DOCSLIB.ORG

Skin Substitutes for Treating Chronic Wounds: Technical Brief

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Skin Substitutes for Treating Chronic Wounds: Technical Brief Technology Assessment Program Skin Substitutes for Treating Chronic Wounds Technical Brief Project ID: WNDT0818 February 2, 2020 Technology Assessment Program - Technical Brief Project ID: WNDT0818 Skin Substitutes for Treating Chronic Wounds Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. HHSA 290-2015-00005-I Prepared by: ECRI Institute - Penn Medicine Evidence-Based Practice Center Plymouth Meeting / Philadelphia, PA Investigators: D. Snyder, Ph.D. N. Sullivan, B.A. D. Margolis, M.D., Ph.D. K. Schoelles, M.D., S.M. ii Key Messages Purpose of Review To describe skin substitute products commercially available in the United States used to treat chronic wounds, examine systems used to classify skin substitutes, identify and assess randomized controlled trials (RCTs), and suggest best practices for future studies. Key Messages • We identified 76 commercially available skin substitutes to treat chronic wounds. The majority of these do not contain cells and are derived from human placental membrane (the placenta’s inner layer), animal tissue, or donated human dermis. • Included studies (22 RCTs and 3 systematic reviews) and ongoing clinical trials found during our search examine approximately 25 (33%) of these skin substitutes. • Available published studies rarely reported whether wounds recurred after initial healing. Studies rarely reported outcomes important to patients, such as return of function and pain relief. • Future studies may be improved by using a 4-week run-in period before study enrollment and at least a 12-week study period. They should also report whether wounds recur during 6-month followup. Disclaimer A skin substitute’s commercial availability is not a reflection of its legal status. Manufacturers self- determine whether their human cells, tissues, or cellular or tissue-based product (HCT/P) can be marketed without FDA preapproval and often misunderstand or mischaracterize the criteria they must meet for the product to be regulated solely for communicable disease risk. See 21 CFR 1271.10(a). For more information, see “FDA Announces Comprehensive Regenerative Medicine Policy Framework.” We note that FDA does not refer to any product or class of products as “skin substitutes,” and we are not proposing an official definition or classification system. The report includes many products cleared by the FDA as wound dressings via the 510(k) pathway which are not intended to treat wounds but only to cover wounds so that the natural healing process can take place. iii This report is based on research conducted by the ECRI Institute-Penn Medicine Evidence-Based Practice Center (ECRI-Penn EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290-2015-00005-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. No statement in this article should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients.) This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied. Individuals using assistive technology may not be able to fully access information in this report. For assistance, contact [email protected]. Suggested citation: Snyder DL, Sullivan N, Margolis DJ, Schoelles K. Skin substitutes for treating chronic wounds. Technology Assessment Program Project ID No. WNDT0818. (Prepared by the ECRI Institute-Penn Medicine Evidence-based Practice Center under Contract No. HHSA 290-2015-00005-I) Rockville, MD: Agency for Healthcare Research and Quality. February 2020. Available at: http://www.ahrq.gov/research/findings/ta/index.html. iv Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The Centers for Medicare and Medicaid Services (CMS) requested this report from the Evidence-based Practice Center (EPC) Program at the Agency for Healthcare Research and Quality (AHRQ). AHRQ assigned this report to the following EPC: ECRI Institute- Penn Medicine Evidence-based Practice Center (Contract Number: HHSA290201500005I). The reports and assessments provide organizations with comprehensive, evidence-based information on common medical conditions and new health care technologies and strategies. They also identify research gaps in the selected scientific area, identify methodological and scientific weaknesses, suggest research needs, and move the field forward through an unbiased, evidence-based assessment of the available literature. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. To bring the broadest range of experts into the development of evidence reports and health technology assessments, AHRQ encourages the EPCs to form partnerships and enter into collaborations with other medical and research organizations. The EPCs work with these partner organizations to ensure that the evidence reports and technology assessments they produce will become building blocks for health care quality improvement projects throughout the Nation. The reports undergo peer review and public comment prior to their release as a final report. AHRQ expects that the EPC evidence reports and technology assessments, when appropriate, will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. If you have comments on this evidence report, they may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857, or by email to [email protected] Gopal Khanna, M.B.A. Arlene Bierman, M.D., M.S. Director Director Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Director David Niebuhr, M.D. Evidence-based Practice Center Program Task Order Officer Center for Evidence and Practice Improvement Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Elise Berliner, Ph.D. Director, Technology Assessment Program Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality v Acknowledgments The authors gratefully acknowledge the following individuals at ECRI Institute for their contributions to this project: Katherine Donahue, Helen Dunn, Eileen Erinoff, Gina Giradi, Kariann Hudson, Janice Kaczmarek, Laura Koepfler, Jennifer Maslin, and Michael Phillips. Key Informants In designing the study questions, the EPC consulted a panel of Key Informants who represent subject experts and end-users of research. Key Informant input can inform key issues related to the topic of the technical brief. Key Informants are not involved in the analysis of the evidence or the writing of the report. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual Key Informants. Key Informants must disclose any financial conflicts of interest greater than $5,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who provided input to this report follows: Sue Bale, OBE, FRCN, Ph.D., BA, RGN, NDN, RHV, PG Dip, Dip Nursing Director of Research and Development Aneurin Bevan University Health Board President and Journal Editor European Wound Management Association Wales, UK Barbara Bates-Jensen, Ph.D., RN, WOCN, FAAN* Professor
Load more

Recommended publications
  • Wound Bed Preparation: TIME in Practice
    Clinical PRACTICE DEVELOPMENT Wound bed preparation: TIME in practice Wound bed preparation is now a well established concept and the TIME framework has been developed as a practical tool to assist practitioners when assessing and managing patients with wounds. It is important, however, to remember to assess the whole patient; the wound bed preparation ‘care cycle’ promotes the treatment of the ‘whole’ patient and not just the ‘hole’ in the patient. This paper discusses the implementation of the wound bed preparation care cycle and the TIME framework, with a detailed focus on Tissue, Infection, Moisture and wound Edge (TIME). Caroline Dowsett, Heather Newton dependent on one another. Acute et al, 2003). Wound bed preparation wounds usually follow a well-defined as a concept allows the clinician to KEY WORDS process described as: focus systematically on all of the critical Wound bed preparation 8Coagulation components of a non-healing wound to Tissue 8Inflammation identify the cause of the problem, and Infection 8Cell proliferation and repair of implement a care programme so as to Moisture the matrix achieve a stable wound that has healthy 8Epithelialisation and remodelling of granulation tissue and a well vascularised Edge scar tissue. wound bed. In the past this model of healing has The TIME framework been applied to chronic wounds, but To assist with implementing the he concept of wound bed it is now known that chronic wound concept of wound bed preparation, the preparation has gained healing is different from acute wound TIME acronym was developed in 2002 T international recognition healing. Chronic wounds become ‘stuck’ by a group of wound care experts, as a framework that can provide in the inflammatory and proliferative as a practical guide for use when a structured approach to wound stages of healing (Ennis and Menses, managing patients with wounds (Schultz management.
    [Show full text]
  • Understand Your Chronic Wound
    Patient Information Leaflet Understanding your Chronic Wound Dressings, management and wound infection In this leaflet Health Care Professional (HCP) refers to any member of the team involved in your wound care. This can include treatment room or practice nurse, community, ward or clinic nurse, GP or hospital doctor, podiatrist etc. Chronic Wounds and Dressings What is a Chronic wound? A wound with slow progress towards healing or shows delayed healing. This may be due to underlying issues such as: • Poor blood flow and less oxygen getting to the wound • Other health conditions • Poor diet, smoking, pressure on the wound e.g. footwear/seating. Can my wound be left open to the air? No, the evidence shows that wounds heal better when the surface is kept moist (not too wet or dry). The moisture provides the correct environment to aid your wound to heal. Does my dressing need changed daily? Not usually, your HCP will explain how often it needs changed. This will depend on the level of fluid leaking from your wound. Some dressings can be left in place up to a week. Most wounds have a slight odour, but if a wound smells bad it could be a sign that something is wrong. See section on wound infection. Your dressing may indicate that it needs changed when the dark area in the centre gets close to the edge of the dressing pad. The dark area is fluid from your wound, this is normal. It will be dry to touch. Let your HCP know if your dressing needs changed before your next visit or appointment is due.
    [Show full text]
  • Ultra Pure Collagen Regenerative Medicine
    ENG Ultra pure collagen Regenerative medicine Because we are committed to limiting uncertainty, Specifications Integra continues to develop new products in regenerative technology. • An established product line with proven results. • Outstanding safety profile. • Integra LifeSciences has leveraged over 30 years of science and innovation in the development of • Implanted in over 900 000 patients. collagen technology. • Integra LifeSciences’ extensive collagen purification process, advanced bio-engineering proficiency, and manufacturing experience add value to our products designed for protection, regeneration and repair of human tissue in various clinical applications. • Ultra Pure Collagen™ is the base material of implants used successfully in over 10 million procedures worldwide. • Ultra Pure Collagen™ has been used in general surgery, burn surgery, neurosurgery, plastic and reconstructive surgery, peripheral nerve/tendon surgery & orthopedic surgery. Products for sale in Europe, Middle-East and Africa only Ultra pure collagen Regenerative medicine How was Integra LifeSciences’ Collagen Matrix Created? For over thirty years, Integra LifeSciences has been a leader in developing and manufacturing high quality collagen implants. In the early 1970’s, John F. Burke, MD, chief of Trauma Services at Massachusetts General Hospital and Shriners Burns Institute, identified the need to improve skin restoration of severely burned patients. While patient related donor skin was an option, immunorejection was a critical issue. Dr. Burke theorized that an artificial means to cover the skin might offer positive results without the potential for donor skin rejection. Dr. Burke collaborated with Dr. Ioannas Yannas, a professor What Makes Integra LifeSciences’ Collagen at MIT with a specialization in material sciences and Unique? physical chemistry, to develop a biocompatible product to improve wound healing.
    [Show full text]
  • Guideline: Wound Bed Preparation for Healable and Non Healable Wounds
    British Columbia Provincial Nursing Skin and Wound Committee Guideline: Wound Bed Preparation for Healable and Non Healable Wounds Developed by the BC Provincial Nursing Skin and Wound Committee in collaboration with Wound Clinicians from: / TITLE Guideline: Wound Bed Preparation for Healable and Non-Healable Wounds in Adults & Children1 Practice Level Nurses in accordance with health authority and agency policy. Conservative sharp wound debridement (CSWD) is a restricted activity according to the Nurse’s (Registered) and Nurse Practitioner Regulation. 2 CRNBC states that registered nurses must successfully complete additional education and follow an established guideline when carrying out CSWD. Biological debridement therapy is a restricted activity according to the Nurse’s (Registered) and Nurse Practitioner Regulation. 3 CRNBC states that registered nurses must follow an established guideline when carrying out biological debridement. Clients 4 with wounds needing wound bed preparation require an interprofessional approach to provide comprehensive, evidence-based assessment and treatment. This clinical practice guideline focuses solely on the role of the nurse, as one member of the interprofessional team providing care to these clients. Background Factors affecting wound healability include the presence of adequate circulation in the area of the wound, wound related factors such as the size and duration of the wound, the ability to treat the cause of the wound and the presence of risk factors impacting wound healing. While many wounds heal, others are determined to be non-healing or slow-to-heal based on the presence or absence of these factors. Wound healability must be determined prior to debridement and moist wound healing. Although wound healing normally occurs in a predictable fashion, wound healing trajectories can be heterogeneous and non- uniform resulting is delayed wound healing for some clients.
    [Show full text]
  • Wound Healing: a Paradigm for Regeneration
    SYMPOSIUM ON REGENERATIVE MEDICINE Wound Healing: A Paradigm for Regeneration Victor W. Wong, MD; Geoffrey C. Gurtner, MD; and Michael T. Longaker, MD, MBA From the Hagey Laboratory for Pediatric Regenerative Medi- CME Activity cine, Department of Surgery, Stanford University, Stanford, Target Audience: The target audience for Mayo Clinic Proceedings is primar- relationships with any commercial interest related to the subject matter ily internal medicine physicians and other clinicians who wish to advance of the educational activity. Safeguards against commercial bias have been CA. their current knowledge of clinical medicine and who wish to stay abreast put in place. Faculty also will disclose any off-label and/or investigational of advances in medical research. use of pharmaceuticals or instruments discussed in their presentation. Statement of Need: General internists and primary care physicians must Disclosure of this information will be published in course materials so maintain an extensive knowledge base on a wide variety of topics covering that those participants in the activity may formulate their own judgments all body systems as well as common and uncommon disorders. Mayo Clinic regarding the presentation. Proceedings aims to leverage the expertise of its authors to help physicians In their editorial and administrative roles, William L. Lanier, Jr, MD, Terry L. understand best practices in diagnosis and management of conditions Jopke, Kimberly D. Sankey, and Nicki M. Smith, MPA, have control of the encountered in the clinical setting. content of this program but have no relevant financial relationship(s) with Accreditation: College of Medicine, Mayo Clinic is accredited by the Accred- industry. itation Council for Continuing Medical Education to provide continuing med- The authors report no competing interests.
    [Show full text]
  • Development of Acellular Dermal Matrix from Skin of Different Species of Animals Using Biological Detergents and Enzymes Combinations
    Central JSM Burns and Trauma Bringing Excellence in Open Access Research Article *Corresponding author Naveen Kumar, Division of Surgery, Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, Pin: 243122, Development of Acellular India, Email: Submitted: 11 July 2016 Dermal Matrix from Skin of Accepted: 27 July 2016 Published: 29 July 2016 Copyright Different Species of Animals © 2016 Kumar et al. Using Biological Detergents and OPEN ACCESS Keywords • Acellular dermal matrix Enzymes Combinations • Decellularization • Rabbit Sanjay Purohit, Naveen Kumar*, Ashok Kumar Sharma, and Anil • Pig Kumar Sharma • Goat • Sheep Division of Surgery, Indian Veterinary Research Institute, India • Buffalo Abstract Decellularized tissues have been successfully used in a variety of tissue engineering/ regenerative medicine applications, and the decellularization methods vary as widely as the tissues of interest. The efficiency of cell removal from a tissue is dependent on the origin of the tissue and the specific physical, chemical, and enzymatic methods that are used. Each of these treatments affect the biochemical composition, tissue ultrastructure, and mechanical behavior of the remaining extracellular matrix (ECM) scaffold, which in turn, affect the host response to the material. We have optimized the protocols for making acellular dermal matrix from rabbit, pig, goat, and sheep and buffalo skin using different combinations of ionic and non-ionic biological detergents. INTRODUCTION Any processing step intended to remove cells will alter the native three-dimensional architecture of the ECM. The most Biologic scaffolds derived from decellularized tissues and commonly utilized methods for decellularization of tissues involve organs have been successfully used in both pre-clinical animal a combination of physical and chemical treatments.
    [Show full text]
  • Reactive Oxygen Species (ROS)
    EuropeanN Bryan etCells al. and Materials Vol. 24 2012 (pages 249-265) Reactive DOI: 10.22203/eCM.v024a18oxygen species in inflammation and ISSN wound 1473-2262 healing REACTIVE OXYGEN SPECIES (ROS) – A FAMILY OF FATE DECIDING MOLECULES PIVOTAL IN CONSTRUCTIVE INFLAMMATION AND WOUND HEALING Nicholas Bryan1*, Helen Ahswin2, Neil Smart3, Yves Bayon2, Stephen Wohlert2 and John A. Hunt1 1Clinical Engineering, UKCTE, UKBioTEC, The Institute of Ageing and Chronic Disease, University of Liverpool, Duncan Building, Daulby Street, Liverpool, L69 3GA, UK 2Covidien – Sofradim Production, 116 Avenue du Formans – BP132, F-01600 Trevoux, France 3Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK Abstract Introduction Wound healing requires a fine balance between the positive The survival and longevity of any animal requires an active and deleterious effects of reactive oxygen species (ROS); vigilant set of defence mechanisms to combat infection, a group of extremely potent molecules, rate limiting in efficiently repair damaged tissue and remove debris successful tissue regeneration. A balanced ROS response associated with apoptotic/necrotic cells. Compromised will debride and disinfect a tissue and stimulate healthy tissue rapidly results in decreased mobility, organ failures, tissue turnover; suppressed ROS will result in infection hypovolaemia, hypermetabolism, and ultimately infection and an elevation in ROS will destroy otherwise healthy and sepsis. Therefore, mammals have evolved an array stromal tissue. Understanding and anticipating the ROS of physiological pathways and mechanisms that enable niche within a tissue will greatly enhance the potential to damaged tissue to return to a basal homeostatic state. In exogenously augment and manipulate healing. an ideal scenario this occurs without compromise of tissue Tissue engineering solutions to augment successful mechanics, scarring or incorporation of microbial material.
    [Show full text]
  • Post-Summer Skin Repair
    36 RIVIERA WELLNESS POST-SUMMER SKIN REPAIR Healthy, radiant skin begins from within season of summer indulgences, whe- Niacin (B3) is found in avocado and turkey and ther it be swimming in chlorinated pools, helps to speed up skin cell regeneration - essen- A several weeks of rosé wine, or too much tial for repairing sun damage, acne hyperpigmen- sun bathing, our skin can look a little worse for tation, and reduces the symptoms of rosacea. wear. Once the summer holidays are over, we Niacin also helps your skin to retain moisture, so can be left with dehydrated and perhaps wrinkly make sure you are properly hydrated! Turkey has skin, sun damage, blocked pores and chapped 30 x more niacin than avocado. lips. So what´s the best remedy? Good nutrition Green Tea - Epigallocatechin gallate (EGCG), the can help protect the skin not just pre-holiday antioxidant found in green tea has been shown season, but also post-holiday to help the skin re- prevent genetic damage in skin cells exposed to pair. UV radiation. A large mug of green tea (250ml) The skin can be thought of as the window to ove- with a squeeze of fresh lemon juice to add the rall health of the body. It is the largest elimination vitamin C may help achieve that post-summer route for toxins, so an overworked liver from a glow! long summer of excesses can show up on the skin. The simplest step to a fresher complexion DON´T FORGET is to address water intake. Well-hydrated skin LIFESTYLE FACTORS! looks plump and less wrinkled.
    [Show full text]
  • The Role of Antioxidants on Wound Healing: a Review of the Current Evidence
    Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 15 July 2021 doi:10.20944/preprints202107.0361.v1 Review THE ROLE OF ANTIOXIDANTS ON WOUND HEALING: A REVIEW OF THE CURRENT EVIDENCE. Inés María Comino-Sanz 1*, María Dolores López-Franco1, Begoña Castro2, Pedro Luis Pancorbo-Hidalgo1 1 Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén (Spain); [email protected] (IMCS); MDLP ([email protected]); PLPH ([email protected]). 2 Histocell S.L., Bizkaia Science and Technology Park, Derio, Bizkaia (Spain); [email protected] * Correspondence: [email protected]; Tel.: +34-953213627 Abstract: (1) Background: Reactive oxygen species (ROS) play a crucial role in the preparation of the normal wound healing response. Therefore, a correct balance between low or high levels of ROS is essential. Antioxidant dressings that regulate this balance is a target for new therapies. The pur- pose of this review is to identify the compounds with antioxidant properties that have been tested for wound healing and to summarize the available evidence on their effects. (2) Methods: A litera- ture search was conducted and included any study that evaluated the effects or mechanisms of an- tioxidants in the healing process (in vitro, animal models, or human studies). (3) Results: Seven compounds with antioxidant activity were identified (Curcumin, N-acetyl cysteine, Chitosan, Gallic Acid, Edaravone, Crocin, Safranal, and Quercetin) and 46 studies reporting the effects on the healing process of these antioxidants compounds were included. (4) Conclusions: These results highlight that numerous novel investigations are being conducted to develop more efficient systems for wound healing activity. The application of antioxidants is useful against oxidative damage and ac- celerates wound healing.
    [Show full text]
  • Hesitant Steps from the Artificial Skin to Organ Regeneration
    Hesitant steps from the artificial skin to organ regeneration The MIT Faculty has made this article openly available. Please share how this access benefits you. Your story matters. Citation Yannas, Ioannis V. “Hesitant Steps from the Artificial Skin to Organ Regeneration.” Regenerative Biomaterials (June 26, 2018). As Published http://dx.doi.org/10.1093/RB/RBY012 Publisher Oxford University Press (OUP) Version Final published version Citable link http://hdl.handle.net/1721.1/120040 Terms of Use Creative Commons Attribution 4.0 International license Detailed Terms https://creativecommons.org/licenses/by/4.0/ Regenerative Biomaterials, 2018, 189–195 doi: 10.1093/rb/rby012 Advance Access Publication Date: 26 June 2018 Review Hesitant steps from the artificial skin to organ regeneration Ioannis V. Yannas* Downloaded from https://academic.oup.com/rb/article-abstract/5/4/189/5045640 by MIT Libraries user on 14 January 2019 Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA *Correspondence address. Department of Mechanical Engineering, Massachusetts Institute of Technology, Room 3-332, 77 Mass. Ave., Cambridge, MA 02139-4307, USA. E-mail: [email protected] Received 7 May 2018; accepted on 10 May 2018 Abstract This is a historical account of the steps, both serendipitous and rational, that led my group of stu- dents and colleagues at MIT and Harvard Medical School to discover induced organ regeneration. Our research led to methods for growing back in adult mammals three heavily injured organs, skin, peripheral nerves and the conjunctiva. We conclude that regeneration in adults is induced by a modification of normal wound healing.
    [Show full text]
  • Skin Resurfacing for the Burned Patient
    00. ם NEW DIRECTIONS IN PLASTIC SURGERY, PART II 0094–1298/02 $15.00 SKIN RESURFACING FOR THE BURNED PATIENT Ryan A. Stanton, MD, and David A. Billmire, MD The ultimate goal and eventual reward in factory quality of life and adapt a functional treating severely burned patients is the estab- postburn lifestyle. A rough indicator of indi- lishment of a protective barrier from the out- vidual psychologic rehabilitation is reflected side world. Skin resurfacing for the burned by employment status. Patients who return to patient has made large strides since the mid- work after burn injury have less behavioral twentieth century. Improvements in resuscita- avoidance, higher self esteem, and greater at- tion, management of inhalation injuries, and tention to goals. It has been shown that the other advances in critical care are responsible most significant predictors of return to work for survival rates in burned patients nearly are involvement of the hand, grafting, size of doubling since the 1950s, increasing by al- burn, and age. Patients younger than 45 have most 1% each year.49, 57 Several factors have a higher return to work rate.74 The care of a contributed extensively to the evolution of severely burned patient requires the infra- clinical burn care, including a better under- structure of a dedicated burn center with in- standing of the critical need for adequate terdisciplinary involvement of nursing, coun- fluid resuscitation immediately postburn, seling, group therapy, and occupational and prophylaxis against wound sepsis and its physical therapy. Interventions designed to complications, the importance of adequate aid adjustment, work hardening, and other nutritional support, burn pathophysiology rehabilitative services and marital and family and its inflammatory mediators, management therapy are also important.
    [Show full text]
  • Sweat Glands • Oil Glands • Mammary Glands
    Chapter 4 The Integumentary System Lecture Presentation by Steven Bassett Southeast Community College © 2015 Pearson Education, Inc. Introduction • The integumentary system is composed of: • Skin • Hair • Nails • Sweat glands • Oil glands • Mammary glands © 2015 Pearson Education, Inc. Introduction • The skin is the most visible organ of the body • Clinicians can tell a lot about the overall health of the body by examining the skin • Skin helps protect from the environment • Skin helps to regulate body temperature © 2015 Pearson Education, Inc. Integumentary Structure and Function • Cutaneous Membrane • Epidermis • Dermis • Accessory Structures • Hair follicles • Exocrine glands • Nails © 2015 Pearson Education, Inc. Figure 4.1 Functional Organization of the Integumentary System Integumentary System FUNCTIONS • Physical protection from • Synthesis and storage • Coordination of immune • Sensory information • Excretion environmental hazards of lipid reserves response to pathogens • Synthesis of vitamin D3 • Thermoregulation and cancers in skin Cutaneous Membrane Accessory Structures Epidermis Dermis Hair Follicles Exocrine Glands Nails • Protects dermis from Papillary Layer Reticular Layer • Produce hairs that • Assist in • Protect and trauma, chemicals protect skull thermoregulation support tips • Nourishes and • Restricts spread of • Controls skin permeability, • Produce hairs that • Excrete wastes of fingers and supports pathogens prevents water loss provide delicate • Lubricate toes epidermis penetrating epidermis • Prevents entry of
    [Show full text]