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PHTH 550- Orthopaedic Management Final > Lecture 23: Wound Healing and Biophysical Agents > Flashcards

Lecture 23: Wound Healing and Biophysical Agents Flashcards

1
Q

What are the modalities that can be used for wound healing?

A

Electrical Stimulation Therapy

  • High Voltage Pulse Current
  • Low Intensity Direct Current

Therapeutic Ultrasound

  • Conventional
  • Low Frequency

Light therapy

  • UV
  • IF
  • Low level laser

Negative Pressure

Hydrotherapy
Intermittent Pneumatic Compression

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2
Q

What are the types of Chronic Wounds/Ulcers?

A

Pressure Ulcers
Venous Ulcers
Arterial Ulcers
Neuropathic Ulcers

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3
Q

Which biophysical agent has the best evidence to support it?

A

Electrical Stimulation Therapy

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4
Q

What is the endogenous bioelectrical potential of the skin?

A

There is a separation of charge b/w the interior and exterior of the skin (exterior is more negative relative to interior)
-This is b/c of the movement of sodium along the concentration gradient from external surface into the epithelial cells.

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5
Q

What effect does a positive bioelectric charge have?

A negative bioelectric charge?

A 
Postive bioelectric charge attracts: 
-Neutrophils
-Macrophages
-Epidermal cells
So if trying to achieve debridement use a positive electrode.

Negative bioelectric charge:
-Neutrophils (if wound is infected or inflamed)
-Fibroblasts
So if trying to stimulate new tissue deposition use a negative electrode.

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6
Q

What effect does a positive bioelectric charge have?

A negative bioelectric charge?

A 
Postive bioelectric charge attracts: 
-Neutrophils
-Macrophages
-Epidermal cells
So if trying to achieve debridement use a positive electrode.

Negative bioelectric charge:
-Neutrophils (if wound is infected or inflamed)
-Fibroblasts
So if trying to stimulate new tissue deposition use a negative electrode.

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7
Q

What are the proposed effects of electrical stimulation?

A
  1. Stimulation of: collagen synthesis, ATP, capillary density, collagen organization and wound strength.
  2. Reduce/prevent edema
  3. Antibacterial effects
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8
Q

What are indications of electrical stimulation therapy?

A
  1. Chronic wounds: diabetic, Pressure ulcers, pvd.
  2. Failure to heal using conventional care (no signs of clinical healing after 14 days)
  3. PMHx of impaired healing.
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9
Q

What are indications of electrical stimulation therapy?

A
  1. Chronic wounds: diabetic, Pressure ulcers, pvd.
  2. Failure to heal using conventional care (no signs of clinical healing after 14 days)
  3. PMHx of impaired healing.
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10
Q

What are some factors that affect the healability of a wound?

A
  • Medical Status: anemia, malnutrition, hyperglycaemia
  • Blood Flow-ABPI normal=0.9, abnormal <0.8 and severe <0.5
  • Patient Compliance
  • Chronicity of ulcer: likely healing of ulcer decreases w/ time.
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11
Q

What is high-volt pulsed current?

What is the difference w/ LIDC?

A

HVPC:
Peak voltage: 150 to 500 V
Short Pulse Duration: 50-100 usec
Frequency: 1 to 120 Hz

  1. Low-Intensity Direct Current
    Amplitude<1mA (10-3A)
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12
Q

How are the electrodes applied in electrical stimulation therapy?

A
  • Electrodes can be reused but only for the same pt.
  • Always use 2 electrodes (1 accumulates negative charge( cathode) and 1 accumulates positive charge (anode)
  1. Active (treatment) electrode: directly over the treatment area (wound)
  2. Reference (dispersive) electrode: away from the treatment site (on intact skin)
    - At least 2X side of active electrode.
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13
Q

What polarity of current should be used for the following treatment goals?

A. Debridement 
B. Infection 
C. Granulation 
D. Wound Contraction 
E. Epithelialization
A

Electrical current will affect cellular movement and physiological factors guiding tissue healing: enhanced, stopped, reversed.

A. Use an anode to recruit macrophages

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14
Q

Is there evidence to support the use of estim for wound healing?

A

Yes, good evidence supports the use of LIDC and HVPC for speeding tissue healing for venous, ischemic and pressure ulcers along w/ burns.

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15
Q

What types of US are available for wound healing?

A
  1. Conventional US: same as before
    Application: 3MHz, 20% duty cycle, 0.1-0.2W/cm2, 3-5X/wk, calculate duration using equation from US lecture.
  2. Low-Frequency US (LFUS)
    - Gaining popularity
    - Frequency is 20 to 40 KHz (lower than conventional MHz).
    - Same principles as conventional US, except different machine is used.
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16
Q

What types of US are available for wound healing?

A
  1. Conventional US: same as before
    Application: 3MHz, 20% duty cycle, 0.1-0.2W/cm2, 3-5X/wk, calculate duration using equation from US lecture.
  2. Low-Frequency US (LFUS)
    - Gaining popularity
    - Frequency is 20 to 40 KHz (lower than conventional MHz).
    - Same principles as conventional US, except different machine is used.

Subtype: Non-contact low frequency US (NCLFUS)

  • Uses a fine saline mist
  • I: 0.2-0.6 W/cm2
  • F: 40 KHz
17
Q

What types of US are available for wound healing?

A
  1. Conventional US: same as before
    Application: 3MHz, 20% duty cycle, 0.1-0.2W/cm2, 3-5X/wk, calculate duration using equation from US lecture.
  2. Low-Frequency US (LFUS)
    - Gaining popularity
    - Frequency is 20 to 40 KHz (lower than conventional MHz).
    - Same principles as conventional US, except different machine is used.

Subtype: Non-contact low frequency US (NCLFUS)

  • Uses a fine saline mist over wound, then US is delivered through that mist.
  • I: 0.2-0.6 W/cm2
  • F: 40 KHz
18
Q

What have In Vitro studies shown about conventional US?

A
  • Alters ca uptake and growth factor production (inflammatory phase)
  • Increases fibroblast activity, collagen deposition (proliferative phase)
  • Increases rate of angiogenesis, formation of capillary beds and BC (proliferative phase)

This suggests that US is a potentially useful modality, studies were in the lab.

19
Q

What are the methods for applying conventional US to a wound?

A

Peri-ulcer: Apply US to skin around the wound.

Water-Bath: Put site being treated in a water bath and conduct US through water

Over ulcer: fill ulcer w/ a saline solution or hydrogel and cover w/ a dressing.

20
Q

Is there evidence to support the use of conventional US? NCLFUS?

A

Ontario Health Quality (meta-analysis)
No evidence at this time for a benefit of using US therapy in treatment of pressure ulcers.

NCLFUS: Limited research, possibly faster wound healing and bacterial reduction.

PHTH 550- Orthopaedic Management Final (13 decks)

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