E-stim for tissue healing

Question 1

Wound healing: inflammatory stage

Answer 1

• hemostasis: blood clotting due to platelets binding and adhering to periphery of wound
• phagocytosis- driven by macrophages, monocytes, inactive neutraphils; breakdown and elimination of bacteria/foreign substances and -Autolysis=breakdown of other foreign debris
• Fibroblast migration

Question 2

Wound healing: hemostasis

Answer 2

• blood clotting occurs platelets bind and adhere to collagen of periphery of injured tissue
• platelets attract other cells> kemotatic influence
• some cells attracted= macrophages, monocytes, and inactive neutraphils

Question 3

Wound healing: proliferation stage

Answer 3

• collagen synthesis
• angiogenesis= new BVs; critical for nutrients for healing
• epithelialization
• wound contraction

Question 4

Wound healing: maturation stage

Answer 4

• collagen lysis

- collagen replacement

Question 5

Factors that impede wound healing

Answer 5

• some systemic medications
• • corticosteriods, aspirin, indomethacin?
• some topical medications
• *iodine- can kill cells that help with healing
• malnutrition
• prolonged pressure or stretch-
• • interrupt development of capillaries (angiogenesis) disrupting blood supply
• infection
• immunodificency
• • impairment to inflammatory response
• smoking
• dryness or necrotic tissue

Question 6

Assessment of chronic wounds:

Answer 6

Size
- Surface area: 
**tape measure width and length of wound @ greatest pt
**most commonly measured
-depth
-volume
** look at total volume of wound
** create (-) mold of wound, volume measured by displacement of model
description of wound base
assessment of periwound tissue
Drainage of wound
- clear or pinkage drainage w/out odor= inflammatory stage
- yellow/cloudy drainage= infection

Question 7

Types of chronic wounds

Answer 7

• Pressure sores
• arterial insufficiency ulcers
• venous insufficiency ulcers
• Diabetic ulcers

Question 8

Pressure sore

Answer 8

• Area of local tissue loss due to prolonged tissue compression between boney prominences and external surfaces
• Common locations
• • sacrum, heels, ischial tuberosity, greater trochanter, malleoli
• etiology:
• • compression of tissue reduces blood perfusion in tissues and produces necrosis

Question 9

Stages of pressure sores

Answer 9

• Stage 1: non-blanchable erythema of intact skin
• Stage II: partial thickness skin loss to epidermis, dermis, or both
• Stage III: full thickness skin loss including damage to subcutaneous tissue
• Stage IV: full thickness skin loss with destruction or damage to muscle, bone, or support structures

Question 10

Arterial insufficiency ulcers

Answer 10

• area of local tissue loss due to arterial blood supply deficiency
• common locations:
• • on foot, over malleoli, toe joints, lateral foot border
• Etiology:
• • arteriosclerosis, arterial occlusion (ex thrombosis), arterial disruption

Question 11

Venous insufficiency ulcers

Answer 11

• area of local blood loss due to deficiency in venous drainage
• common locations:
• • above the ankle, medial lower leg
• etiology:
• *sustained venous hypertension, venous valvular dysfunction

Question 12

Diabetic ulcers

Answer 12

• area of local tissue loss due to sensory neuropathy and arterial blood supply deficiency
• common locations:
• *plantar surface of foot, over heel, lateral border of foot, plantar surface of metatarsal heads
• etiology:
• • tissue trauma in insensate tissue, PVD

Question 13

biological effect of electricity: electrochemical

Answer 13

Formation of new chemical compounds

• negative electrode
• • 2 Na + 2 H20 > 2 NaOH + H2 (alkaline)
• positive electrode
• • 2 Cl2 + 2H20 > 4 HCL + O2 (acid)

Question 14

biological effect of electricity: electrophysical

Answer 14

• electrokinetic effect- ion movement
• negative electrode = attraction of + ions, drive (-) electrodes away
• ex. depolarization of excitable membrane

Question 15

biological effect of electricity: electrothermal

Answer 15

• Microvibration of charged particles produces heat
• H= 0.24 x I^2 x R x t
• • H=heat produced
• • I= RMS amp current
• • R= impedance of tissue
• • t= time
• High RMS, high skin impedance and prolonged treatment time increase thermal effect

Question 16

Physiological effects of E-Stim that benefit wound healing

Answer 16

• Galvanotaxis= ability to attract ions
• collagen synthesis
• proliferation of fibroblasts
• angiogenesis and wound microperfusion
• bacteriacidial
• enhanced rate of epithelialization
• enhanced blood flow to wound

Question 17

Galvanotaxis of cells during the phases of healing: inflammatory

Answer 17

• macrophages- negative > phagocytosis

- inactive neutrophils- negative > autolysis

Question 18

Galvanotaxis of cells during the phases of healing: proliferation

Answer 18

-Fibroblasts- positive > collagen fomation

Question 19

Galvanotaxis of cells during the phases of healing: maturation

Answer 19

• myofibroblasts- positive > wound contraction
• keratinocytes- positive > epithelialization
• epidermal - negative > epithelialization

Question 20

Collagen Synthesis and Proliferation of Fibroblasts study

Answer 20

• Stimulation of human fibroblast cell culture
• cathode > protein synthesis in fibroblasts increased 160% over control
• parameters: 50-75 V and 150 pps

Question 21

Stimulation of Angiogenesis and Wound Microperfusion study

Answer 21

• Cathode 7-14 treatments followed by anode 3-10 days followed by cathode
• 44% increase in capillary density
• 82% increase in transcutaneous oxygen partial pressure

Question 22

Enhancing the Rate of Epithelialization study

Answer 22

• Partial thickness wounds in pigs
• Anode x 7 days or cathode day 1 and anode x 6 days  wound closure in 6 days
• Cathode  62% closure in 6 days

Question 23

Enhanced Blood Flow to Wound study

Answer 23

• Rectangular, balanced, biphasic pulsed current
• 250μs pulse duration, 30 pps x 5 minutes
• 50% greater ave blood flow measured with laser doppler

Question 24

Types of current used in wound healing: low intensity direct current (DC)

Answer 24

• Amplitude: 200-800 mA
• tx duration: 1-2 hours
• tx per day: 1-3 per day
• Tx days per week: 5-7 days per week

Question 25

Types of current used in wound healing: high volt pulsed current (HVPC)

Answer 25

- Pulse amp: 100-150 V peak - pulse duration: 100 usec - pulse frequency: 30-130 pps - mode: continuous - tx duration: 30-60 mins - tx per day: 1-2 - tx day per week: 5-7 days

Question 26

HVPC

Answer 26

Twin peaked monophasic pulse - pair of monophasic spike like waveforms - almost instantaneous rise followed by exponential decline - pulse duration: short * * 100-200 usec

Question 27

Types of current used in wound healing: rectangular monophasic pulsed current (RMPC)

Answer 27

- Pulse amp: 30-35 mA peak - pulse duration: 150 usec - pulse frequency: 64-128 pps - mode: continuous - tx duration: 30 mins - tx per day: 2 - tx days per week: 7 days

Question 28

Types of current used in wound healing: biphasic pulsed current (rectangular asymmetric)

Answer 28

- pulse amp: strong sensory; just less than motor level - pulse duration: 100 usec - pulse frequency: 50 pps - mode: continuous - tx duration: 30 mins - tx per day: 3 - tx days per week: 5-7 days

Question 29

The human battery

Answer 29

- outside of skin has negative chare - inside of skin has positive charge - with injury, polarity shifts * * outside> positive * * inside> negative

Question 30

Polarity used in wound healing: protocol 1

Answer 30

- Protocol 1 | * * cathode over wound days 1-5

Question 31

Polarity used in wound healing: protocol 2

Answer 31

- Protocol 2 * * cathode over wound if infected with E. coli, P aeruginosa * * anode over wound if infected with S. aureas

Question 32

Polarity used in wound healing: protocol 3

Answer 32

Based upon type of healing clinician wants to induce - anode: attract macrophages, and neutrophils to stimulate phageocytosis and autolysis - cathode: attract fibroblasts to increase granulation tissue; stimulate myofibroblast to increase wound contraction; stimulate keratinocytes to increase rate of re-epithelialization

Question 33

Polarity Used in Wound Healing: protocol 4

Answer 33

Based upon electrochemical response in tissues being stimulated - Cathode – solubilize, liquefy, soften tissue -Anode – stimulate epithelialization

Question 34

Cathode – NegativeTherapeutic Effects

Answer 34

- Increased blood flow - Galvanotaxic for * *activated neutrophils, fibroblasts, lymphocytes, platelets, mast cells, keratinocytes - Enhances growth of granulation tissue - Induces epidermal cell migration - Antimicrobial

Question 35

Anode – Positive Therapeutic Effects

Answer 35

- Galvanotaxic for: * *macrophages, epidermal cells, inactive neutrophils, - Promoted growth and reorganization of epithelial cells - Decreases mast cells in healing wounds - Vasoconstriction - Decreases blood flow - Antimicrobial

Question 36

Physiological and Therapuetic Effects

Answer 36

Reduce edema formed with acute injury and inflammation - -Negative pole (Theories) * *Repel negatively charged serum proteins * *Reduce microvessel diameter * *Reduce pore size

Question 37

Edema Reduction Parameters

Answer 37

- Waveform: HVPC - Pulse Duration: 40 – 100 μsec. - Polarity: Negative - Frequency: 100 – 200 pps - On/off time: continuous - Current amplitude: comfortable sensory - Treatment time: 20 – 30 minutes