Foreword: A Recap on Basics xiii

        Santos F. Martinez

        Preface: We Take on the Business xv

        Xiaohua Zhou and Cassandra Buchanan Renfro

        General Skin Issues in the Adult Rehabilitation Population 745

        Cheryl Anderson Lane and Karion Gray Waites
        The skin’s ability to function optimally is compromised when skin integrity is altered. The goals for skin management during rehabilitation include maintaining skin integrity, avoiding skin injury, providing early intervention, and comprehensive education for long-term skin management. Assessment of the whole patient as well as the skin is essential. Common issues seen in rehabilitation such as aging skin, incontinence dermatitis, intertrigo/yeast, surgical wounds, and pressure injuries are addressed.

        Considerations for Skin and Wound Care in Pediatric Patients 759

        Elizabeth Day Dechant
        Wound care in pediatrics is a specialized area of practice that requires consideration of factors unique to pediatric patients. With a slowly growing body of evidence to support treatment choices in this vulnerable population, it is critical that wound experts develop and oversee evidence-based skin care regimens and wound treatment practices. This article discusses some common issues in pediatric skin and wound care. A successful prevention or treatment plan is collaborative and addresses the developmental, physiologic, and social needs of the pediatric patient and their family. Conflicting plans of care and limited resources are frequent challenges.

        Comprehensive Management of Pressure Injury: A Review 773

        Lyndsay A. Kandi, India C. Rangel, Nellie V. Movtchan, Nicole R. Van Spronsen, and Erwin A. Kruger
        Pressure injuries (PIs) are a spectrum of localized tissue destruction that develops most often at a bony prominence. PIs are the result of a combination of extrinsic (eg, pressure, shear, friction, and moisture) and intrinsic (nutritional status, spasticity, decreased sensation, and vascular disease) factors. Given their complex etiology, management of PIs requires a multidisciplinary approach from a team of health care professionals. After addressing both extrinsic and intrinsic factors, local wound care is generally recommended for stages 1 to 2 PIs and surgical intervention for stages 3 to 4.

        Seating and Wheeled Mobility Clinicians Contribute to the Wound Care Team 789

        Cathy H. Carver, Stacey Mullis, and Kathleen H. Fitzgerald
        Many know that the wound care team consists of physicians and nurses with specialized training. Many may not know of physical therapists (PT) or occupational therapists (OT) with training in seating and wheeled mobility who address skin injuries in people who are full-time wheelchair users. PTs/OTs address the fit and use of their wheelchair to their body and look at their daily function while looking for causes of skin injury otherwise not seen and can help prevent them in the future. Therefore, this makes PTs and OTs with this expertise a valuable part of the wound care team.

        Establishing a Comprehensive Wound Care Team and Program 805

        Scott Schubert, George Marzloff, Stephanie Ryder, Kaila Ott, Jennifer Hutton, and Mallory Becker
        A comprehensive, interdisciplinary wound care team is of great importance to the management of acute, chronic, and recurrent wounds. This management functions best for the patient when all members of the team are in regular discussion regarding the wound care plan, providing more efficient and timelier patient-centered care. This article reviews the roles of different disciplines in the management of wounds. These disciplines include rehabilitation physicians, wound care nurses, registered nurses and certified nursing assistants, surgical teams, specialists of infectious diseases and mental health, dieticians, and patients and caregivers. A case study is also provided.

        Nutrition and Wound Care 811

        Nancy Munoz, Mary Litchford, and Emanuele Cereda
        Nutrition is an important component of health and well-being. A compromised nutritional status has been linked to increased risk for wound development, difficulty managing, and decreased wound healing rate. Malnutrition contributes to an immunocompromised system, reduced collagen synthesis, and diminished tensile strength during the wound healing process. This is why assessment and optimization of nutritional status should be incorporated as part of a comprehensive treatment plan for individuals with wounds. The nutrition care plan must include individualized interventions designed to address the individual’s nutrition diagnosis. This article reviews the role of nutrition in wound prevention, management, and treatment.

        The Role of Hyperbaric Oxygen Therapy for the Treatment of Wounds 823

        Merrine Klakeel and Karen Kowalske
        Hyperbaric oxygen (HBO) is a Medicare-approved treatment for a variety of diagnoses including chronic nonhealing wounds and radiation necrosis. Hyperbaric oxygen therapy (HBOT) uses high pressures to saturate hemoglobin and dissolve oxygen into blood plasma to create a hyperoxemic environment to nourish and reverse local tissue injury caused by ischemia and hypoxemia. HBOT is expensive and not without risk; therefore, the underlying etiology for the presenting diagnosis must be adequately treated before starting HBO as an adjunct therapy to get maximum benefit.

        A Stepwise Approach to Nonoperative and Operative Management of the Diabetic Foot Ulceration 833

        Katherine M. Raspovic, Matthew J. Johnson, and Dane K. Wukich
        There are multiple factors that lead to the development of the diabetic foot ulceration (DFU). The ultimate goal when treating DFU is to prevent amputation. Initial therapy should include debridement, maintaining a healthy wound environment, and offloading. In the setting of infection or a nonhealing DFU, surgical intervention may be necessary. The goals of this article are to discuss the key aspects of the initial examination, standard nonoperative treatment, and the operative treatment options for patients with DFU.

        Shoe and Bracing Considerations for the Insensate Foot: Shoe considerations for diabetic foot 845

        Daniel Moon, Ning Cao, and Bianca Martinez
        Diabetic individuals with peripheral neuropathy are at risk for the development of foot ulcers due to musculoskeletal abnormalities and abnormal loading in the gait cycle leading to elevated plantar pressures. To prevent diabetic foot ulcers, practitioners should regularly screen patients for the presence of neuropathy as well as neuroarthropathies and prescribe the appropriate shoes and orthotics based on the best available clinical evidence. Although not widely available, there is potential for data-driven customization of orthotics and shoe wear based on plantar pressure data to prevent the development of diabetic foot ulcers more effectively, and ultimately prevent lower limb amputations.

        Post Amputation Skin and Wound Care 857

        Michael Kwasniewski and Danielle Mitchel
        Management of the post amputation wound and skin is an individualized and evolving process. Although no consensus recommendations are available, optimal wound healing occurs with a dressing that provides the appropriate level of moisture, and management of edema, and can assist in contracture prevention and limb protection. Management of comorbid conditions and complications that might impede healing, as well as nutritional optimization help promotes wound closure. A faster time to heal increases the opportunity and likelihood of prosthetic fitting and use, working toward improved functional independence.

        An Introduction to Burns 871

        Sarah Ashouri
        Burn injuries are often devastating and result in lifelong sequelae such as scar contracture, pain, and disfiguration with care beginning at the time of injury and extending through discharge to outpatient care where the largely becomes scar and mobility optimization. The Physical Medicine and Rehab (PM&R) team are integral in improving the quality of life of burn patients during and following recovery. This article functions to provide a brief overview of burn care to the non-burn specialized audience, discuss select advanced burn interventions, and provide an introduction to the role of PM&R in the life of a burn patient.

        Current Concepts in Surgical Management of Lymphedema 885

        Rebecca Knackstedt and Wei F. Chen
        Video content accompanies this article at
        The decision on whom to offer surgical interventions for lymphedema requires collaboration and input from all involved specialists and should address patients’ expectations, invasiveness of procedures, and disease severity. There is no consensus on what constitutes success or failure of complex decongestive therapy and when to pursue surgical intervention. Surgery has the potential to fundamentally affect the pathophysiology of the disease state and can be a powerful tool when used correctly. The dogma of which surgery to offer for a given clinical situation has been undergoing revision and is an area of ongoing research.

        Emerging Technologies in the Wound Management Field 901

        George Marzloff, Stephanie Ryder, Jennifer Hutton, Kaila Ott, Mallory Becker, and Scott Schubert
        Technological advances are incorporated into wound care management to enhance prevention through specialty mattresses and pressure mapping, assessment using modern imaging, and treatment with dressings and active therapies. We review specific equipment and evidence-based practice in the context of managing pressure injuries in patients with spinal cord injury.