Wound Glossary

Wound Terms, Definitions

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Wound Glossary

Postby patoco » Fri Jun 22, 2007 3:26 am

Wound Glossary

Pat O'Connor

Lymphedema People

http://www.lymphedemapeople.com

.............

ABPI: Ankle Brachial Pressure Index. A hand-held Doppler ultrasound test used to determine the presence and degree of peripheral arterial disease in patients with leg ulcers.

Abdominal wounds: sores from surgery on the front of the body between the chest and the pelvis.

Abrasion: Wearing away of the skin through some mechanical process (friction or trauma).

Abscess: a localized collection of pus and inflammation.

Absorptive Dressings: Products which absorb wound exudate and conform to wound surface This type of dressing is only suited to wounds with exudate. i.e. Calcium Alginate Dressings.

ACE inhibitors: medications that relax the arteries.

Acute Wound: Occurs traumatically, accidently or surgically. Healing progresses through wound healing phases without interruption.

Albumin: a form of protein.

Alginate: A dressing made from seaweed which can be composed of galuronic and mannuronic acid, with the proportions of these determining the gel forming properties of the final fibre. Best used in moderate to highly exuding wounds. If the wound bed is too dry the alginate will not gel and will adhere to the wound bed. Some alginates have haemostatic qualities.

Amputation: the surgical removal of a limb or appendage.

Angiogenesis: The generation and growth of new blood vessels. Provant has been shown to produce a number of positive biological effects, which may be associated with cellular activity leading to wound healing, such as angiogenesis.

Anemic: deficient in red blood cells, in hemoglobin, or in volume of blood.

Anesthesia: medical pain relief causing partial or total loss of sensation with or without loss of consciousness.

Angiogenesis: This occurs during the proliferative phase of healing when new blood vessels infiltrate the wound and capillaries are formed by endothelial budding.

Ankle-Brachial Indices (ABI): a test that measures blood pressure at the foot, ankle, calf, thigh.

Arterial ulcers: sores related to impaired blood flow through the arteries.

Atherosclerosis: hardening of the arteries due to plaque build-up.

Asepsis: The absence of bacteria. Safeguard to prevent introduction of organisms that cause infection.

Autolysis: The term used for the natural, spontaneous process of devitalised tissue being separated from viable tissue. Together with proteolytic enzymes, macrophage activity is thought to be responsible for autolysis.

Autolytic Debridement: Type of debridement that utilizes the body's own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough.

Bacteria: a common term for microscopic organisms; some bacteria can cause serious infections.

Bacteriostatic: An agent that is capable of inhibiting the growth or multiplication of bacteria.

Basic Metabolic Panel (BMP): a test to measure basic blood chemistry.

Bioengineered Tissue Constructs (Biological Devices): Artificially produced tissue constructs manufactured in the laboratory, which may consist of cells and/or other factors normally found in tissue.

Blisters: Collection of fluid under the epithelial layer, fluid may be clear or pink/red in colour.

Carbon-Silver dressing: Carbon dressing impregnated with Silver. Activated charcoal attracts and traps bacteria and odour. Silver kills bacteria. Both components are effective in wet or dry wounds.

Cardiologist: a physician who specializes in treating the heart and its diseases.

Cataracts: the milky clouding of the lens which prevents clear vision.

CBC with differential: a complete blood count.

Cellulitis: an inflammation or infection of cellular or connective tissue. Inflammation of the tissues presenting as oedema, redness, pain and heat, often with hardness of the tissues and a demarcation of the red area.

Chest X-ray: shows the size and shape of the heart, any fluid present, any abnormalities in the lungs, and the major blood vessels in the chest.

Chronic: of long duration; continuous; on-going
Coagulation profile: a test that measures the blood's ability to clot.

Chronic Wound: Wound that has failed to proceed through an orderly and timely process to healing.

Clean technique: involves using instruments/supplies which are not thoroughly sterilized (completely free of potentially infectious agents). Boxes of nonsterile gloves and gauze that comes many in a package are examples of “clean” supplies. These “clean” supplies are less expensive than “sterile” supplies. Appropriate use of clean technique can save valuable resources while not increasing the risk for infection.

Clean wound: a wound that is in the process of healing; usually it has a bed of healthy granulation tissue (see below) without overlying exudate or surrounding cellulitis.

Collagen: Main supportive protein of the skin.

Colonisation: Multiplication of micro-organisms without a corresponding host reaction.

Colonized: Bacteria which exist in an area (wound) in sufficient number to cause local or systemic signs and symptoms; not an infection.

Compression: Application of a bandage or stocking which provides sufficient pressure externally to relieve venous congestion and promote venous circulation.

Contact Dermatitis: Acute inflammation caused by external agents, toxicity or allergic reaction.

Contamination: Soiling by contact and introduction of micro-organisms.

Contraction: Pulling together of wound edges in healing process.

Creatinine: a chemical found in both urine and blood; elevated levels indicate impaired kidney function.

CT or CAT scan: computer assisted tomography, a non-invasive imaging procedure.

Dead Space: Any unfilled space in a cavity between the surface of tissue in a deep wound and the skin level.

Debridement: the surgical removal of foreign matter or dead tissue from a wound. This is the removal of devitalised and foreign matter from a wound. There are a number of methods including: sharp debridement; dressings which have properties within them which assist with the removal of devitalised tissue; larvae and the VAC.

Decubitus: Act of lying down; ulcer caused by pressure (bedsore) or bedsore. The more common and more modern term is pressure sore and pressure ulcer.

Dehisce: To split apart or open as in the abnormal spontaneous reopening of a surgical abdominal wound.

Dehiscence: Separation of wound edges.

Delayed primary closure: initially treating the wound with dressing changes, and then, usually after 48 hours when the swelling has diminished and there are no signs of infection, suturing the wound closed.

Denude: Loss of epidermis.

Dependent Pain: Pain occurring when the extremity is lower than the heart.

Dermatitis: inflammation of the skin; can cause itching, redness, and skin lesions.

Dermis: the connective tissue underlying the skin's surface (epidermis).

Diabetic Wound: Wounds, when they develop in the diabetic patient are slow to heal. It is thought that in the poorly controlled diabetic patient there is an increased affinity of hemoglobin for oxygen, which hampers the release of oxygen to the healing tissues. Additionally, poorly controlled diabetic patients have an abnormal function of the phagocytes, which predisposes wounds to infection.

Diabetologist: a physician who specializes in the treatment of diabetes.

Dirty wound: a wound covered with proteinaceous debris or eschar, but without surrounding cellulitis.

Doppler Studies: Non-invasive technique used to determine the systolic blood pressure in the lower limb, expressed as a ratio to the arm brachial systolic pressure. This allows estimation of the limb perfusion (circulation).

Dry: Dehydration of the skin presenting as flaky, scaly or thick skin plaques.

Eczema: chronic dermatitis.

Eczematous: Acute or chronic inflammation of teh skin presenting as redness, irritation, weeping, crusting or scaly areas.

Edema: swelling; fluid retention. The presence of abnormally large amounts of fluid in the interstitial space (space between cells), resulting in swollen tissues.

Electrocardiogram (EKG): a test to measure the heart's electrical activity.

Endocrinologist: a physician who specializes in the treatment of the hormonal systems of the body.

Epidermis: outer layer of skin.

Epithelium: Cells that cover the internal and external surfaces of the body, including the lining of vessels and other small cavities. It serves as protection for the body and aids in secretion and absorption.

Epithelialisation: The final stage of wound healing where epidermal cells migrate across the surface of the wound from the wound margins and the remaining hair follicles. These cells are pink/white in colour at the wound edges or in islands over the granulation tissue.

Erode: Loss of epidermis.

Erythema: A redness of the skin caused by congestion of capillaries in lower layer of the skin, maybe due to injury, infection, inflammation or hyperaemia.

Eschar: a dry scab especially following cauterization or burn. Dried, proteinaceous material covering a wound.

Excoriation: Linear scratches on the skin. Red, raw skin; any superficial erosions and ulcerations produced mechanically or chemically.

Exenteration: Radical surgical procedure for excision of the contents of a body cavity.

Exudate: the tan/grayish material that is found on the surface of an open wound. It is proteinaceous material which comes from the wound itself. It is not pus. Therefore, the presence of exudate on a wound does not mean that the wound is infected.

Fascia: a fibrous membrane covering and separating muscles; unites skin with underlying tissue.

Fibrinogen: A protein that is present in the blood plasma, which through the action of thrombin (another protein in the blood plasma),and in the presence of calcium ions is converted into fibrin; this results in blood clotting.

Fibroblasts: a cell which develops connective tissue.

Film dressings: Used as primary of secondary dressing. Semi-permeable films are made of clear polyurethane coated with an adhesive. They are conformable and resistant to shear and tear. They prevent bacterial colonisation but do not absorb exudate.

Fistula: Abnormal hollow passage from an abscess, cavity, or hollow organ to the skin or between two internal organs.

Flap: tissue (skin/subcutaneous tissue, muscle, fascia, bone or some combination) with a blood supply that can be moved to cover a wound.

Types of flaps:

a) local flap: the tissue is adjacent to the open wound.

b) distant flap: the tissue is not adjacent to the open wound and must be moved to the defect.

c) free flap- a distant flap that is completely detached from the body and transferred to the defect. The artery and vein that supply the flap must be reconnected to vessels near the wound.

Foam: A dressing produced from polyurethane a soft, open cell sheets and may be single layer or multiple layers. They are non-adherent, can absorb large amounts of exudate and can also be used as secondary dressings. They are also available impregnated with charcoal and with a waterproof backing.

Foot ulcers: sores on the feet, most commonly affecting people with diabetes.

Full-thickness: Tissue destruction extending through the dermis to involve subcutaneous level and possibly muscle, fascia or bone.

General anesthesia: medical pain relief of the whole body, including loss of consciousness.

Granulation: During the proliferative phase of healing, this is the bright red tissue formed from new capillary loops or "buds" which are red/deep pink and moist with a "bumpy" appearance.

Granulation tissue: the red, shiny tissue that forms at the base of an open wound during the wound healing process. It is composed of inflammatory cells necessary for wound healing, and also bacteria. Granulation tissue is very vascular and bleeds easily. This is why a healing wound may bleed with dressing changes or minor trauma.

Growth factors: synthetic hormones injected to promote healing.

Healthy: Normal skin with no breaks and no problems.

Heel lift: shoe insert that shifts weight on foot, potentially relieving pressure on a foot ulcer.

Hematocrit (HCT): the percentage of mature red blood cells in a given volume of blood.

Hemoglobin: the oxygen-carrying protein in the blood.

Hemoglobin A1c: a test to measure blood sugar level.

Hemostasis: Stopping the escape of blood by either natural (clot formation) or artificial (compression or ligation) means or the interruption of blood flow to a part.

Hemostatic: An agent that aids in stopping the flow of blood i.e. calcium alginate. Heparin: an anticoagulant; prevents the blood from clotting.

Holistic: complete; in total.

Hydroactive: Functions or changes from the original state in the presence of moisture.

Hydrocolloid: A waterproof, occlusive dressing that consists of a mixture of pectins, gelatins, sodium carboxymethylcellulose and elastomers. Hydrocolloids create an environment that encourages autolysis to debride wounds that are sloughy or necrotic. As the hydrocolloid mixes with exudate, it produces a yellow gel with a characteristic odour, which the patient should be told about.

Hydrofibre: A highly absorbent wound dressing made up of 100% Hydrocolloid (Sodium Carboxymethylcellulose). The hydrocolloid is spun into fibres and needled to make a soft, non-woven fleece-like dressing that comes as a sheet or ribbon. An alternative to alginate dressing. The dressing retains a high quantity of water without releasing it, thereby forming a thick conformable gel.

Hydrogel: A dressing that comes as a sheet or gel. Sheets are used for shallow or low exuding wounds. The gels are suitable for cavities and are effective for desloughing and debriding wounds. Gels have a high water content, which aids the rehydration of hard eschar and promotes autolysis in necrotic wounds. Secondary dressing is required to keep the gel moist and in situ. To prevent possible maceration a protective barrier film may be applied on peri-wound areas.

Hydrophillic: Attracting moisture.

Hydropolymer Cavity Dressing: Highly absorbent polyurethane dressing consisting of a vapour-permeable foam matrix.

Hyperbaric Oxygen: Oxygen at a greater than atmospheric pressure that can be applied either to the whole patient inside a pressurized chamber or to a localized area (such as an arm or leg) inside a smaller chamber.

Induration: Engorgement of tissues, evidenced as firm, elevated, area of inflammation.

Infected wound: a wound, covered with necrotic tissue/foreign material with surrounding cellulitis.

Infection: the spread of disease; implantation of a germ. The deposition and multiplication of organisms in tissue with an associated host reaction.

Inflammation: Bacteria are killed, foreign matter and toxins are removed and damaged tissue is walled off. Symptoms are: erythema, raised temperature, swelling, exudate and pain.

Insulation: Maintenance of wound temperature close to body temperature.

Insulin: a hormone produced by the pancreas that is necessary to metabolize and maintain blood sugar; some individuals with diabetes require oral insulin or insulin injections.

Intact: No obvious breaks in the skin surface.

International Normalized Ratio (INR): the ratio of the patient's clotting time to the lab's mean reference value; corrects for variations between hospitals and reagents used to perform the test.

Ischemia: temporary anemia due to restricted circulation of the blood.

Ischial: located in the buttock region.

IV antibiotics: IV antibiotics are medications administered through a needle directly into the bloodstream.

Keloids: A new growth of the skin consisting of dense scar tissue. Most likely to occur in Polynesians, Orientals, Blacks, and within certain families.

Keratinocytes: proteins similar to those responsible for tough cells, e.g., hair and nails.

Larval therapy: Larval therapy offers an effective approach to wound debridement and removing bacteria. Specially bred, sterile maggots which liquefy dead tissue using enzymes are now available to treat a range of wounds. The treatment appears to have no adverse side-effects.

Lesion: Broad term referring to wounds, sores.

Lipid panel: measures fat in the blood.

Local anesthesia: pain medication affecting the location of the wound only
multipodus heel lifts.

Maceration: A softening or sogginess of the tissue owing to retention of excessive moisture which presents as moist, red/white and wrinkled.

Malodorous: Smelling badly.

Maturation Phase: This phase involves turnover and remodeling of collagen in the wound and results in the formation of a scar.

Mechanical Debridement: Allowing a dressing to proceed from moist to wet, then manually removing the dressing causing a form of non-selective debridement.

Mesentery: Membranous fold attaching various organs to the body wall.

Mucus: The clear viscid secretions of the mucous membrane, consisting of mucia, epithelial cells, leukocytes and various inorganic salts suspended in water.

Necrosis: death of areas of tissue surrounded by healthy parts. The local death of tissue. This tissue is often black/brown in colour and leathery in texture.

Necrotic: tissue dead tissue.

Nephrologist: a physician who specializes in diseases of the kidneys.

Neurologist: a physician who specializes in treating diseases of the nervous system.

Neuropathy: disease of the nerves.

NIFs see Non-Invasive Flow.

Non-Invasive Flow (NIF): studies imaging tests that do not penetrate the skin, such as X-ray, ultrasound, CT scan.

NPO: nothing to eat or drink after midnight.

Occlusive: Impermeable e.g. wound covering that blocks out external air, bacteria, or fluid.

Oedematous: Abnormal collection of fluid in the tissue, skin is swollen, shiny and tense.

Offloading: shifting weight from sensitive points through use of orthotics and specialized shoes.

Ophthalmologist: a physician who specializes in the eye and its diseases

Oral antibiotics: medications taken by mouth to counter specific infections.

Osteomyelitis: an infection of the bone.

Overgranulation: Granulation tissue which grows above the level of the surrounding skin, preventing epithelial cells from growing across the wound.

Paraffin impregnated gauze:

Partial-thickness: Wounds that extend through the epidermis and may involve the dermis; these wounds heal by re-epithelialization.

Partial Thromboplastin Time (PTT): a test that measures the blood's ability to clot.

Pathogen: Any virus, microorganism, or other substance that causes disease.

Pathology: study of the nature and cause of disease from tissue samples.

Periwound: The area immediately around the wound.

Platelets: an element in blood that aides in coagulation.

Podiatrist: a person who specializes in foot care.

Polyvinyl Dressings: Are transparent, adhesive wound dressings that are semi-permeable to oxygen and moisture and impermeable to bacteria and other contaminants. Advantages of this type of dressing is that they maintain a moist wound environment and concentrate the normal defenses of leukocytes, plasma, and fibrin in the wound bed

Prealbumin: a marker of nutrition.

Pressure Reduction Devices: Mattresses and pads overlays that reduce pressure but do not keep interface pressure consistently below capillary closing pressure.

Pressure Relief: Mattresses and pads that consistently reduce interface pressure below the capillary closing pressure of 25-32mmHg.

Pressure Sores: Area of ischemic necrosis and ulceration that overlies an area of tissue that has been subjected to prolonged pressure.
Pressure ulcers: sores causes by stress on the skin, most common in people with limited mobility.

Primary closure: suture the edges of a wound together to close the wound.

Proliferation: Proliferation or reconstruction is when new granulation tissue is formed to replace lost volume. Epithelial cells grow around the wound, or in islets, to form a new protective covering.

Proliferative Phase: New blood vessels and collagen are laid down in the wound bed. The result of this process is referred to as granulation tissue. Contraction and epithelialization of the wound also occur during this phase.

Prothrombin Time (PT): the time it takes prothrombin, a clotting chemical, to clot the blood.

Purulent: A thick, opaque drainage that contains dead cells and tissue debris.

Pus: Thick fluid composed of leukocytes, bacteria, and cellular debris.

Reconstructive ladder: gives you a logical way to think about how to close an open wound, regardless of the etiology of that wound. Whether it be an acute traumatic wound or a wound that resulted from excising a tumor, the same principles apply. This ladder is set up so that if the first “rung” doesn’t work, it will not prevent the next higher “rung” on the ladder from being able to be attempted. The rungs on the ladder are (in increasing order of complexity):

1. Secondary closure-leave the wound open
2. Primary closure
3. Skin grafting
4. Local flaps
5. Distant flaps

Regional anesthesia: pain management of part of the body, with or without loss of consciousness.

Renal failure: failure of the kidneys.

Revascularization: improvement of circulation of the blood.

Revascularization surgery: surgery to repair blood vessels, thereby improving circulation.

Rubor: Redness, especially when it accompanies inflammation.

Sacral: located in the tailbone.

Scab: Dried exudates covering superficial wounds.

Secondary closure: allow the wound to heal using dressing changes alone.

Semi-Occlusive: Permeable to some molecules but not to others. A membrane that allows gas exchange in both directions.

Semi-permeable adhesive film:

Shear: Sliding of skin over subcutaneous tissues and bones causing a kink in cutaneous capillaries which may lead to ischemia.

Sickle cell anemia: a hereditary form of anemia in which the red blood cells are abnormally shaped.

Sickle cell ulcers: sores caused by sickle cell anemia.

Sinus Tract: A course or pathway which can extend in any direction from the wound base; results in dead space with potential for abscess formation.

Skin Barriers: Products that provide protection from chemical injury.

Skin Equivalent: A material used to cover open tissue that acts as a substitute for nascent (beginning) dermis and epidermis and that has at least some of the characteristics of human skin (e.g. amniotic tissue, xenografts, human allografts). For the purpose of this guideline, only tissue with viable, biological active cells is given this designation.

Skin graft: a thin layer of skin used to cover an open wound. Two types:

a) split thickness skin graft- all of the epidermis and part of the dermis is included. The donor site (where the skin graft was taken from) will heal by secondary intention.

b) full thickness skin graft- all of the epidermis and all of the dermis is included. Subcutaneous tissue must be removed from the undersurface of the dermis. The donor site must be closed primarily or a large open wound will result.

Slough: The term for the viscous yellow layer which often covers the wound and is strongly adherent to it. Its presence can be related to the end of the inflammatory stage of healing when dead cells have accumulated in the exudate.

Stage I. Pressure Ulcer: An observable pressure-related alteration of intact skin whose indicators, as compared to an adjacent or opposite area on the body, may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue or purple hues.

Stage II. Pressure Ulcer: Involves the epidermis, dermis or both. It is a superficial wound and may present as an abrasion, blister or shallow crater.

Stage III. Pressure Ulcer: Involves subcutaneous tissue that may extend down to, but not through, underlying fascia. It may present as a deep crater with or without undermining of tissue.

Stage IV. Pressure Ulcer: Involves muscle, bone or supporting structures. Undermining or sinus tracts may also be present.

Stasis: Stagnation of fluid resulting from venous congestion. Venous Stasis can result from constant high blood pressure that pushes out against the delicate vein walls. As a result, these walls stretch out of shape, which prevents proper blood flow within the blood veins.

Sterile technique: uses instruments/supplies that have been specifically treated so that there are NO bacterial/viral particles on their surfaces. Examples of sterilized supplies include instruments that have been autoclaved (subjected to high temperatures to kill microorganisms) and gauze/gloves which have been specially prepared at the factory and are individually packaged. Procedures done in an operating room are usually done using sterile technique.

Stoma products:

Strike-through: The point at which a liquid pathway is formed between the inner and outer surfaces of a dressing by the penetration of blood, exudate or tissue fluid.

Strip: Removal of epidermis by mechanical means, usually tape.

Subcutaneous: under the skin.

Support Surfaces: Product that reduces tissue interface pressures over the bony prominences by redistributing weight over the larger area.

Tangential excision: the technique used to excise burned tissue, leaving the uninjured deeper tissue intact. This is done in the operating room under general anesthesia. A special knife is used to remove the burned tissue in thin slices. You know when you have reached healthy tissue, because it bleeds. Dead, burned tissue does not bleed.

Therapeutic bed: bed designed to relieve pressure and minimize bedsores.

Topical dressings: bandages applied to sores.

Topical treatments: treatment applied to affected, localized surface area only.

Transthoracic Echocardiography (TEE): ultrasound of the heart and cardiac blood flow.

Trochanteric: located in the hip.

Ulcer: Loss of epidermis/dermis or mucous membrane with definite margins.

Ultrasound: a non-invasive imaging method using sound waves.

Undermine: Skin edges of a wound that have lost supporting tissue under intact skin.

Unstageable Pressure Ulcer: Covered with eschar or slough which prohibits complete assessment of the wound.

VAC: Vacuum-assisted closure is a system that creates a hypoxic environment within the wound bed in which aerobic bacteria cannot survive. The environment forces the microcirculation to regenerate rapidly and produce large amounts of capillaries. The negative pressure also removes slough, loose necrotic material and exudate from the wound bed.

Vacuum-Controlled Assisted Closure (VAC) Therapy: a device to assist healing of wounds.

Venous reflux: backward flow of blood in the veins.

Venous ulcers: sores related to impaired blood flow through the veins.

Ventral hernia: stretching of the abdominal wall, allowing the gut to bulge under a thin layer of skin.

Wet-to-dry dressing: a dressing technique used to treat a dirty wound or to prevent build-up of exudate on a wound. Apply a saline moistened (damp not soaking wet) gauze pad to the wound and then cover this with a dry gauze pad. The reason it is called a “wet to dry dressing” is that the moist gauze directly on the wound is allowed to dry out. When this bottom layer of gauze is removed, it pulls off the exudate, debris, and non-viable tissue which have become stuck to the gauze. Studies have shown that wound healing is optimized by being in a moist environment, so it is best to not let the dressing completely dry out, making it more of a wet-to-damp dressing.

Wet-to-wet dressing: a dressing technique that will keep a clean wound clean, and promote healing. Apply a saline moistened (slightly wetter than for a wet-to-dry dressing) gauze over an open wound and cover it with a dry gauze pad. The dressing is removed when it is still wet. If the bottom layer of gauze dries out, pour saline over the gauze prior to removing it.

White blood count/WBC: a test to measure the number of white blood cells in the blood.

Wound: A break in the integrity of the skin; an injury to the body which causes a disruption of the normal continuity of the body structures

Wound Bed: Uppermost visible tissue layer of a wound.

Wound culture: Performing a bacterial culture in a manner that allows the number of bacteria present in a known quantity of tissue biopsy, wound aspirate, or sampled surface to be quantified.

Wound margin: Rim or border of a wound.

X-ray: a non-invasive imaging technique

Original Post September 26, 2006 - 519 views

REFERENCES AND CREDITS:

http://www.edu.rcsed.ac.uk/Wound%20Mana ... ry%202.htm

http://www.hollister.com/us/wound/resou ... ssary.html

http://www.columbiasurgery.org/pat/wound/glossary.html

http://www.convatec.ca/convatec/jsp/CVT ... lId=-13204
patoco
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Re: Wound Glossary

Postby patoco » Thu Oct 08, 2009 10:43 am

Reviewed October 8, 2009
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