Total care of a wound often goes beyond the actual closure of the affected area. Over many areas the primary goal is for the successful closure of an open wound or lesion. When this occurs the treatment is considered successful, and the patient is simply given management techniques to care for the problem on their own. However, often lesions over movable areas, or areas referred to as joints, when closed need to maintain a normal level of elasticity. These areas are of specific concern to patients' and their care givers as these areas need to move as a part of normal every day life. Obviously, the normal elastic nature of tissue is altered (reduced). When this occurs the tissue is much more susceptible to re-injury, and further skin breakdown. The normal flexion/extension movement of a joint (knee, elbow) will cause stretching and contraction of the surrounding tissue in question. With time there is a likelihood of reopening of that area. Simply because of the constant need of the tissue to move which has lost its normal elastic properties.
In many cases, physical therapy intervention can be valuable to the total rehabilitation care of this patient. Soft tissue mobilization and transverse friction massage techniques are often performed which can alleviate the abnormal scaring and maximize the return of elasticity. Therapy care can also reassure the normal joint range of movement. Any time a joint is restricted in movement, either secondary to painful and/or a structural problem, joint capsular tightness (adhesive capsulitis) is a common secondary problem that can further limit the normal joint mobility.
Wound areas of the tibial tuberosity, olecronon process of the elbow, and the malleoli of the ankle are common areas of concern. Perhaps lesions that occur in these areas can benefit from the consult of a physical therapist, especially from one who is familiar with the subtleties of wound care and the healing process. Sometimes, it is valuable for physical therapy intervention during the healing process, as well as in the post healing process. To understand the mechanics of scaring one could appreciate the importance of maintaining proper soft tissue elasticity, and the normal joint range of movement.
In all cases, therapists are trained in the education of patients on how to prevent abnormal or excessive pressure to affected areas, and can often advise patient's on the proper padding, or cushioning, that may be available to assist in maintaining the skin's integrity. Therapy can work in conjunction with nursing, physicians, or other patient support people that together look after the total management of patient care.
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