Page 22 - Mobility Management, July/August 2022

ATP Series
Wound Care & Seating
but it would also include scar tissue because of all the things
we know about scar tissue. Not only is the chemical makeup different, but there are also adhesions and skin contractures, and adhesions that happen under the skin. So as that scar is making all of those connections on the outside that we see, it’s also on that underside surface, and those can become very adhered to the other tissues. Even if that area could have handled pressure before, it’s different now. That’s where knowing the [patient’s] history comes in. That will tell us the makeup of [the affected skin and tissues], but also how they relate to the other tissues. The tissues are not as mobile. Our skin is made to flex and move and shift, and it can’t do that anymore.”
Giles said she has contacted physicians before flap surgeries to emphasize the importance of maintaining weight-bearing areas. “If I’ve got somewhere where I normally want to apply a lot of pressure [but that area is compromised], we might apply pressure to the posterior buttocks area, above those landmarks,” she said. “A lot of times in the old days, flap surgeries would include this arch, kind of up over the hips. That was very dangerous for us, because we want to load there. So we might have to look at, again, avoiding that, even though it’s not a bony prominence. It’s now part of the scar tissue area. And that would be much less
tolerant to load before it would break down. [Compromised skin] may be in one of our traditional, more tolerant areas, and we really have to watch out for that.
“I’ve told physicians, ‘Please, we’re at a place where this guy is barely able to sit. We’ve had multiple scar tissues, multiple episodes, years in bed. The only treatment strategy we have left to safely sit is an orthotic concept. And if I’ve got a scar in these two places, I’m not going to be able to use that strategy either.’ So we have worked with them to strategically bring those scars elsewhere, to preserve the surfaces of our orthotic kind of concept.”
Giles also advocates for tissue mobility after surgery. “Physical therapists do soft tissue mobility,” she noted. “We do scar mobili- zation. It’s important that once it’s healed and once the physician says it’s fine, there is a place and time in the healing process where we should be making sure that tissue moves to its best ability. Because that’s like how the skin used to be, and where it functions the best. And so we can make a difference [by incorpo- rating soft tissue mobility strategies].
“We could have a much better relationship with wound care professionals in order to address some of those things that could make the situation much better for our sitting population.” m
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