3/21/2024

Wound Treatment Optio

Integumentary assignment 1

Name: Rumesa Bint e Siddiq

Roll no.: 203
Enrollment No.: 06-112201-044
DPT Batch IV
Submitted to: Dr. Prem Lata
 WOUND TREATMENT OPTIONS:
MOIST WOUND THERAPY AND DRESSING OPTIONS:
 A dressing is a sterile pad or compress applied to a wound healing and prevent further harm.
 The essential function of a wound dressing is to provide the right environment to enhance and promote wound
healing.
 Moist wound dressings create an optimal environment for wounds to heal faster and with less scar formation.

Ideal Dressing Properties:

 Remove excessive exudate from your wound but will not allow the wound to dry out so as to maintain a moist
environment.
 Will allow gaseous exchange so that oxygen water vapor, and carbon dioxide can pass into and out of the dressing.
 Will be thermally insulating to maintain the wound core temperature at approximately 37°C.
 Will be impermeable to microorganisms to minimize contamination of the wound from outside of the wound.
 Will be free from either particles or toxic contamination.
 Will be non-traumatic and will not adhere to the wound, so that on removal no damage is done to granulating
tissue.

Major Dressing Categories:

Dressing Type
Absorptive Dressings
Characteristics Pictures
 Highly absorbent dressing materials,
such as cotton or cellulose fibers
 Absorb exudate from the wound
surface, maintaining a dry
environment
 May require frequent changing in
heavily exuding wounds

Antimicrobial Dressings  Contains agents such as silver, iodine,

or honey with antimicrobial
properties
 Helps reduce bacterial colonization
and infection risk
 Can be effective in managing infected
wounds or preventing infection in
high-risk wounds

Contact Layer Dressings  Non-adherent dressing placed

directly on the wound surface
 Prevents trauma during dressing
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 Allows exudate to pass through to a

secondary absorbent dressing
Collagen Dressings  Contains collagen derived from
various sources, promoting tissue
regeneration and wound healing
 Provides a scaffold for cell migration
and granulation tissue formation
 Enhances wound closure and re-
epithelialization

Composite Dressings  Combination of multiple layers, such

as foam, film, or hydrocolloid
 Provides a balance of moisture
control, absorption, and protection
 Can be tailored to specific wound
types and exudate levels

Calcium Alginate  Derived from seaweed and forms a

Dressings gel when in contact with wound
exudate
 Highly absorbent, suitable for heavily
exuding wounds
 Facilitates autolytic debridement and
conforms to wound shape
 Provides hemostasis
 Used in infective wounds
Foam Dressings  Absorbent dressing with a foam-like
structure
 Absorbs excess exudate while
maintaining a moist wound
environment
 Provides cushioning and protection
to the wound site
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Honey (Active
Leptospermum)  Natural antimicrobial properties due
to high sugar content and low pH
 Creates a moist environment
conducive to wound healing
 Promotes autolytic debridement and
reduces malodor

Hydrogel Dressings  Gel-like dressing containing water or

glycerin
 Maintains moisture at the wound site
 Soothes and cools the wound surface
 Aids in autolytic debridement

Hydrocolloid Dressings  Absorbent dressing that forms a gel

when in contact with wound exudate
 Creates a moist environment
conducive to healing
 Provides a barrier against bacteria
and other external agents
 Provides waterproof surface
 Used for bed sores prevention
 Aids in autolytic debridement
Transparent Film Dressing  Thin, flexible film that adheres to the
skin
 Provides a moist environment for
wound healing
 Protects against external
contaminants
 Enables autolytic debridement
 Can remain in place for one week
 Waterproof

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HYPERBARIC OXYGEN THERAPY (HBOT):

 HBOT is defined as treatment during which a patient inhales 100% oxygen while enclosed in a pressurized chamber
exceeding 1.4 atmospheres absolute (ATA).

Physiological Effects of HBOT:

 Hyperoxygenation of ischemic tissue
 Angiogenesis
 Vasoconstrictive effects of oxygen
 Improved wound metabolism
 Up-regulation of growth factors
 Antibacterial effects
 Antioxidant effect

Indications:
 Air or gas embolism
 Carbon monoxide poisoning
 Carbon monoxide poisoning complicated by cyanide poisoning
 Clostridial myositis and myonecrosis (gas gangrene)
 Crush injury, compartment syndrome, and other acute
traumatic ischemias
 Decompression sickness
 Arterial insufficiencies (enhancement of healing in selected
problem wounds)
 Central retinal artery occlusion
 Severe anemia
 Intracranial abscess
 Necrotizing soft tissue infection
 Osteomyelitis (refractory)
 Delayed radiation injury (soft tissue and bony necrosis)
 Compromised grafts and flaps
 Acute thermal burn injury
 Idiopathic sudden sensorineural hearing loss

THE ROLE OF PHYSICAL THERAPY IN

WOUND CARE:
 Physical therapy is a non-invasive and non-pharmacological
approach to healing wounds.
 It can help promote healing, reduce inflammation, and
prevent complications related to wounds.
 Physical therapy can also be beneficial for patients who have
sustained a variety of different types of wounds, including
surgical wounds, pressure ulcers, and traumatic wounds.
 It can also be useful for patients who have developed complications related to wound healing, such as lymphedema
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or muscle atrophy.
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 Physical therapists may utilize several wound care techniques such as therapeutic exercise, manual therapy,
electrical stimulation, and help with wound care dressings.
 These techniques aim to promote tissue healing, reduce swelling, and increase circulation to the affected area.
PHYSICAL THERAPY INTERVENTIONS:
Laser Therapy for Wound Healing:
 Laser Therapy for Wound Healing, also known as Low Level Laser Therapy (LLLT), Photo biomodulation Therapy
(PBMT) or Red-Light Therapy, uses specific light wavelengths in the 600-800nm range of visible and invisible light
(infrared and near infrared) to trigger a biological process of photo biomodulation, which generates energy at a
mitochondrial level to intensify the healing
process.
 Low Level Laser Therapy, or Therapeutic Laser
is successfully used for:
 Post-operative wound care and healing,
including C Section procedures.
 Scar prevention and reduction.
 Breast enhancement surgery and facial
aesthetic surgery recovery.
 Rapid healing of pressure sores, also
known as bedsores.
 Accelerated healing of ulcers and burns.
 Therapeutic Laser emits specific wavelengths into the skin, to create an increase in the production of ATP (energy)
within the mitochondria at a cellular level within the dermis, which promotes an accelerated healing of damaged
tissue.
 Light wavelengths in the 600nm range are particularly effective for skin and wound healing because these photons
of light attach to melatonin which is found within the skin.
 Low Level Laser is non-thermal, which means that does not create heat within tissue.
 A treatment is without sensation and may relieve pain at the same time as healing a wound, because of a rise in
endorphins and a reduction in pain receptors, also triggered by the process of photo biomodulation.

Ultraviolet Light Therapy:

 Ultraviolet (UV) light therapy, specifically UVB (ultraviolet B) and
UVA (ultraviolet A) light, has been explored for its potential
benefits in wound healing.
 UV light is categorized into different types based on wavelength.
UVB and UVA light are the most used for therapeutic purposes.
 Ultraviolet therapy has been reported to be very effective in
destroying bacteria and promoting wound healing and therefore a
promising adjunctive therapy for chronic wounds infected with
resistant bacteria.
 UV light exposure can stimulate various cellular processes in the skin, including:
 Promotion of collagen production.
 Modulation of inflammatory responses.
 Production of reactive oxygen species (ROS)
 Enhancement of tissue repair mechanisms.
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 Destruction of bacteria
Types of ultraviolet radiations:
 Based on dominant biological effects displayed by each region as:
 UV - A 315 - 400 nm Encourage wound healing
 UV - B 280 - 315 nm Skin erythematous region
 UV - C 100 - 280 nm Germicidal region

Contraindications of Ultraviolet radiation therapy:

 Irradiation of the eyes
 Skin cancer
 Pulmonary tuberculosis
 Cardiac, kidney and liver disease
 Systemic lupus erythematosus
 Fever

Therapeutic ultrasound:
 Therapeutic ultrasound is utilized by physical therapists to deliver a high frequency mechanical vibration to facilitate
healing at a cellular level.
 Therapeutic ultrasound is often used by physiotherapists to reduce pain, increase circulation, and increase mobility
of soft tissues.
 Additionally, the application of ultrasound can be helpful in the reduction of inflammation, reducing pain, and the
healing of injuries and wounds.

Effects on the Phases of Wound Healing:

 Inflammatory Phase: enhances the degranulation of mast cells resulting in the release of histamine and other
mediators that attract fibroblasts and endothelial cells to the injured area.
 Proliferative Phase: stimulates fibroblast migration and proliferation to secrete collagen, improving tensile
strength of the healing connective tissues. The production of vascular endothelial growth factor and angiogenesis
are also promoted by the application of ultrasound in this phase.
 Epithelialization Phase: Application of Ultrasound to the peri-wound area stimulates the release of growth factors
needed to regenerate epithelial cells, further protecting the body from infection and reinstate skin integrity.
 Maturation or Remodeling Phase: Application of thermal ultrasound during this phase affects the collagen
extensibility and enzyme activity and therefore also improves tensile strength of the healing tissue.

Suggested Frequencies:
 Dermal Wounds – 3MHz
Deep lacerations or Peri-wound Skin – 1Mhz

Application to Peri-wound Tissue:

Parameters:
 1MHz, continuous mode with intensity at 1 – 1.5 W/ cm squared.
 The aim is to produce a thermal effect for vasodilation and increased tissue oxygen levels.
 The ultrasound head should be 1.5 or 2 times the size of the area to be treated.
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 The aqueous medium is applied to the transducer and is moved in a slow circular motion around the treated area. 2-
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3 minutes complete per zone, 3 times per week.

Application to Wound:
Parameters:
 Use ultrasound with a 20% duty cycle, 3MHz intensity.
 Aim to stimulate protein synthesis and increase cell proliferation.
 Remove dressings and debride the wound.
 Apply a hydrogel sheet, removing air bubbles.
 Use an ultrasound head 1.5-2 times the treated area.
 Treat large wounds in sections for 1-2 minutes per zone.
 Apply ultrasound medium to the transducer and hydrogel sheet.
 Treat acute wounds 1-2 times daily, then 2-3 times weekly.

Precautions and Contraindications:

 Contraindicated over eyes, genital areas, abdominal area and exposed neural tissue
 Should be avoided in cases of thromboembolic diseases
 Avoided in patients with pacemakers
 Precautions should be taken with sensory impairments
 Ultrasound should be terminated if there is increased pain

Negative Pressure wound therapy:

 Negative pressure wound therapy (NPWT) is a broad term used to
describe a unique and versatile system that aids the optimization of
wound healing through the application of sub-atmospheric pressure to
help reduce inflammatory exudate and promote granulation tissue.
 It can be utilized to manage acute and chronic wounds, ranging from
open fasciotomy wounds and diabetic foot ulcers to closed surgical
incisions.
 It can effectively promote wound healing by:
 Controlling wound infection and inflammation
 Removing wound exudates
 Reducing tissue oedema
 Promoting granulation tissue formation, angiogenesis, and blood flow
perfusion
 By using a closed wound dressing and providing a sterile environment, it can reduce infectious complications and
provide optimal moisture for wound healing.
 It includes vacuum sources, drainage tubes, wound dressings, and semipermeable foils.
 Several types of dressings are used with these devices, including form, moistened cotton gauze, and non-woven
polyester layers joined by a silicone elastomer.
 Manufacturers recommend initially changing the dressing 48 hours after beginning treatment, then two to three
times per week as indicated by wound’s response to the NPWT intervention.
 Once the dressing is applied, an evacuation tube runs from the wound through the dressing, drawing excess exudate
away from the wound and into the canister attached to the other end of the tubing.
 The canister is attached to a vacuum pump that provides either continuous or intermittent negative pressure,
adjusted for the type of wound being treated.
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 Negative pressure created by the pump is in the range of 0 to 200mm Hg depending on the system used.
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Indications:
 Acute wounds when the wound cannot be closed by primary intention due to the risk of infection, active infection,
skin tension, or swelling
 Open fractures
 Open lacerations
 Degloving injuries
 Burns which caused partial thickness skin loss
 Dehisced wounds which can be acute or chronic wounds
 Skin breakdown due to ulceration secondary to multiple etiologies
 Close wounds such as surgical incisions, including skin flaps and grafts

Contraindications:
 Any exposed vasculature or organ surfaces
 Non-enteric and unexplored fistulae
 Any necrotic tissue or eschar present in the wound bed
 Presence of underlying malignancy
 Active osteomyelitis

Electrical stimulation:
 Electrical stimulation can help speed wound healing by:
 Increasing capillary density and perfusion
 Improving wound oxygenation
 Encouraging granulation and fibroblast activity
 Electrical stimulation can be applied in one of two ways.
 For the first method, one electrode [positive or negative
polarity] is applied to sterile, conductive material, such as
saline moisten gauze, placed in the wound.
 The conductive surface of the other electrode is applied nearby on intact dry skin.
 The second method involves positioning the conductive surfaces of two electrodes with the same polarity on
intact dry skin on opposite borders of the wound, straddling the wound.
 A third electrode with the opposite polarity is placed nearby on intact dry skin.
 Polarity of the electrode or electrodes placed on or straddling the
zone depends on the wound’s clinical needs.
 To promote autolysis, use positive polarity to attract negatively
charged neutrophils and macrophages.
 To encourage granulation tissue development, use negative
polarity to attract positively charged fibroblasts.
 To stimulate wound resurfacing, use positive polarity to attract
negatively charged epidermal cells.
 Electrical stimulation can be used on chronic wounds, including
pressure ulcers, diabetic ulcers, venous ulcers, and arterial ulcers.

Contraindications:
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 Basal cell carcinoma in the wound or peri-wound skin

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 Squamous cell carcinoma in the wound or peri-wound skin

 Wounds with osteomyelitis that aren't responding to systemic antibiotic therapy
 Wounds containing iron residues of iodine or silver
 If the patient has a pacing device
 If the wound is over the heart
 Treatments are typically given for one hour a day, five to seven days a week, as long as documented assessment
indicates that the wound is healing.

Compression therapy:
 Compression therapy is a treatment approach that involves the use of bandages or
other wound compression products to improve blood flow circulation in the lower
legs.
 By adding pressure with wraps, it helps prevent fluid buildup, reduce venous
pressure and edema, and aids the body in moving blood around.
 Compression therapy can aid in treating certain chronic wounds, improve healing
time and significantly improve overall quality of life.
 Compression therapy is used for several different injuries caused by poor circulation
such as:
 Chronic venous insufficiency (CVI)
 Edema
 Deep vein thrombosis (DVT)
 Leg ulcers and wounds
 Orthostatic hypotension
 Benefits of compression therapy:
 Improved blood flow and circulation
 Reduced edema in legs and feet
 Reduced risk of blood clots

Types of Compression Therapy Products:

 There are several types of compression products that may be used for wound healing.
 These products are typically broken down by the level of compression they offer.
 Compression bandages
 Compression stockings or socks
 Intermittent pneumatic compression (IPC) system

REFERENCES:
 Wound care essentials practice principles, 5th ed
 KLOTH, LUTHER C. CWS, PT, MS, FAPTA. How to use electrical stimulation for wound healing. Nursing 32(12):p 17,
December 2002.
 Ultrasound in Wound Healing. Physiopedia n.d. https://www.physio-pedia.com/Ultrasound_in_Wound_Healing.
 Wu L, Wen B, Xu Z, Lin K. Research progress on negative pressure wound therapy with instillation in the treatment of
orthopaedic wounds. International Wound Journal 2022;19:1449–55. https://doi.org/10.1111/iwj.13741.
 Zaver V, Kankanalu P. Negative Pressure Wound Therapy. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2024 Jan–. PMID: 35015413.
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 Laser Therapy for Wound Healing - Laser Medicine London. Laser Medicine London 2024.
https://www.lasermedicine.co.uk/laser-therapy-services/laser-therapy-for-health/laser-therapy-for-wound-
healing/.
 Ultraviolet Therapy. Physiopedia n.d. https://www.physio-pedia.com/Ultraviolet_Therapy.
 Gupta A, Avci P, Dai T, Huang Y-Y, Hamblin MR. Ultraviolet Radiation in Wound Care: Sterilization and Stimulation.
Advances in Wound Care 2013;2:422–37. https://doi.org/10.1089/wound.2012.0366.

THE END

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