The document discusses wound healing and various modalities used to promote wound healing such as ultrasound, laser, ultraviolet light, and pulsed shortwave diathermy. It covers the normal phases of wound healing including inflammatory, proliferation and maturation phases. Factors that can inhibit wound healing and importance of wound measurement are summarized. Electrical stimulation modalities like high voltage pulsed current and low voltage pulsed current are described along with their proposed mechanisms of action in accelerating wound healing. Placement and treatment procedures for electrical stimulation are also outlined.

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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
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6. 1. Healing by primary intention
2. Healing by secondary intention
3. Delayed primary closure

7. 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.

15. 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

20. 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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UVC 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 ofTGF-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
TraumaticWounds
SurgicalWounds
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. HighVoltage Pulsed current, monophasic
2. LowVoltage Pulsed Current, monophasic/biphasic

30. 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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