AI/VI characteristics

Question 1

Location of AI wounds

Answer 1

Commonly below the ankle

• foot, heel, met heads, tips of toes, bunion areas
• possible superior lateral malleolus or anterior lower leg

Question 2

AI Presentation

Answer 2

• Starts shallow then deepens
• Punched out appearance
• Usually round

Question 3

AI Drainage

Answer 3

Minimal to none

Usually dry and hard

Question 4

AI Tissue

Answer 4

• Black and brown eschar
• Pale granulation
• Mixed

Question 5

Dry Gangrene

Answer 5

• Mummification
• no drainage, hard
• Little/no odor
• Clear demarcation

Question 6

Dry Gangrene treatment

Answer 6

Protect/off load
Monitor for conversion
-Auto Amp

Question 7

Wet Gangrene

Answer 7

• Drainage
• Odor
• Fluctuance /edema
• Erythema
• Less clear demarcation

Question 8

Wet Gangrene Treatment

Answer 8

• Urgent referral

to Vascular surgeon

Question 9

Should you place a moist dressing on dry eshcar?

Answer 9

• NEVER

- careful at other times, depends on surgical candidacy

Question 10

Moist dressing on unhealable AI ulcer?

Answer 10

Keep dry until proven healable

- AVOID ADHESIVES

Question 11

What is the healable conditions for AI ulcers?

Answer 11

Vascular status ABI > .5 and consultant with MD

• slow progression
• AVOID ADHESIVES

Question 12

What is the PT role in AI wounds?

Answer 12

ID, Refer, protect, monitor, educate

• wound care exercise
• Treatment after re-vascularization/AMP. team effort

Question 13

Debridement precautions for AI

Question 14

ABI and Compression

Answer 14

• ABI > .08 35-40mmHg OK
• ABI < .8 but >.6 caution but light compression 17-25mmHg
• ABI

Question 15

After Re-Vascularization/AMP

Answer 15

GO AFTER IT - moist wound environment, debridement

Question 16

VI location

Answer 16

• Above the malleoli in distal 3rd of lower leg (medial and lateral)
• If outside the area, may not have VI etiology

Question 17

Surrounding Skin VI

Answer 17

-Hyperpigmentation - hemosiderin staining
- Lipodermatosclerosis
(scarring of skin/fat, results in hard thickening, immobile skin, can cause “champagne bottle leg, scarring can restrict fluid)
- Thick and scaley epidermis
-Irritation from chronic
-exposure to large amounts of drainage
- Varicose veins

Question 18

VI would characteristics

Answer 18

• Uneven edges (can be diffused or rolled)
• Highly exudative (esp at initiation of tx)
• Pain not bad, if severe consider AI/vasculitis

Question 19

VI periwound

Answer 19

• Maceration common (intially or w/inadequate dressings or change schedule
• Diffuse edges
• irritation

Question 20

VI compression

Answer 20

• Comfrt, cosmesis, tolerance (some compression is better than none)
• Ok to compress over most wound dressings
• Ambulation?
• Vascular status?

Question 21

Tube-like (Tubigrip)

Answer 21

• least compression, inexpensive, east to apply
• light compression but can be doubled
• Conservative trial to determine tolerance
• Utilized with UE and LE issues or with at risk sprains, wounds
• Variation in compression
  (different sizes, can pair different stizes, depends on limp contour, 10-12mmHG)

Question 22

Long Stretch

Answer 22

• Stretches a long way
• ACE wrap
• delivers constant compression, can feel tight at rest
• Applied with figure 8 or spiral technique
• CAUTION with AI

Question 23

Short Stretch

Answer 23

• Short distances
• Applied with consistent tension/spiral layering
• can telescope
• Use ABI levels to determine safe
• HIGH compression during contraction
• LOW during rest

Question 24

In Elastic

Answer 24

• Unna Boot
• enough tension to hold in place
• 2-3 layers over entire LE or UE
• Secondary wrap
• Longer wear time (1 week)
• Telescopes
• Can rub against bend at ankle

Question 25

Multi Layer

Answer 25

- 2-4 layers - More layers = higher levels of compression 30-40mmHg - On during work or rest - Specific layering techniques and sequence - More expensive, More time for application - Long wear - 1 week - Both ambulation and non

Question 26

Stockinga

Answer 26

Not just for VI, can be support/Vein health - replace 6 months Custom vs OTC - Lowest effective level for maintenance - comfort, application, heat

Question 27

Compression levels

Answer 27

- 15-20 mmHG SUPPORT - w/o ulcer, lite prophylaxis for high risk pt's (tired legs) - 20-30mmHG THERAPEUTIC Mild VI w/wo uler, prophylaxis, inability to tolerate high compression

Question 28

La Place's Law

Answer 28

- Adjustments to overal amount of compression graded or graduated - increase/decrease tension - # layers - based on girth

Question 29

Exercises for VI ulcers

Answer 29

- Gastoc stretches ROM (muscle pump) - ankle pumps, circumduction, ABCs - Heel toe raises in sitting - Step overs - Step over 3-4 inch obstacle using heel strike in foot, toe push off - Exaggerated heel toe sequence during walking - biking, Aquatics

Question 30

Education VI

Answer 30

Compression (chronic situation) - Extend standing, sitting crossing legs, ankle pumps - Elevation above heart level - Care and replacement of compression stocking - Lifestyle

Question 31

Spiral / Figure of 8

Answer 31

50% overlap, 50% tension Base of toes over gastroc 2 fingers Leg shape and padding

Question 32

Want Graduated/Graded Compression

Answer 32

Ankle -30-40mmHG, proximal calf ~18mmHG - Ankle circumference w/ multilayer systems due to higher levels of compression - Leg shape & padding