ELECTRICAL STIMULATION FOR TISSUE HEALING Flashcards
4 stages of wound healing
Hemostasis
Inflammation
Proliferation
Maturation
Cascade of initial hemodynamic reactions where in
the platelet will aggregate to stop/control the
bleeding
• Followed by influx of various inflammatory cells
Hemostasis
first line of defense for any tissue
injuries
Neutrophils
Hemostasis process
Aggregation of platelet
Influx of neutrophils
Neutrophils release mediators & cytokinesis
cells responsible for cleaning the wound and
protecting it from injuries
Neutrophils, macrophages, and lymphocytes
Inflammatory process
Neutrophils, macrophages, and lymphocytes cleaning of wound and protecting from injuries
Vasodilation of blood vessels (better circulation, inc vasopermeability) = inc heat, erythema, inc flow
Phagocytosis ( neutrophils and macrophages will migrate towards the area)
Lymphocytes = cellular immunity and antibody production + mediator
Inflammation would trigger the release of growth factor
Proliferation phase
Reconstruction part of wound healing
Cells are working in order to form granulation tissues
and to allow formation of new epithelial cells and
restore the function of skin and blood vessels
Fibroblast
-granulation of tissues
- myofibrolast = wound contraction + inc tissue strength
- collagen synthesis
-protoglycan, ground substance=collagen- based scar tissue
-matrix deposition
Angiogenesis
- blood vessels
- endothelial cells= migration & replication= new blood vessels formation
Epithelial cells
-coverings, skin
- re-epithelialization
Remodelling phase
Cells are becoming more mature
• Maturation phase
• Can start early during the 3rd week or after a month,
or even up to a year
• Collagen remodels to ensure better tensile strength
of the healed area
o Collagen is reorganized and reoriented
Types of current for wound healing
Low intensity direct current
High voltage pulsed current
Russian current
Biphasic pulsed current
Monophasic waveform that is continuous or pulsed
modulated with polarity reversal
LIDC
Type of current and peak amplitude of LIDC
amp: 99 ma
Type: constant
Twin-peak monophasic pulses
o 2 high peaks that are seen in the waveform
HVPC
Peak voltage of hvpc, pulse duration, type
500 V, 10-100 msec, constant
MFBurstAC wave, wave output, burst, type
Sine, 2500-5000 Hz, 50 burst per sec, polyphasic time-modulated AC
The human epidermis exhibits a natural endogenous
battery
o Generates small electric current when we
are wounded
Normal skin battery
Location of normal skin battery
Between stratum corneum and dermis
system to maintain tissue
health
Direct current
mimics and amplifies the weak
human skin batteries at the wound site
Microcurrent
Attraction of cells to an electrical charge
Galvanotaxis
key feature in wound healing
Polarity
Cells towards the anode
Neutrophils
Vascular endothelial cells
Macrophages
Cells towards the cathode
Monocytes, fibroblasts, epidermal cells, keratinocytes
Wound healing waveform
LIDC & HVPC
Lidc wound healing parameter
W, m, pf, pd, a, time
W: LIDC
Pf: cont 0 hz, pulsed 100-200 hz
Pd: n/a
Amp: comfortable tingling (1-999 mA)
Time: 30- 90 min
HVPC
W, m, pf, pd, a, time
W: HVPC
Mode: pulsed
pf: 60-125 pps, 1-200 hz
Pd: 40-100 msec
Amp: Comfortable tingling (150-500 V)
Time: 45 - 60 min, 30-90 mins
Edema Control waveform
HVPC (inflammation) /BPC (immobilization)
Edema d/t inflammation parameters
W, m, pf, pd, a, time
W: HVPC
M: Pulsed
Pf: 100-120 Hz
Pd: 40-100mSec
Amp: Comfortable tingling
Time: 20-30min
Edema d/t immobilization
W, m, pf, pd, a, time
W: BPC
M: Pulsed
Pf: 30-50 pps, 2-5 sec on:off time
Pd: 150- 350 usec
Amp: visible contraction
Time: 20-30min
Blood circulation
W, m, pf, pd, a, time
W: bpc
M: pulsed
Pf: 30-50 pps/hz, 1-2 sec on:off time
Amp
Visible contractions
Time: 20-30 min
Considerations
Electrode placement
o Over the wound: if wound is already closed
o Around the wound: if there are still infection
or aseptic issues
• Infection control
o Wrap electrodes with sterile gauze pads;
saturate pads with normal saline solution
o Observe proper aseptic techniques (use of
gloves, mask, gown and goggles)
• Electrodes
o Should be warmer than the wound but not
warmer than 380C
