Lecture 7: Bio-Physical Agents for Wounds

After 4 weeks of evidence based wound care, what % of venous wounds should have reduced?

40% area reduction

After 4 weeks of evidence based wound care, what % of diabetic foot wounds should have reduced?

50% area reduction

What are the most commonly used biophysical agents commonly used by PTs in wound care? (3)

• Negative pressure wound therapy

• Intermittent pneumatic compression

• Compression bandaging

E Stim: Indications

• What type of wound is E Stim most beneficial for?

• For reimbursement, must have received evidence- based wound care for at least how many weeks w little to no progress.

• Most Non-Healing Wounds

• 4 Weeks

HVPC:

• What is Treatment Set Up?

  • Usage and Frequency:

  • Direct Tx Method:

  • Indirect Tx Method:

• Anodal or cathodal use, 50 mins per day, 5x/wk for 8 weeks

• Direct tx:

  • Active electrode or alligator clip to wound, dispersive electrode 20 cm from wound

• Indirect tx:

  • Active electrodes next to wound, dispersive electrode 20 cm from wound

Why would we use negative pressure wound therapy (NPWT)?

To remove fluid from a wound or surgical site, promote proliferation, and approximate wound edges

What are the 3 main types of NPWT?

• Negative Pressure Unit

• TRAC Pad

• Foam or Gauze

In NPWT,

• Where is Foam directly applied?

• What does it provide?

• Foam applied directly to wound, Sealed into place

• Provides negative pressure to wound

NPWT:

• Define Foam Macrostrain:

visible stretch that occurs when negative pressure contracts the foam

NPWT:

• What occurs in Foam Macrostrain (3)

• Suction approximates wound edges

• Distributes negative pressure throughout the wound

• Pulls exudate and debris from wound

NPWT:

• Define Foam Microstrain

Microdeformation at the cellular level, which leads to cell sretch

NPWT:

• What occurs in Foam Microstrain (3)

• Promotes microcirculation

• Rromotes cell migration and proliferation

• Removes fluid, reducing edema

What are the Indications for using NPWT? (5)

• Non healing or chronic wounds

• Post surgical or traumatic wounds

• As a bridge to tertiary closure

• Skin grafts and flaps

• Enterocutaneous fistulas

What are the Precautions to using NPWT? (5)

• Pt on anticoagulants

• Elevated INR

• Low platelets

• Active bleeding

• Poor tolerance of VAC therapy

What are the Contraindications for NPWT? (4)

• Malignancy

• Untreated osteomyelitis

• Non electric and unexplored fistulas

• Majority of wound necrotic

  • Need 75% viable tissue

  • Need 25% eschar to use

What are the Economic Benefits of NPWT? (8)

REDUCED
1. length of stay
2. overall medical costs
3. hospital staff time
4. need for outpt visits
5. need for emergency care or readmission
6. amputations in pt's w diabetic foot ulcers
7. risk for other surgical procedures

8. more rapid wound closure of diabetic foot ulcers

What are some challenges for NPWT? (4)

• Wounds w enterocutaneous fistulas

• Wounds in close proximity to:

  • external fixators

  • moist areas

  • sacrum// coccyx / perineum

• Tubing

• Exposed Structures

What is the main Indications for Intermittent Pneumatic Compression?

Non healing venous leg ulcers

What are the 2 main benefits to intermittent pneumatic compression?

• Positive pressure to assist lymphatic system with limb drainage

• May enhance venous leg ulcer healing

What is the set up for intermittent pneumatic compression?

• Sleeve applied to affected limb

• Machine set to safe pressure for pt

• Therapy time generally 60 mins

what is the main Precautions for intermittent pneumatic compression?

Dermatitis or other skin conditions

What are the Contraindications for intermittent pneumatic compression?

• Cellulitis

• Infection

• Fluid overload from cardiac, kidney, or other organ failure

Compression bandaging applied what type of pressure to the leg?

Positive pressure applied to leg