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August 8, 2012

Spray-on Skin

I see all the time in the hospital: people have skin problems on their lower legs. What does this have to do with physical therapy, you might ask? When I do a physical therapy evaluation, I have to test sensation, I have to test lower extremity strength and during those tests, I have to come in contact with the legs and ankles.

Nothing raises the "eeew" factor in me more (except maybe vomit) than coming away from a sensation test, and realizing my fingers are wet. Or, maybe, as I conduct a manual muscle test, there is a telltale "squish" under my hand as I apply pressure. This is why it is so important to wear gloves - not only for the patient's safety and the prevention of spreading infection, but for my safety from exposure to bodily fluids, as well.

So what is going on with these people that the skin on their legs is in such poor condition? Venous stasis is a condition where the circulation in the legs is compromised, resulting in excess fluid build up in the legs. Congestive heart failure also causes the lower legs to swell. I often see cellulitis, a painful inflammatory condition, is an infection of the connective tissue under the skin. Patients with sickle cell anemia have poor circulation because of a genetic deformity in the shape of the actual blood cells. Many more conditions exist that compromise the circulation to lower legs, either preventing fresh healthy blood getting down to the legs or getting excess fluid out of the legs.

What is exciting to me is the development of "spray-on" skin. This invention, while currently showing preliminary benefits, would allow application of skin cells in a spray solution that would give instructions to surrounding cells (they do that naturally when present in the bed of a wound) for granulation and wound closure. Currently designed for slow-healing or non-healing wounds, for larger wounds, this invention could prevent the need for skin grafting, which essentially creates another wound that the body has to heal.

In Physical Therapy therapy, it is possible to become a wound care specialist. In our hospital, we have nurses who specialize in wound care. My exposure to wound care in physical therapy came in the nursing home where some residents developed pressure ulcers. Another arena for wound care exists in trauma centers for accident and burn patients. Looking into the future, if this technique proves to be safe and effective, spray on skin could revolutionize the standard of care for burn patients.

Posted by linda at August 8, 2012 6:38 AM

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