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 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...