

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Reducing Pain and Associated Depression The antidepressant supplement S-adenosylmethionine (SAMe) has been shown to be specifically effective as a therapy to reduce the chronic pain and depression associated with fibromyalgia (Jacobsen et al. 1991). SAMe is synthesized in the body from the amino acid methionine. An enzyme called methionine S-adeno-syltransferase (MAT) catalyzes a reaction between methionine and ATP to form SAMe. SAMe has been tested for depression caused by a variety of diseases, including Parkinson s disease (PD), fibromyalgia, cancer, cardiovascular disease, and rheumatoid arthritis. Researchers have used SAMe successfully in conjunction with drug and alcohol withdrawal. xseries

In a study reported in the Scandinavian Journal of Rheumatology, 44 fibromyalgia patients took 800 mg of SAMe for 6 weeks. Results showed that SAMe reduced pain at the tender points, as well as fatigue, morning stiffness, and resting pain (Jacobsen et al. 1991). maxtor

Buprenorphine is a mild narcotic with agonist and antagonist properties that has a very low addiction liability, if any, indicating it can be used for a long period of time without developing serious withdrawal symptoms. Buprenorphine is effective in conditions with multiple symptoms such as MFS because it acts rapidly on depression, reduces pain, and induces sleep (Cathelin et al. 1980). data storage

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