electrotherapy in wound healing
DESCRIPTION
Electrotherapy, wound healing, physiotherapyTRANSCRIPT
Sreeraj S R
Wound Healing
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Pathological / physical insult
Inflammatory Phase Proliferation Phase Maturation Phase
Vasoconstriction
Vasodilatation
Clot Formation
Phagocytosis
Epithelialization
Fibroplasia / Collagen Formation
Wound Contraction
Neovascularization
Collagen synthesis/ Lysis
Collagen fiber orientation
Healed Injury
Normal Phases of Repair
21 3
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1. Healing by primary intention
2. Healing by secondary intention
3. Delayed primary closure
� Infection
� Poor hygiene
� Local blood supply
� Oedema
� Inhibited wound
oxygenation
� Smoking
� Cooling of the wound
� Delayed inflammatory
response
� Insufficient diet or
malnutrition
� Proteins
� Carbohydrates
� Fats
� Vitamins
� Minerals
� Psychological Stress
� Age effects
� Diabetes mellitus
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The purpose of any wound measurement is to
monitor the progress of healing through changes in
the length, width, area or volume of a wound.
� Part of initial assessment
� Aids re-evaluation
� for accurate communication between professionals
� Objective form of assessment
� Enhances quality of patient care
� Monitors treatment efficacy
� May help predict healing
� Enhances overall wound management
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� Simple measurements: measuring its linear dimensions with a tape
measure or ruler like length x width.
� Wound tracing: a pen is used to trace the outline of the wound directly
onto sterile transparent film.
� Moulds: A three-dimensional mould of the wound can be created by
taking a cast of the wound cavity using a saline or alginate filling.
� Scaled photographs: This uses a photograph processed by a special
used to calculate length and width, which are expressed in simple
measurements.
� Planimetrics: A transparent sheet of graph paper is laid over the
photograph or wound tracing, and the number of complete graph
squares within the boundaries of the wound are added up to produce a
scale area calculation by using either manually or using a computer.
� Computerized stereophotogrammetry: This uses two pictures of the
same area taken from different known positions to produce a three-
dimensional image for measurement.
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Wound Healing
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High Frequency modalities used to promote
wound healing are…
1. Ultrasound
2. LASER
3. Ultraviolet
4. PSW
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Ultrasound benefit wound healing in..
1. Inflammatory Phase :
causes a degranulation of mast cells
resulting in the release of histamine.
2. Proliferative Phase :
effect fibroblasts and stimulate them to
secrete collagen. This can accelerate the
process of wound contraction and increase
tensile strength of the healing tissue
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1. Treat at the lowest intensity.
2. Assure that the applicator is kept in constant
motion throughout treatment
3. Proper acoustic coupling medium is used.
4. Reduce the intensity or terminate treatment
if the patient complains of any increase in
pain.
1. remove dressings and clean wound
2. A hydro gel sheet should be placed in direct contact with the wound bed and wound margins
3. In cases of cavity type of wound a sterile aqueous hydro gel filler should be used. The cavity is filled with the aqueous gel and then covered wit the hydro gel sheet
4. Apply an ultrasonic coupling gel on top of the sheet.
5. Remove all underlying air bubbles
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� frequency of 3 MHz
�20 % duty cycle
� intensity usually 0.3 to 0.5 watts/cm 2.
�Duration 5 to 10 minutes
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� 1 MHz, continuous ultrasound
� intensity is typically set to between 1 and 1.5
watts/cm 2.
� Initial treatment is about 2-3 minutes per
zone.
� can be increased by 30 second increments to
a maximum of 5 minutes per zone and
delivered 3 times per week.
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�20% Zink Oxide ointment
� frequency of 3 MHz
�20 % duty cycle
� intensity usually 0.3 to 0.5 watts/cm2
�Duration 5 to 10 minutes
�Should not be given to patients sensitive to
metal
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�Stimulate ATP production
� Increase immune system
� Increase collagen synthesis
Wound margins
� Direct contact
� 1 – 2 cm from edges
� 4 – 10 j/cm2
Wound bed
� Non contact
� 1 – 5 j/cm2
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� U VC is the frequency band most commonly used
because it:
� enhances epithelialisation
� destroys bacteria
� Causes minimal erythema
� and is absorbed almost equally by all skin colours
� Antibiotic effects of UVR - C ( 100 – 280 nm) used for
Sterilization of wound
� UVR – A and UVR – B known to
1. Promote granulation tissue
2. Remove slough
3. Stimulate epidermal growth
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� Goldin et al (1981) list the following as the primary
effects of pulsed SWD:
1. Reduction (resolution) of the inflammatory
process.
2. Increased number of white cells, histocytes &
fibroblasts in a wound.
3. Improved rate of oedema dispersion.
4. Encourages absorption of heamatoma.
5. Prompts a more rapid rate of fibrin fibre
orientation & deposition of collagen.
6. Encourages collagen layering at an early stage.
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�25 – 30 W
�20 min.
�Longer pulse duration
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Wound Healing
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� The body has its own bioelectric system
� A current termed the "current of injury" is generated
between the skin and inner tissues when there is a break
in the skin.
� Healing of the injured tissue is arrested or will be
incomplete if these currents no longer flow while the
wound is open.
� A rational for applying electrical stimulation is that it
mimics the natural current of injury and will jump start or
accelerate the wound healing process
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�Up regulates insulin receptors on fibroblasts.
�Up regulation of TGF-β.
(Transforming growth factor beta) is
a protein that controls proliferation, cellular
differentiation in most cells
� Increases angiogenesis
�Decreases bacterial burden
� Increases blood flow
� Increases wound tensile strength
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�Pressure Ulcers
�Diabetic ulcers
�Venous Ulcers
�Traumatic Wounds
�Surgical Wounds
� Ischemic Ulcers
�Donor Sites
�Wound Flaps
�Burn wounds
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There are three types of electrical current that
assist in wound closure and healing:
� Direct current (DC)
� Alternating current, and
� Pulsed current (PC)
1. High Voltage Pulsed current, monophasic
2. Low Voltage Pulsed Current, monophasic/biphasic
� Application of high voltage, low
amperage and direct current to a
specific region of the body
Characteristics of HVPS include:
� a very short pulse
duration between 20-200µs,
� voltage greater than 100 volts
� stimulation range between 0-
150Hz,
� unique twin peak monophasic
waveform
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�Pulse frequency: 100 pps
�Pulse duration: 20 to 100 µ sec.
�Polarity:
� + ve for anti microbial effects and
� – ve to enhance granulation tissue
formation and re epithelialization
� Intensity: 100-150 volts
�Treatment duration: 45 to 60 min. 5 to 7 days
per week.
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� Have supplies ready before undressing the wound.
� Position patient for ease of access by staff and comfort of
both.
� Remove the dressing and place in an infectious waste
bag.
� Cleanse wound thoroughly to remove slough, exudates
and any petrolatum products
� Open gauze pads and soak in normal saline solution,
squeeze out excess liquid.
� Fill the wound cavity with gauze including any
undermined/tunneled spaces. Pack gently.
� An alternative is to use an amorphous hydro gel
impregnated gauze/ Hydro gel sheets
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Stimulating Electrode Placement:
� Place over the gauze packing and hold in place with
bandage tape.
� Connect to stimulator lead
Dispersive electrode placement:
� Usually placed proximal to the wound
� Place over soft tissues, avoid bony prominences
� Place a wet lint pad under the dispersive electrode
� Dispersive pad should be larger than the sum of the
areas of the active electrodes and wound packing.
� The greater the separation between the active and
dispersive electrode the deeper the current path. Use
for deep and undermined wounds
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1. Georgina G. The importance of continuous wound measuring. Wounds UK, 2006,Vol
2, No 2. 60-68
2. http://www.worldwidewounds.com/2006/january/Fette/Clinimetric-Analysis-
Wound-Measurement-Tools.html#ref10
3. http://medicaledu.com/ultrasnd.htm
4. http://www.campbellteaching.co.uk/sample.pdf
5. Electrotherapy explained, 4th edition, Low & Reed, Elsevier
6. Clayton’s electrotherapy, 10th edition, Sheila Kitchen
7. Handbook of practical electrotherapy, Mitra PK, Jaypee publications
8. Physical Agents in Rehabilitation, From Research to Practice, 2nd edition, Michelle
H. Cameron, Saunders Elsevier
9. David Cukjati, Rajmond Savrin. Electric Current Wound Healing.
10. Katheriene Lampe, Electrotherapy in Tissue Repair, Journal of Hand Therapy, 1998,
131 – 138
11. Julia Shaw , Patrick M. Bell. Wound Measurement in Diabetic Foot Ulceration.
Global Perspective on Diabetic Foot Ulcerations. InTech 2011. 72 - 82