Electrotherapy in wound healing


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Electrotherapy, wound healing, physiotherapy

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Electrotherapy in wound healing

  1. 1. Sreeraj S R Wound Healing
  2. 2. Sreeraj S R 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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  6. 6. 1. Healing by primary intention 2. Healing by secondary intention 3. Delayed primary closure
  7. 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
  8. 8. Sreeraj S R 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
  9. 9. Sreeraj S R 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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  11. 11. Sreeraj S R Wound Healing
  12. 12. Sreeraj S R High Frequency modalities used to promote wound healing are… 1. Ultrasound 2. LASER 3. Ultraviolet 4. PSW
  13. 13. Sreeraj S R 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
  14. 14. Sreeraj S R 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. 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
  16. 16. Sreeraj S R frequency of 3 MHz 20 % duty cycle intensity usually 0.3 to 0.5 watts/cm 2. Duration 5 to 10 minutes
  17. 17. Sreeraj S R 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.
  18. 18. Sreeraj S R 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
  19. 19. Sreeraj S R Stimulate ATP production Increase immune system Increase collagen synthesis
  20. 20. Wound margins Direct contact 1 – 2 cm from edges 4 – 10 j/cm2 Wound bed Non contact 1 – 5 j/cm2
  21. 21. Sreeraj S R 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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  23. 23. Sreeraj S R 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.
  24. 24. Sreeraj S R 25 – 30 W 20 min. Longer pulse duration
  25. 25. Sreeraj S R Wound Healing
  26. 26. Sreeraj S R 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
  27. 27. Sreeraj S R 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
  28. 28. Sreeraj S R Pressure Ulcers Diabetic ulcers Venous Ulcers TraumaticWounds SurgicalWounds Ischemic Ulcers Donor Sites Wound Flaps Burn wounds
  29. 29. Sreeraj S R 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. 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
  31. 31. Sreeraj S R 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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  33. 33. Sreeraj S R 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
  34. 34. Sreeraj S R 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
  35. 35. Sreeraj S R 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 inTissue Repair, Journal of HandTherapy, 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