DPT 5381: Wound Care Modalities

what PT modalities are used in wound care?

- e-stim

- US: MIST, Arobella

- hyperbaric oxygen

- UV C treatments

what does the bioelectrical system communicate with?

skin and other body tissues calling repair cells to site of injury

when is there a change in voltage gradient or "current of injury"?

when injury occurs

initiated healing process

continues until healed

when is e-stim used?

when current of injury is stalled

dying tissues eliminated voltage gradient

what does e-stim transfer?

energy to a wound through electrical current

what is the electrode placement for e-stim?

one over wet medium in wound bed

one adjacent on intact skin

what are the effects of e-stim in wound care?

- increases blood flow and subsequently oxygen and other nutrients to promote wound healing

- decreases edema

- decreases pain

- increases fibroblast and collagen production

- improves scar tissue elasticity

e-stim indications

- stage II-IV pressure injuries

- venous ulcers

- traumatic/surgical wounds

- arterial ulcers

- donor sites

- flaps

- burns

e-stim contraindications

- osteomyelitis

- cardiac pacemaker

- malignancy

- placement of electrodes over heart, along phrenic nerve, over carotid sinus, over laryngeal musculature, over topicals with metal ions

what is the treatment protocol for e-stim?

pulse freq = 80-120 pps

intens = 100-150 V

tx time = 45-60 min

duration = 3-7 days/week

what needs to be done prior to e-stim?

- educate pt.

- prep wound

- irrigate w/ saline

- fill dead space

what can be used to fill dead spaces prior to e-stim?

moist gauze or hydrogel

e-stim negative polarity

- epidermal migration

- debridement of necrotic tissue

- decreases edema

- attracts neutrophils if wound is infected

- increases blood flow to promote tissue growth

- wound contraction

how does e-stim negative polarity increase BF to promote tissue growth?

attracts lymphocytes, platelets, epidermal cells and keratinocytes

how does e-stim negative polarity facilitate wound contraction?

- fibroblast proliferation to increase collagen production

- stim granulation tissue formation

e-stim positive polarity

- most effective to promote proliferative phase of wound healing

- attracts macrophages

- maintains low bacterial count

- epithelial growth

- granulation tissue formation

when should e-stim be discontinued?

if there are no measurable healing signs in 30 days or wound bed has re-epithelialized

what is MIST therapy?

painless, non-contact US waves transmitted to wound using saline

what does MIST therapy promote?

- healing thru cell stim

- removes bacteria and bioburden

- reduces inflammation and increases BF

what are the indications for MIST therapy?

- cleansing of wounds with necrotic tissue, exudate or bacteria

- acute

- traumatic

- chronic

- dehisced surgical wounds

what are the MIST therapy parameters?

freq = 40 KHz

intens = 0.1 W/cm2

duration = 3x/week 3-20 min

what do wounds need to heal?

oxygen

what does hyperbaric oxygen do?

increased pressure increases and improves oxygen in blood supply and damaged tissue

enhanced solubility of oxygen in blood

what are the parameters of HBO?

14.7 psi

60-90 min

HBO purposes:

- angiogenesis

- phagocytosis

- collagen Synthesis

- cell division

- decrease edema

what does HBO require?

24/7 physician oversight

HBO indications

- acute ischemia

- neuropathic

- thermal burns

- crush injuries

- skin grafts, muscle

- flaps

- radiation necrosis

- gas gangrene

- necrotizing infections

- osteomyelitis

HBO contraindications

- DVT

- phlebitis

- severe ischemic ulcers

- CHF (relative)

- COPD

- untreated pneumothorax

- antineoplastic medications

HBO complications

- flammable items in chamber

- ear injuries

- cardiopulmonary issues

- temporary vision impairments

- CNS oxygen toxicity seizures

what modality is not generally accepted, does not receive Medicare reimbursement, augments immune function, increases granulation, and is applied directly to the wound?

topical HBO

what modality is FDA approved for open wounds for bactericidal effects?

UV C

chronic wounds, esp with drug-resistant organisms

what wavelength of UV C is used?

254 nm

what does UV C impact?

DNA sequence within bacterial cells that prevents duplication and replication of DNA causing cell death

UV C contraindications

- acute eczema, dermatitis, psoriasis

- cancerous growths

- eyes

- hepatic disease

- herpes simplex

- hyperthyroidism

- pulmonary tuberculosis

- lupus

UV C precautions

- generalized fever

- malignant wounds for palliative care

- photosensitivity

- photosensitizing medications

- recent x-rays or other radiation treatments

- skin cancer history

UV C adverse effects

- burning

- itching

- pain

how is UV C applied?

1. WEAR EYE PROTECTION

2. cover periwound with UV block or draping

3. light held 1 inch away

4. 30-60 seconds

when should treatment of UV C be stopped?

if pt. complains of adverse effects