ES FOR WOUND HEALING

Electrical stimulation for tissue healing and repair / wound healing

Tissue regen

Edema control

Improved circulation

Would healing process

Homeostasis

1. Inflammation

2. Proliferation

3. Maturation

What facilitates inflamm response

Blood clots

Inflammatory phase

inc fibroblastic activity

Macrophages proliferate & migrate to injured area

Proliferative phase

Fibroblast proliferation @ area of injury

In the proliferative phase: ES = promote __ by imitating the _/naturally-occuring electrical currents that attract the appropriate cells to facilitate wound healing

Soft tissue healing

Endogenous

G_ happens during the proliferative phase

Galvanotaxis

Galvanotaxis

Attracts cells to wound area

Activates cells through alteration of cell mem func

Enhances anti-microbial activity

Galvanotxis promotes circulation = _ edema & _ soft tissue oxygenation

dec

inc

Inflammation phase: Inc permeability of vessels = __ BF = _ circulating cells

Inc

Inc

During the remodeling phase, Type __ collagen replaced by type _ collagen

III
I

What happens in:

Homeostasis

Inflammation

Proliferation

Remodeling

Tissue damage/injury (clot formation)

Vascular and cellular response

Fibroblasts, angiogenesis, epithelial cells

Reabsorption, replacement, reorientation

Types of Currents for Wound Healing

Microcurrents / Low-Intensity Direct Currents (LIDC)

High Voltage Pulsed [Galvanic] Current (HVPGC / HVPC)

Russian Currents (MFBurstAC)

Biphasic Pulsed Currents (BPC)

Monophasic waveform that is continuous or pulsed modulated with polarity reversal

LIDC

Peak amplitude of LIDC

999 μA / <1mA

LIDC uses constant _

current

Twin peak monophasic pulses

HVPC

Peak voltage of HPVC

500V

Pulse duration of HVPC

10-100 usec

HVPC uses constant _

voltage

MFBurst AC has a continuous _ wave output of about _

sine

2,500-5,000 Hz

Modulated to yield 50 bursts/sec

MFBurstAC

MFBurstAC: Each burst is _ time-modulated AC

polyphasic

What is used when muscle contraction is required to reduce edema

BPC

Normal Skin Battery: Loc

Bw stratum corneum and dermis

Direct current bioelectrical system to maintain tissue health

Normal skin battery

Current flow shift to the injured area→ __

“Current of Injury”

__ or HVPC mimics and __ the weak human skin batteries at the wound site

Microcurrent

amplifies

Cell migration is aka

galvanotaxis

Physiological basis: General effects

Galvanotaxis

Galvanotaxis: Electrical stimulation promotes tissue healing by ionic effects→ __

attract or repels charged particles

Galvanotaxis is d/t _

polarity

Effects of ES on wound healing at cellular level: Inflammation

Macrophages migration & activation

Antibacterial effect

Effects of ES on wound healing at cellular level: Proliferation

Epidermal cell migration & proliferation

Vascular epithelial cell migration & sensitivity

Fibroblast migration, proliferation, activation

Myofibroblast creation & activation

Effects of ES on wound healing at cellular level: Remodeling

Epidermal cell migration & proliferation

Fibroblast migration, proliferation, activation

Myofibroblast creation & activation

Effects of ES on wound healing at systemic level: Inflamation

Faster inflamm phase

Vasodilation; tissue regen, BF, & skin temp

Effects of ES on wound healing at systemic level: Proliferation

Angiogenesis

Wound contraction

Collagen synthesis

Re-epithelialization

Effects of ES on wound healing at systemic level: Remodeling

Angiogenesis

Wound contraction

Collagen synthesis

Re-epithelialization

Advanced remodeling

Galvanotaxis: Cells migrating toward the anode

Neutrophils

Vascular endothelial cells

Macrophages

Galvanotaxis: Cells migrating toward the cathode

Monocytes

Fibroblasts

Epidermal cells

Anode (_) = __ ; Cathode (_) = _

Anode (+) = inflamm phase

Cathode (-) = prolif & maturation

Inflammation phase: Effect __: Cell polarity _

Phagocytosis & autolysis

Macrophages (-) & Neutrophils (-)

Proliferative phase: Effect __: Cell polarity _

Fibroplasia

Fibroblasts (+)

Maturation phase: Effect __: Cell polarity _

Wound contraction

Keratinocytes (+), Epidermal cells (+)

General Effects: Inflammation phase

Initiates the wound repair by its effect on the current of injury

Inc blood flow

Promotes phagocytosis

Inc tissue oxygenation

Controls infection

Solubilizes blood products including necrotic tissue

General Effects: Proliferative phase

Stimulates fibroblasts and epithelial cells

Stimulates DNA and protein synthesis

Stimulates wound contraction

Inc ATP generation

Improves membrane transport

Produces better collagen matrix organization

General Effects: Maturation phase

Stimulates epidermal cell reproduction and migration

Produces a smoother, thinner scar

General Effects: Germicidal effect: Inhibiting the growth of action of microorganisms

Escherichia coli

Pseudomonas aeruginosa

Staphylococcus aureus

General Effects: Germicidal effect: Conflicting evidences whether _ or __

anode or cathode

Edema control: Indicated or contraindicated

d/t inflamm

d/t immob

d/t systemic disorders

indic

indic

contra

Edema control d/t inflam

ES to retard edema formation

ES cant dec edema

Edema control d/t inflam: Use of → __ repels _ charged proteins back to BV and reduces _ size in microvessel walls

cathode

neg

pore

Edema control d/t inflam: Stimulation

HVPC @ sensory lvl stimulation

Edema control d/t immob

M contraction → pumping effect

ES should be used c limb elevation followed by compression

Improve Circulation: Conflicting evidences in improving circ via __

m. contraction

Indications

Wound healing

• burns, ulcers (pressure, neuropathic, vascular), surgical wounds

Infections

Retardation & reduction of edema

Inc BF

Dosimetry: Wound healing: LIDC mode

Cont/pulsed

Dosimetry: Wound healing: LIDC polarity

Neg cells → anode

Pos cells → cathode

Dosimetry: Wound healing: LIDC pulse freq

Cont: 0Hz

Pulsed : 1-200 Hz

Dosimetry: Wound healing: LIDC Pulse duration

-

Dosimetry: Wound healing: LIDC Amplitude

comf, tingling (1-999 uA)

Dosimetry: Wound healing: LIDC time

30-90 mins

Dosimetry: Wound healing: HVPC mode

pulsed

Dosimetry: Wound healing: HVPC polarity

neg cells → anode

pos cells → cathode

Dosimetry: Wound healing: HVPC pulse freq

60-125 pps/Hz

1-200 Hz

Dosimetry: Wound healing: HVPC Pulse duration

40-100 usec

Dosimetry: Wound healing: HVPC amplitude

Comfortable tingling (150-500 V)

Dosimetry: Wound healing: HVPC time

45-60 min

30-90 min

Dosimetry: Edema control: Inflamm waveform

HVPC

Dosimetry: Edema control: Inflamm mode

pulsed

Dosimetry: Edema control: Inflamm polarity

neg cells → anode

Dosimetry: Edema control: Inflamm pulse freq

100-120 pps/Hz

Dosimetry: Edema control: Inflamm pulse duration

40-100 usec

Dosimetry: Edema control: Inflamm amplitude

comf tingling

Dosimetry: Edema control: Inflamm time

20-30 min

Dosimetry: Edema control: Immob waveform

BPC

Dosimetry: Edema control: Immob mode

pulsed

Dosimetry: Edema control: Immob polarity

N/A

Dosimetry: Edema control: Immob pulse freq

30-50 pps/Hz

2-5s equal on:off time

Dosimetry: Edema control: Immob pulse duration

150-350 usec

Dosimetry: Edema control: Immob amplitude

visible contraction

Dosimetry: Edema control: Immob time

20-30 min

Dosimetry: Inc BF: Circulation Waveform

BPC

Dosimetry: Inc BF: Circulation Mode

Pulsed

Dosimetry: Inc BF: Circulation Polarity

N/A

Dosimetry: Inc BF: Circulation pulse freq

30-50 pps/Hz

1-2s equal on:off time

Dosimetry: Inc BF: Circulation pulse duration

150-350 usec

Dosimetry: Inc BF: Circulation amplitude

visible contraction

Dosimetry: Inc BF: Circulation time

20-30 min

Considerations

Electrode placement

Infection control

Electrodes

Considerations: electrode placement

Over wound

Around wound

Considerations: Infection control

Wrap pads c gauze

Saturate c normal saline solu

Antiseptic techniques

Considerations: Electrodes

Warmer than wound but not warmer than 38ºC

Docu

ES using <machine> on <body area> x <waveform> x <active electrode> x <pulse frequency> x <pulse duration> x <treatment duration> to <rationale>