5th Annual GWEP Wound Care Workshop Merce Veneracion

1. Role of Rehabilitation in
Wound Management
By: Merce Veneracion, PT,CCI

2. Something is
not right !

3. The Team Approach
Identifying Roles

4. History
• History of PT and wound care
• Scope of practice
• Focus is prevention , positioning and
intervention

5. Prevention
Risk Factor Assessment
A. Conduct a structured risk assessment
B. Use a structured approach to risk assessment that
includes assessment of activity, mobility and skin
status.
C. Consider the impact of the following factors on an
individual’s risk of pressure injury development
such as perfusion and oxygenation, poor
nutritional status and increased skin moisture .

6. Mechanical Forces
Avoid :
• Pressure
• Shear
• Friction
Goal :
• Pressure Redistribution
Lateral Force
Perpendicular
Opposite Direction

7. Prevention
A. Consider the potential impact of the following factors on
an individual’s risk of pressure injury development such
as :
• increased body temperature
• advanced age
• sensory perception
• hematological measures and
• general health status.

10. Common Areas of Pressure Points

12. Prevention
Skin Tissue Assessment
A. Conducting Skin and Tissue Assessment
B. Preventive skin care
• Avoid positioning the individual on an area where erythema
whenever possible
• Keep the skin clean and dry
• Do not massage or vigorously rub skin that is at risk of pressure
ulcer
• Develop and implement an individualized continence management
plan
• Protect the skin from exposure to excessive moisture with a barrier
product to reduce the pressure damage
• Consider using a skin moisturizer to hydrate skin

13. Prevention
Emerging Therapies for Prevention of Pressure Injury
• Microclimate Control
• Prophylactic Dressings
• Fabrics and Textile
Consider using silk like fabrics instead of cotton blend
fabrics to reduce shear and friction.
• Electrical Stimulation for prevention
ES induces intermittent muscle contractions and reduces
the risk of pressure ulcer development in at risk body parts
especially in individuals with spinal cord injury (SCI)

14. Prevention and Treatment
Repositioning and Early Mobilization
• Reposition all individuals at risk of or with existing
pressure ulcer
• Consider the support surface
Repositioning Frequency
• Establish a turning frequency based on the characteristics
of the support surface and the individual’s response

15. Prevention and Treatment
Repositioning Techniques
• Pressure should be relieved or redistributed
• Avoid positioning the individuals on bony prominences
• Avoid subjecting the skin to pressure and shear forces
• Use manual handling aids to reduce friction and shear
• Use mechanical lifts when available to transfer
• Avoid positioning the individual directly into medical
devices ,such as tubes etc.
• Do not leave individual directly on a bed pan longer than
necessary

16. Prevention and Treatment
Repositioning Individuals in Bed
• Use 30 degrees tilted side lying position
• Limit head of the bed elevation to 30
degrees unless contraindicated by medical
condition.

17. Prevention and Treatment
Repositioning in Seated Position
• Wheelchair and seating mobility
assessment and intervention is necessary
• Limit the time an individual spends seated
in a chair without pressure relief

18. Prevention and Treatment
Support Surfaces
Specialized Devices for Pressure Redistribution:
• Mattress : overlay, low air loss , air fluidized ,
alternating pressure.
• Wheelchair Cushions : foam, gel, air flotation
and urethane honeycomb cushions.
• Additional devices such as positioners, braces,
splints , lifts , special sliding board and wedges.

19. Positioning Devices
• Do not use ring or donut shaped devices
• Synthetic sheepskin pads
• Intravenous fluid bags and water filled gloves
to elevate heels

20. Reference:
National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific
Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily
Haesler(Ed) . Cambridge Media : Osborne Park, Australia ; 2014

21. –Merce Veneracion
“Every step is a building block , never stop learning”