Wound Modalities

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Last updated 7:38 PM on 4/18/26

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15 Terms

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electrical stimulation

WOUND HEALING MODALITY

direct or indirect high-voltage pulsed current (HVPC)

*evidence based treatment for chronic pressure wounds stage 2-4

INFLAMMATORY PHASE

- increases vasodilation, reduced edema, inhibits bacterial growth, prohibits migration of macrophages

PROLIFERATIVE PHASE

- stimulates protein and DNA synthesis in fibroblasts, promotes migration of healthy cells, generates angiogenesis and collagen formation

<p>WOUND HEALING MODALITY</p><p>direct or indirect high-voltage pulsed current (HVPC)</p><p>*evidence based treatment for chronic pressure wounds stage 2-4</p><p>INFLAMMATORY PHASE</p><p>- increases vasodilation, reduced edema, inhibits bacterial growth, prohibits migration of macrophages</p><p>PROLIFERATIVE PHASE</p><p>- stimulates protein and DNA synthesis in fibroblasts, promotes migration of healthy cells, generates angiogenesis and collagen formation</p>

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direct e-stim

fill negative cavity with hydrogel sheet/moistened gauze and place disposable electrode directly on top

*place larger dispersive pad 2-15 cm from wound

**rotate position of pads each treatment

deep--> place further away

shallow--> place closer

INFLAMMATORY PHASE--> anode

PROLIFERATION PHASE--> cathode

TREATMENT PARAMETERS:

- HVPC, 60 mins, 5-7 days/week

<p>fill negative cavity with hydrogel sheet/moistened gauze and place disposable electrode directly on top</p><p>*place larger dispersive pad 2-15 cm from wound</p><p>**rotate position of pads each treatment</p><p>deep--> place further away</p><p>shallow--> place closer</p><p>INFLAMMATORY PHASE--> anode</p><p>PROLIFERATION PHASE--> cathode</p><p>TREATMENT PARAMETERS:</p><p>- HVPC, 60 mins, 5-7 days/week</p>

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indirect e-stim

fill negative cavity with hydrogel sheet/moistened gauze and secure in place then place electrodes straddling the wound bed 2-15 cm from wound edge

*rotate position of electrodes each treatment

**place larger dispersive pad 20-30 cm from wound

TREATMENT PARAMETERS:

- HVPC, 60 mins, 5-7 days/week

<p>fill negative cavity with hydrogel sheet/moistened gauze and secure in place then place electrodes straddling the wound bed 2-15 cm from wound edge</p><p>*rotate position of electrodes each treatment</p><p>**place larger dispersive pad 20-30 cm from wound</p><p>TREATMENT PARAMETERS:</p><p>- HVPC, 60 mins, 5-7 days/week</p>

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low-frequency ultrasound

WOUND HEALING MODALITY

non-contact, using saline (MIST)

- reduces bioburden

(microbial load of contaminated organisms)

- microstreaming

- promotes cavitation

(BUBBLES = NORMAL)

<p>WOUND HEALING MODALITY</p><p>non-contact, using saline (MIST)</p><p>- reduces bioburden </p><p>(microbial load of contaminated organisms)</p><p>- microstreaming</p><p>- promotes cavitation </p><p>(BUBBLES = NORMAL)</p>

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high frequency ultrasound

WOUND HEALING MODALITY

full contact, traditional US

- apply hydrogel to fill wound bed--> plastic wrap--> apply US gel on plastic then perform modality

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low (increases penetration of US waves and effect on cells and tissue)

Is there more research supporting low or high frequency ultrasound for wound management?

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pulsatile lavage

WOUND HEALING MODALITY

form of mechanical debridement (low pressure)

- direct, localized hydrotherapy to wound via a pulsed stream of sterile saline

- average rx time: 5-20 mins

- work non-necrotic areas first

sterile technique is essential!!

(PPE and face mask needed to not inhale bacteria)

<p>WOUND HEALING MODALITY</p><p>form of mechanical debridement (low pressure)</p><p>- direct, localized hydrotherapy to wound via a pulsed stream of sterile saline</p><p>- average rx time: 5-20 mins</p><p>- work non-necrotic areas first</p><p>sterile technique is essential!!</p><p>(PPE and face mask needed to not inhale bacteria)</p>

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negative pressure wound therapy (NPWT)

WOUND HEALING MODALITY

aka wound vac

- continuous suction

- dressings changed every other day and canister replaced 1x/week

*good for accelerated granulation tissue formation and drainage management

CONTRAINDICATIONS:

- untreated osteomyelitis

- CA

- unexplored fistulas

- direct contact on structures

- >25% necrotic tissue

<p>WOUND HEALING MODALITY</p><p>aka wound vac</p><p>- continuous suction</p><p>- dressings changed every other day and canister replaced 1x/week</p><p>*good for accelerated granulation tissue formation and drainage management</p><p>CONTRAINDICATIONS:</p><p>- untreated osteomyelitis</p><p>- CA</p><p>- unexplored fistulas</p><p>- direct contact on structures</p><p>- >25% necrotic tissue</p>

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diathermy

WOUND HEALING MODALITY

pulsed short wave

- NOT typically used anymore

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light therapy (infrared)

WOUND HEALING MODALITY

monochromatic light

- RBCs absorb light energy and release nitric oxide

(vasodilation, analgesia, reduced inflammation, collagen synthesis, angiogenesis)

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hyperbaric oxygen (HBO)

WOUND HEALING MODALITY

inhalation of 100% oxygen at >1 atm

INDICATIONS: osteomyelitis, diabetic wounds, radiation necrosis

*increases O2 perfusion in tissues--> antibiotic effect

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arterial wound treatment

TESTING:

- pulses, rubor dependency, claudication, ABI

- exudate assessment

DEBRIDEMENT:

- NO sharp

(leave dry stable eschar intact)

- enzymatic or autolytic to remove necrotic tissue

DRESSING:

- "wet" dressing to add moisture to dry wound

MODALITIES:

- e-stim, MIST ultrasound, infrared, hyperbaric O2

PT:

- walking program, LE strengthening

<p>TESTING:</p><p>- pulses, rubor dependency, claudication, ABI</p><p>- exudate assessment</p><p>DEBRIDEMENT:</p><p>- NO sharp</p><p>(leave dry stable eschar intact)</p><p>- enzymatic or autolytic to remove necrotic tissue</p><p>DRESSING:</p><p>- "wet" dressing to add moisture to dry wound</p><p>MODALITIES:</p><p>- e-stim, MIST ultrasound, infrared, hyperbaric O2</p><p>PT:</p><p>- walking program, LE strengthening </p>

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venous wound treatment

DEBRIDEMENT:

- selective mechanical and sharp

DRESSING:

- "dry" dressing to decrease moisture

(alginate, hydrocolloid, foam, etc.)

MODALITIES:

- pulsed lavage, e-stem, MIST

PT:

- control edema w/ compression

- LE elevation

- LE strengthening program (calf mm pump)

<p>DEBRIDEMENT:</p><p>- selective mechanical and sharp</p><p>DRESSING:</p><p>- "dry" dressing to decrease moisture</p><p>(alginate, hydrocolloid, foam, etc.)</p><p>MODALITIES:</p><p>- pulsed lavage, e-stem, MIST</p><p>PT:</p><p>- control edema w/ compression</p><p>- LE elevation</p><p>- LE strengthening program (calf mm pump)</p>

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pressure wound treatment

DEBRIDEMENT:

- selective sharp or mechanical debridement

DRESSING:

- based on need

(manage moisture & bacteria)

MODALITIES:

-MIST ultrasound, e-stim, NPWT

PT:

- weight shifts, bed mobility, transfers, gait training, contracture management

<p>DEBRIDEMENT:</p><p>- selective sharp or mechanical debridement</p><p>DRESSING:</p><p>- based on need</p><p>(manage moisture & bacteria)</p><p>MODALITIES:</p><p>-MIST ultrasound, e-stim, NPWT</p><p>PT:</p><p>- weight shifts, bed mobility, transfers, gait training, contracture management</p>

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diabetic wound treatment

DEBRIDEMENT:

- remove/shave down periwound callus

DRESSING:

- based on wound needs

(manage moisture and bacteria)

MODALITIES:

- e-stim, MIST ultrasound, NPWT, hyperbaric O2

PT:

- gait training for off loading, AD training

- stretches & joint mobilizations for improved foot mobility