Adjunctive Treatment

1. Describe strategies for electrode placement in the use of electrical stimulation in wound healing:
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Underwater stim is soothing - good for weird shape/large surface area wounds - don't have to put electrode directly on the wound - water is the conducting agent - also can act as a mechanical debrider

Direct technique - put electrode directly on the wound (treatment electrode)

Periwound technique: two active electrodes placed around the wound so that the path of the current passes through wound bed
Either positive or negative charge increases local blood flow

Alternating polarity periodically during Rx may optimize results

E-stim improves transcutaneous oxygen content

E-stim may increase number of mast cells and mast cell degranulation
Early end to inflammatory phase-------------------------------------------------- Stimulation of growth factor receptors

Increased formation and release of VEGF

Metanalysis showed a 144% net increase in healing as compared with control
Anodal Stimulation - Magnifies the current of injury to enhance body's natural healing process

Enhances migration of macrophages & fibroblasts (proliferative phase) [Galvanotaxis] -----------------------------Impact on collagen formation: anode attracts fibroblasts, it may allow collagen to be deposited in a more regular pattern, and increased collagen synthesis (can increase strength)
UV-C: 200-280 nm eg cold quartz. it increases blood flow, has bacterialcidal effects (MRSA and group A strept), stimulates production and release of interleukin 1 by keratinocytes(enhances epithelialization and fibroblastic activity), and stimulates fibronectin release ( formation of ground substance and promotes cell migration)

LILT?: increased growth factor production, increased cellular metabolism (increased light absorption by mitochond., increased rate of cell division, increased rate of RNA/DNA synthesis, increased rate of fibroblastic activity. On scar tissue: more uniform alignment of collagen fibers, smaller scars, and less incidence of contractures.
Hyperbaric O2 increases the carrying capacity of the blood 3x-5x (increases healing times) - reduces necrosis and secondary tissue death - has bacterialcidal effects (especially against anaerobic agents)

Benefits: Decreased local edema
Improved cellular metabolism
Improved local tissue oxygenation
Enhanced leukocytic activity
Increased effectiveness of antibiotics
Increased uptake of PDGF
Increased rate of angiogenesis
Improved epithelial migration
May have a synergistic effect with concurrent application of topical growth factors


Untreated pneumothorax
Concomittant chemotherapy Rx
Relative contraindications:
Known malignancy
PPM (pacemaker)
Chronic sinusitis
Sz disorders (need decompression before people can enter/exit)
H/o thoracic Sx

**Systemic uses an oxygen chamber, topical uses a O2 bag around the affected region, topical is not well supported by research**