Biophysical Treatments for Wounds

biophysical treatments for wounds

estim, ultrasound, hyperbaric oxygen, light therapy

e-stim promotes wound healing by

changing epidermal polarity, cell migration/function, bloodflow, edema and wound contraction - decreases bioburden and improves autolysis

if a wound being treated with estim stalls

change polarity of treatment every 3rd day to promote proliferation (switch placement of anode and cathode)

changing the electrode placement/polarity every other day for estim may

trigger epithelialization (change every 3 days)

estim is approved for reimbursement by medicare if

wound is considered chronic and they have not responded to traditional wound care treatment in 30 days

estim contraindications

malignancy, untreated osteomyelitis, electrical implants, heart, metallic products/dressings, active bleeding, pregnancy

estim application

can place pad directly in the wound with a saline moistened gauze, put a larger dispersive pad elsewhere on the body (further away) (2x larger)

treatment and dispersive pads should be placed

10-15cm apart

chronic wounds (based on medicare)

ulcers have not healed within 30 days of occurrence (accompanied by standard care with coverage)

ultrasound for wounds

increases bloodflow, reduces bioburden and enhances all 3 phases of wound healing, debridement and pain reduction

ultrasound for wound care works via

nonthermal effects of cavitation and microstreaming

US in inflammatory phase

changes cell permeability and release GF and enzymes

US in proliferative phase

accelerate granulation tissue - increase migration of fibroblasts and endothelial cells

US in remodeling phase

provides stronger more organized collagen

low frequency US can

liquify nonviable tissue via unstable cavitation (no pain caused to patient)

US contraindications

growth plates, malignancy, near joint cement or pacemaker, over heart, over untreated osteomyelitis or DVT

dont use thermal settings over

arterial insufficiency or acute inflammation, caution with bleeding or with decreased sensation

hyperbaric oxygen therapy

oxygen under pressure, breathing in a special chamber where the air is 100% O2 - need to breath in (doesn't work local to limb/wound)

HBO works by

increases carrying capacity of O2 to the wound which increases all healing factors

HBO indications

gas gangrene, ischemia, thermal burns, necrotizing infections, compromised flaps or grafts, osteomyelitis

HBO absolute contraindications

untreated pneumothorax

HBO precautions

emphysema, CHF, HTN

light therapy

low level laser therapy ultraviolet C

UVC used in

chronic wounds because of its bactericidal effects (FDA approved and reduced risk of skin cancer that is associated with UVA and UVB)

contraindications to UVC treatment

acute eczema, dermatitis, psoriasis, cancer, cardiac disease, diabetes, lupus, renal disease

UVC treatment parameters

30-60sec treatments, not more than 180 - daily for 5 days (hold 1in away from wound bed)

precautions of LLT

over eyes, 3rd trimester pregnancy, cancerous growth, over thyroid

dosing of LLT

1x/day, 5 days/week - apply over transparent film dressing on wound