CHAPTER 1 - ADJUNCTIVE THERAPY, MANAGEMENT OF SPECIFIC WOUNDS, RECENT INNOVATIONS IN WOUND CARE TECHNOLOGY

ADJUNCTIVE THERAPY

• refers to any treatment that is used in conjunction with another treatment in order to increase the chance of cure, or to increase efficacy of the initial / 1st treatment

  
  

ADJUNCTIVE THERAPY

• serves as an aid & it is not the main course of treatment

1. HYPERBARIC OXYGEN THERAPY

2. THERAPEUTIC ULTRASOUND / MEGAHERTZ (MHz)

3. ELECTRICAL STIMULATION (ES)

4. ELECTROMAGNETIC THERAPY / MAGNETIC FIELD ENERGY / BIOELECTRICITY

5. NEGATIVE PRESSURE WOUND THERAPY (NPWT)

6. ULTRAVIOLET LIGHT

7. LOW INTENSITY LASER THERAPY (LILT)

8. SHORT WAVE DIATHERMY

DIFFERENT TYPES OF ADJUNCTIVE THERAPY

HYPERBARIC OXYGEN THERAPY

accomplished in a specialized chamber typically maintained between 2.5 & 3.0 atmospheres of pressured oxygen or air) that allows patient monitoring

ADVANTAGE OF HYPERBARIC OXYGEN THERAPY

adjunct to wound care in the therapy of both acute & chronic wounds

HYPERBARIC OXYGEN THERAPY

therapy of non-healing wounds generally involves daily sessions of 1.5 - 2 hours for 20 - 40 days

THERAPEUTIC ULTRASOUND/ MEGAHERTZ (MHz)

utilized to deliver a high frequency mechanic vibration to facilitate healing at a cellular level

ADVANTAGES OF THERAPEUTIC ULTRASOUND / MEGAHERTZ (MHz)

• often used to reduce pain

• increase circulation

• increase mobility of soft tissues,

• can be helpful in the reduction of inflammation & the healing of injuries or wounds

  
  

THERAPEUTIC ULTRASOUND / MEGAHERTZ (MHz)

• treatment parameters are usually 3 MHz for 5 - 10 minutes a day for 2 - 3 weeks

ELECTRICAL STIMULATION (ES)

involves the application of one cathode to the skin near the wound and the application of a 2nd electrode to the saline-moistened gauze placed over a wound

ELECTRICAL STIMULATION

• indications: for acute & chronic wounds including pressure ulcers, diabetic ulcers, arterial ulcers, and venous ulcers

• contraindications: malignancy, metal ions, implants, and osteomyelitis

ADVANTAGES OF ELECTRICAL STIMULATION

• has shown enhanced wound healing with increased perfusion in human studies,

• improves flap & graft survival,

• accelerates postoperative healing, and

• decreases necrosis following reconstruction

ELECTRICAL STIMULATION

• length of treatment is usually 1 hour daily for 5 - 7 days

ELECTROMAGNETIC THERAPY / MAGNETIC FIELD ENERGY / BIOELECTRICITY

uses a pulsed magnetic field to induce an electric current (coming from a solenoid placed around the patient) and it can be used in combination with standard wound therapy for patients with chronic wounds & pressure ulcers

ADVANTAGES OF ELECTROMAGNETIC THERAPY / MAGNETIC FIELD ENERGY / BIOELECTRICITY

• reduces pain & inflammation;

• improves energy & circulation;

• aids in blood / tissue oxygenation;

• accelerates the repair of bone & soft tissue/s;

• relaxes muscles;

• balances the immune system;

• stimulates deoxyribonucleic acid (DNA) & ribonucleic acid (RNA);

• and regulates blood pressure, cholesterol levels, & the uptake of nutrients

ELECTROMAGNETIC THERAPY / MAGNETIC FIELD ENERGY / BIOELECTRICITY

• some signs of improvement may be experienced with this treatment when it is done twice a day for 1 - 2 weeks to enhance wound healing (15 minutes at 1 hertz/ Hz) and for relief from wound pain (15 minutes at 11 - 17 hertz / Hz)

NEGATIVE PRESSURE WOUND THERAPY (NPWT)

utilizes continuous or intermittent suction to the wound bed by the use of controlled subatomic pressure (80-125 mmg) applied to the wound which is covered with a foam dressing that is changed every 48 - 72 hours

ADVANTAGES OF NEGATIVE PRESSURE WOUND THERAPY (NPWT)

• Enhances wound healing by reducing edema surrounding the wound,

• stimulates circulation,

• increasing the rate of granulation tissue formation,

• manages large defects until closure can be performed,

• and it is available in portable devices that can be used at bedside

NEGATIVE PRESSURE WOUND THERAPY (NPWT)

• discontinued if there is no progress within 2 weeks

ULTRAVIOLET LIGHT

• is a therapeutic light from the electromagnetic spectrum that is at a higher frequency than visible light and is divided into 3 bands / wavelengths: UVA, UVB, and UVC (which is produced by a cold-quartz lamp)

ULTRAVIOLET LIGHT

UVC is safe & produces biological effects that are used to treat chronic wounds

ADVANTAGE OF UV

• modifies the cell wall function by altering the shape of proteins,

• promotes sloughing of necrotic tissue,

• enhances epithelialization by increasing cell turnover,

• and it is bactericidal & virucidal to wound pathogens including Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE)

ULTRAVIOLET LIGHT

treatment frequency is 3 times per week & exposure time is 15 - 240 seconds (depending on the progression of the wound)

LOW INTENSITY LASER THERAPY (LILT)

uses infrared (IR) light to change the call membrane permeability and stimulate tissue repair

LOW INTENSITY LASER THERAPY (LILT)

not be used on patients with thin skin & its improper use have been reported to cause burns

LOW INTENSITY LASER THERAPY

• treatment is 5 times per week for 20 - 30 minutes

SHORT WAVE DIATHERMY

describes uniform heating produced by the conversion of high-frequency electrical currents

SHORT WAVE DIATHERMY

different from hot packs (i.e., hot compress) due to its ability to heat subcutaneous tissue/s & also the deep tissue structures

ADVANTAGES OF SHORT WAVE DIATHERMY

• affects circulation,

• provides an increase in blood flow, &

• helps in pain reduction

SHORT WAVE DIATHERMY

• treatment time varies from 15 minutes twice a day to once per month

1. SIMPLE LACERATION

2. COMPLICATED LACERATION

3. LARGE TISSUE DEFECT

4. BURNS

5. PRESSURE ULCERS

6. DIABETIC FOOT ULCER (DFU)

7. VENOUS ULCER

8. ISCHEMIC ULCERATIONS & GANGRENE

MANAGEMENT OF SPECIFIC WOUNDS

SIMPLE LACERATION

- may be cleaned & closed primarily with either sutures or staples

COMPLICATED LACERATION

after cleansing the wound (irrigation & debridement), an attempt is made to close more complicated lacerations through plastic surgery techniques (Z-plasty) to provide an acceptable cosmetic & functional result

LARGE TISSUE DEFECT

• It can result from traumatic wounds or the need to remove devitalized tissue due to infection (Fournier's gangrene)

  
  

LARGE TISSUE DEFECT

• after debridement, the wound can be packed open with wet to moist gauze dressing (normal saline solution / NSS) or use negative pressure wound therapy (NPWT) until the wound bed allows for skin grafts or flap closure

Burn wound care depends on many factors including:

• the depth of the burn (i.e., 1s degree burns, 2nd degree burns, & 3rd degree burns)

• and the anatomic locations or body surface area (such as the Rule of 9 for adults and Lund & Browder chart for children)

burn wounds are dynamic

• requires examination & reassessment in the 1st 24 - 72 hours since depth can increase as a result of inadequate treatment or a superadded infection

for minor burns after prompt wound cleaning & debridement:

• utilization of non-adhesive dressings with gauze padding for adults & biologic dressing for children are effective

dressings on superficial burns

• can either be changed daily (with infection) or after 3 - 5 days (without infection)

PRESSURE ULCERS

• treatment for pressure ulcers will depend on the stage of the ulcer

TREATMENT OF PRESSURE ULCERS

• management of local & distant infections,

• debridement of necrotic tissue (if present),

• maintenance of a moist environment,

• and possible surgery

PRESSURE ULCERS

• urgent surgical debridement is performed if advancing cellulitis or sepsis occurs

PRESSURE ULCERS

• wound cleansing using normal saline solution (NSS) & appropriate dressing manages bacterial load and it is considered the mainstay of treatment for clean ulcers after debridement

DIABETIC FOOT ULCER (DFU)

• management varies depending on the grade of the ulcer

DIABETIC FOOT ULCER (DFU)

• emphasis in wound care for diabetic foot ulcers is radical

TREATMENT FOR DIABETIC FOOT ULCER

• repeated tissue debridement

• frequent inspection & bacterial control

• careful moisture balance through optimal dressing selection

• and epithelial edge advancement to prevent maceration

COMPRESSION

• mainstay treatment for venous ulcer

VENOUS ULCER

• wound cleansing is done using normal saline solution (NSS) followed by a non-adhesive wound dressing to apply compression bandages

ISCHEMIC ULCERATIONS & GANGRENE

• presence of ischemia influences the timing of debridement & its definitive intervention

• dressing choice depends upon the level of anticipated drainage & the size of the wound

• after revascularization, the wound is monitored closely for signs of healing or instability that indicates a need for debridement

primary goal of the dressing

• Is the protection of the wound which reduces the risk for trauma & infection: accomplished by lightly wrapping the wound in a bulky dry gauze bandage to not aggravate the level of ischemia

for wet gangrene or abscess:

• wound should be debrided immediately regardless of the need for revascularization

for dry gangrene without cellulitis

limb must be revascularized first

• for dead space

management is done with gauze packing

TIME System

mnemonic that corresponds to tissue debridement, infection control or inflammation, moisture balance, and edge of the wound or epithelial edge advancement of the wound

• A) Tissue debridement

• B) Infection control / Inflammation control

• C) Moisture balance

• D) Edge of the wound / Epithelial edge advancement

Tissue debridement

refers to tissue viability since necrotic tissue, slough or eschar delays healing & needs to be removed

Infection control / Inflammation control

absence or presence of infection that would necessitate treatment

Moisture balance

proper balance is important since too much or too little is considered detrimental to the wound

Edge of the wound / Epithelial edge advancement

if it is non-progressive or undermined (debridement and grafts are done)

RECENT INNOVATIONS IN WOUND CARE TECHNOLOGY

1. Crab Shell Bandages

2. Vacuum-Esque Bandages

3. EPFL Bandage

4. Neural Tourniquet

5. Tilapia Skins

CRAB SHELL BANDAGES

bandage from China that are made from chitosan (a mineral found in most crustacean shells) which is described as a composite fiber & also contains alginate

CRAB SHELL BANDAGES

it is said to heal wounds faster and possesses powerful antimicrobial agents that kill several strains of bacteria

VACUUM-ESQUE BANDAGES

• a new fast-acting vacuum plaster from Australia (Nanova) which is small, lightweight, and connects to a vacuum pump that is the size of a standard smartphone

VACUUM-ESQUE BANDAGES

• it works by creating a small area of negative pressure that removes dead tissue & debris

VACUUM-ESQUE BANDAGES

• added pressure encourages increased blood flow which causes the wound to heal faster

VACUUM-ESQUE BANDAGES

• available in the United Kingdom, but it will be available in the US in a few years

EPFL BANDAGES

latest development from Switzerland's Ecole Polytechnique Federale de Lausanne (EPFL) that help burns heal faster & avoid infection

EPFL BANDAGES

• dendrimers are added to the collagen gauze strip which then attack the microbes around & within the wound

EPFL BANDAGES

• it is undergoing a trial run at Zurich before it can be implemented across the world

NEURAL TOURNIQUET

• device from the Feinstein Institute of Medical Research that is a new, groundbreaking way to treat injuries & bleeding disorder

NEURAL TOURNIQUET

• device is placed somewhere on the body, at which point it generates an electrical pulse that is sent to the vagus nerve which acts as the communication relay system between the brain & the rest of the body's organs

NEURAL TOURNIQUET

• vagus nerve activates the spleen which releases a stream of platelets & blood cells to help close wounds and other bleeding injuries much more quickly

NEURAL TOURNIQUET

• it will primarily be used for surgeries to prevent any hemorrhage accidents

TILAPIA

• is a species of cichlid fish and also known as St. Peter's fish

TILAPIA SKINS

• scientists from the Federal University of Cara (Brazil) have started clinical trials of using _____ for treating burns on human patients with promising results

TILAPIA SKINS

• are sterilized through irradiation (gamma radiation), packed, sealed, and then refrigerated where it can be stored for as long as 2 years

TILAPIA SKINS

• placed directly on the wound and can stay in place up to 10 days

• high level of moisture,

• protection & resistance to tears (due to tough fish scales),

• helps with pain management (by covering nerve endings with less traumatic bandage changes), and

• promotes faster healing which prevents scarring (since it contains collagen proteins that have 5 times more collagen than human skin)

• tilapia skins provide various benefits:

TILAPIA SKINS

• useful for developing countries with few skin banks that offer human skin & pig skin