Pre Tibial Laceration Essay
Case Study of Pre-Tibial Laceration
I have chosen the injury known as ‘pre-tibial laceration for my case study. Pre-tibial lacerations or skin tears are acute wounds caused by trauma and most common in older people, pre-dominantly women. They can often develop into chronic wounds, involving necrosed tissue and become difficult to heal due to factors such as the patients age and other co-existing disease processes, also the pre-tibial region of the leg naturally has a poor vascular network. Most pre-tibial lacerations are caused by blunt trauma such as when the shin hits a step or the edge of a piece of furniture. This causes an oblique blow applying shearing forces to the soft tissue. The result is either a flap laceration or a linear laceration with undermining of one edge.
Predisposing factors
Pretibial injuries are predominantly found in older people as a consequence of several predisposing factors: 1. Aging skin 2. Falls (it is always important to determine the cause of the fall such as dizzy spells or cardiac arrhythmia). 3. Diabetes (consider the development of sensory neuropathy leading to falls as mobility is affected). 4. CVA/TIA reducing mobility 5. Neurological disease such as Parkinsons affecting mobility. 6. Anaemia which can cause …show more content…
dizzyness leading to a fall. 7. Oedema due to cardiac failure leading to venous disease and frailty of the skin.
Anatomy and Physiology
The skin is formed of two layers—the Epidermis, which is maily composed of dead epithelial cells and has no blood supply, and the Dermis which consists mainly of fibrous connective tissue and contains blood vessels, hair follicles, sweat and sebaceous glands,and sensory nerves.
These dermal structures facilitate perspiration, temperature regulation, protection against extremes of heat and cold, touch and sensory input, as well as tissue repair and maintenance (woodrow, 1998). There is also a reduction in the number of capillaries carrying blood to the tissues. Consequently, the number of cells in the dermis is reduced and it becomes thinner, meaning the skin is dryer and more prone to
injury. www.Enchanted learning.com
Presentation
The patient with a pretibial laceration can present with a wound in a wide spectrum in severity. There will be a history of blunt trauma to the affected area usually associated with a fall. The wound is often extremely painful and there can be varying degrees of haemhorrage. Typically there is an avulsion of part of the skin on the anterior aspect of the limb often exposing the underlying adipose tissue or bone. This skin flap can quickly die due to the circulatory disruption so careful management is important.
Summary for management
In the pre-hospital setting these wounds should be handled minimally. If there is a significant flap of skin hanging from the wound this should be carefully replace as close as possible into its original position. These skin tears are very delicate and should not have adhesive tapes or dressings applied. Non adhesive dressings applied are preferrable dampened with a sterile saline solution to help prevent the skin drying. Pain management is important and should be offered at the earliest possible convenience.
Woodrow P (1998) Physiological ageing: 1. Prof Nurse 13(8): 528-614
I have chosen the injury known as ‘pre-tibial laceration for my case study. Pre-tibial lacerations or skin tears are acute wounds caused by trauma and most common in older people, pre-dominantly women. They can often develop into chronic wounds, involving necrosed tissue and become difficult to heal due to factors such as the patients age and other co-existing disease processes, also the pre-tibial region of the leg naturally has a poor vascular network. Most pre-tibial lacerations are caused by blunt trauma such as when the shin hits a step or the edge of a piece of furniture. This causes an oblique blow applying shearing forces to the soft tissue. The result is either a flap laceration or a linear laceration with undermining of one edge.
Predisposing factors
Pretibial injuries are predominantly found in older people as a consequence of several predisposing factors: 1. Aging skin 2. Falls (it is always important to determine the cause of the fall such as dizzy spells or cardiac arrhythmia). 3. Diabetes (consider the development of sensory neuropathy leading to falls as mobility is affected). 4. CVA/TIA reducing mobility 5. Neurological disease such as Parkinsons affecting mobility. 6. Anaemia which can cause …show more content…
dizzyness leading to a fall. 7. Oedema due to cardiac failure leading to venous disease and frailty of the skin.
Anatomy and Physiology
The skin is formed of two layers—the Epidermis, which is maily composed of dead epithelial cells and has no blood supply, and the Dermis which consists mainly of fibrous connective tissue and contains blood vessels, hair follicles, sweat and sebaceous glands,and sensory nerves.
These dermal structures facilitate perspiration, temperature regulation, protection against extremes of heat and cold, touch and sensory input, as well as tissue repair and maintenance (woodrow, 1998). There is also a reduction in the number of capillaries carrying blood to the tissues. Consequently, the number of cells in the dermis is reduced and it becomes thinner, meaning the skin is dryer and more prone to
injury. www.Enchanted learning.com
Presentation
The patient with a pretibial laceration can present with a wound in a wide spectrum in severity. There will be a history of blunt trauma to the affected area usually associated with a fall. The wound is often extremely painful and there can be varying degrees of haemhorrage. Typically there is an avulsion of part of the skin on the anterior aspect of the limb often exposing the underlying adipose tissue or bone. This skin flap can quickly die due to the circulatory disruption so careful management is important.
Summary for management
In the pre-hospital setting these wounds should be handled minimally. If there is a significant flap of skin hanging from the wound this should be carefully replace as close as possible into its original position. These skin tears are very delicate and should not have adhesive tapes or dressings applied. Non adhesive dressings applied are preferrable dampened with a sterile saline solution to help prevent the skin drying. Pain management is important and should be offered at the earliest possible convenience.
Woodrow P (1998) Physiological ageing: 1. Prof Nurse 13(8): 528-614