Procedures and Tests (9)

• Diagnostic Procedures:

  • Mammography - a radiographic examination
  • mammogram - of the breast to detect abnormalities of breast tissue.
  • xeromammography - process to produce x-ray images on paper rather than on x-ray film
• Diagnostic Tests:

  • Allergic Testing - (2) Patch Test & Scratch Test
  • Cultures - (2) Gram Stains & Tzank Test
  • Biopsy - (4) Skin Biopsy, Shave Biopsy, Punch Biopsy, and Excision Biopsy
  • Smear Tests
• Patch test to identify allergy to such substance as dust, molds, and foods.

  A paper or gauze that has been saturated with a possible allergen (substance capable of producing an allergic reaction) is applied to the skin. If redness or swelling develops, the test is positive
• Scratch Test this test involves inserting small amounts of possible allergens on the skin surface and watching a sensitivity reaction.
• Cultures – is used to isolate and identify an infectious agent. In a culture, a sample tissue or fluid is placed in a jellylike medium that provides nutrients for microorganisms. If organism is present, it may multiply rapidly.
• Gram stains provides diagnostic information about which organism is causing an infection, A gram stains separates bacteria into 2 categories based on cell wall composition:

  • Gram-positive organisms retain crystal violet stain after decoloration.
  • Gram-negative organisms lose the violet stain but stain red with safranine.
• Tzanck test requires smearing a vesicular fluid or drainage from an (Zank) ulcer on a glass slide, then staining the slide with several chemicals. Herpes virus infection is confirmed by examining the fluid under microscope.
• A biopsy is the removal of tissue for microscopic examination. Types of biopsy used for skin disorders are:

  • Skin biopsy tests a small piece of tissue from a lesion suspected of malignancy or other disorder.
  • Shave biopsy cuts the lesion above the skin line, leaving the lower layers of dermis intact.
  • Punch biopsy removes an oval core from the center of a lesion.
  • Excision biopsy may remove an entire lesion that is small
• Smear Tests are somewhat less invasive method than biopsy. In this kind of test, cells are spread on a slide and studied under a microscope. In buccal smear test, cells are scraped from the inner surface of the cheek to detect hereditary abnormalities.
• Surgical and Therapeutic Procedures:

  • Skin Grafts
  • Biological Dressings
• Skin Grafts cover defects caused by burns, trauma, or surgery. They are used when primary closure of the skin is not possible or cosmetically acceptable, when the defect is on a weight-bearing surface, when primary closure would interfere with functioning and when a skin tumor is excised (cut out) and the site need to be monitored for recurrence.
• Types of skin grafts:

  • Split-thickness graft
  • Full-thickness graft
  • Composite grafts
  • Autologous graft or autograft
  • Isologous graft or isograft
• Skin graft

  A) Epidermis

  B) Split thickness

  C) Dermis

  D) Full thickness

  
• Biological Dressings function like skin grafts to ease pain and prevent infection and fluid loss. However, they are only temporary; eventually the body will reject them. If the wound has not healed, these dressings must be replaced with a graft of the patient’s own skin.
• Debridement is borrowed from the French and means to unbridle. It uses mechanical, chemical and surgical techniques to remove necrotic (dead) tissue from a wound. It is necessary to prevent infection and promote healing of burns and skin ulcers.
• Types of debridement:

  • Chemical debridement
  • Mechanical debridement
  • Surgical debridement
• Chemical debridement calls for special wound-cleaning beads or topical medications, which absorb drainage and debris from a wound. These agents absorb bacteria, reducing the risk of infection.
• Mechanical debridement uses dressings, irrigation, hydrotherapy (whirlpool bath) and bedside debridement to remove necrotic tissue. During bedside debridement, dead tissue is scraped off or cut away with a scalpel or scissors.
• Surgical debridement requires anesthesia and is usually reserved for burn patients or those with extremely deep or large ulcers.
• Types of biological dressings:

  • Homograft (allograft)
  • Heterograft (xenograft)
  • Amnion
  • Biosynthetic grafts
• Homograft (allograft) - use to débride wounds, protect new tissue growth. Allo is a Greek word meaning “deviating from normal” and homo refers to human beings.
• Heterograft (xenograft) – a graft harvested from animals. Used for the same purpose as homograft and is used to cover exposed tendons and burns that is slightly contaminated.
• Amnion – made from amnion and chorionic membranes (fetal membranes) used to protect burns and temporarily cover new tissue while waiting for autograft.
• Therapeutic Baths also known as balneotherapy, baths are used to treat many skin conditions, including psoriasis,eczema, exfoliative dermatitis, and bullous diseases that cause blisters.
• The 4 types of baths commonly used are:

  • antibacterial baths
  • colloidal baths
  • emollient baths
  • tar baths
• Antibacterial Baths - treat infected eczema, dirty ulcerations, and the runculosis.

  Ex. Acetic acid, hexachlorophene, potassium permanganate soaks, povidone iodine, aluminum acetate (Burow soaks)
• Colloidal Baths - Relieve itching and soothe irritated skin. Good for skin conditions such as atopic eczema.

  Ex. Colloidal Oatmeal, starch and baking soda.
• Emollient bath - Use bath oils and mineral oil to clean and hydrate the skin. For dry skin condition.
• Tar baths - Utilize special bath oils with tar and coal tar concentrate to treat scaly skin disorders. This bath loosens scales and relieves itching.
• Phototherapy – used to treat skin conditions by exposure to ultraviolet radiation, phototherapy slows the growth of epidermal cells, most likely by inhibiting the synthesis of deoxyribonucleic acid (DNA)

  Two ultraviolet lights are used: ultraviolet A (UVA) and ultraviolet B.
• Photochemotherapy – combines light with a drug called psoralen making skin more sensitive to UVA. Psoralen + UVA is also known as PUVA therapy.