Wound Care Challenges: Physical Therapy Strategies to Support Healing

Physical therapy modalities of ultrasound, E-stim, and sharp debridement allow for aggressive treatment of wounds. Some deficits may occur in etiology treatment of skin issues traditionally not managed by therapists, such as moisture-associated skin dermatitis.

Four questions may guide you in assigning etiology of areas of the trunk where moisture may be a contributing factor:

1. Where is the wound located on the body?
2. What is the appearance of skin/wound?
3. What is the clinical history?
4. What are the best treatment options?

Below are examples of the answers to these questions as well as treatment options per four etiologies of the trunk.

Incontinence-Associated Dermatitis

1. Location
   • Perineal, buttocks, thighs
2. Appearance
   • Superficial
   • With or without fungal component
3. History
   • Persistent or recurrent incontinence
   • Fecal and/or urinary
4. Treatment Options
   • Resolve incontinence when possible through toileting, thickening stool, eliminating aggravating factors
   • Contain incontinence through super absorbent polymer (SAP) briefs/pads
   • Protect/treat skin through emollients (lanolin, mineral oil, petroleum types) or crusting applications (copolymer powders & skin barrier wipes/sprays)

Intertriginous Dermatitis

1. Location
   • Base of body fold
   • Opposing surfaces of body fold
2. Appearance
   • Linear opening/break in the skin
   • Shallow kissing lesions
   • No ischemia
3. History
   • Diaphoresis
   • Trapped moisture
4. Treatment Options
   • Separate wet skin folds
   • Use wicking products for weeping skin folds
   • Drying powders or skin barrier wipes

Friction

1. Location
   • Fleshy skin areas in contact with linens, bed, or chair
   • Heel or area that rubs against linen, etc.
2. Appearance
   • Skin moist or fragile
   • Serous blister over heel
   • No ischemia
3. History
   • Patient restless
   • Fragile skin
   • Frequent perineal cleansing
4. Treatment Options
   • Manage moisture
   • Protect skin in agitated patients
   • Emollients or skin protectants for prevention/treatment
   • Early recognition

Pressure Ulcer

1. Location
   • Over bony prominence
   • Under medical device
2. Appearance
   • Defined edges
   • Tissue ischemia
3. History
   • Periods of immobility
   • Compression by device
4. Treatment Options
   • Redistribute pressure and envelopment within a surface
   • Moisture management via surface & wicking products
   • Debridement
   • Infection prevention/treatment
   • Nutrition

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This blog was brought to life by PESI speaker and author Kim Saunders, MSN/ED, RN, CWON®, CFN. Kim Saunders has 18 years as a wound, ostomy, and continence expert in home health, acute care, hospice, and outpatient settings. Kim consults for patients related to wounds, ostomy, and incontinence-associated dermatitis. Her experience includes healthcare system-projects related to bed, stretcher, and wheelchair surfaces as well as system processes for skin and wound issues. She also is a co-owner of WOC Consulting, LLC.

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