Effects of a normothermic dressing on pressure ulcer healing.

OBJECTIVE: To determine the effects of radiant heat applied through a semiocclusive dressing on periwound skin temperature and wound healing. DESIGN: Before-after trial. SETTING: Spinal cord injury and geriatric units of a VA medical center. PATIENTS: Twenty inpatients with 21 Stage III and IV pressure ulcers. INTERVENTIONS: A semiocclusive, heated dressing was applied to 15 Stage III and IV pressure ulcers for 4.5 hours, Monday through Friday, for 4 consecutive weeks. The dressing emitted heat at 38.0 degrees C for 2 60-minute periods daily. At all other times, the wounds received only standard wound care. Six wounds in a separate control group received only standard wound care during the same 4-week period. MAIN OUTCOME MEASURES: Periwound skin temperature within and adjacent to the dressing and measurements of wound surface area. MAIN RESULTS: Mean skin temperatures inside and outside the heated dressing increased by 0.97 degree C and 1.08 degrees C (P < .05), respectively, from baseline values. Wounds treated with standard care plus the heated dressing underwent a statistically significant reduction in mean surface area of 60.73%. Wounds in the control group underwent a statistically insignificant reduction in mean surface area of 19.24%. CONCLUSION: Wounds treated with a radiant heat dressing healed significantly faster than wounds that received only standard care. There were no adverse effects from the radiant heat dressing.

Promotion of wound healing with electrical stimulation.

Clinicians involved in the conservative care of chronic wounds have many treatment interventions from which to choose, including debridement/irrigation, dressings, pressure-relieving devices, hyperbaric or topically applied oxygen, whirlpool/pulsed lavage, ultrasound, topical antibiotics, and cytokine growth factors. All except the last two interventions are physical treatments that create a wound-tissue environment conducive to healing. Unfortunately, many chronic wounds heal very slowly, do not heal, or worsen despite the best efforts of caregivers to promote tissue repair. An intervention commonly used to treat chronic wounds, especially by physical therapists, is electrical stimulation (ES). The rationale for use of this method is based on the fact that the human body has an endogenous bioelectric system that enhances healing of bone fractures and soft-tissue wounds. When the body's endogenous bioelectric system fails and cannot contribute to wound repair processes, therapeutic levels of electrical current may be delivered into the wound tissue from an external source. The external current may serve to mimic the failed natural bioelectric currents so that wound healing can proceed. Certain chemotaxic factors found in wound substrates contribute to tissue repair processes by attracting cells into the wound environment. Neutrophil, macrophage, fibroblast, and epidermal cells involved in wound repair carry either a positive or negative charge. When these cells are needed to contribute to autolysis, granulation tissue formation, anti-inflammatory activities, or epidermal resurfacing, ES may facilitate galvanotaxic attraction of these cells into the wound tissue and thereby accelerate healing.

Commentaries on venous leg ulcers diagnostic and treatment draft guideline.

A guideline on venous leg ulcer diagnosis and treatment was developed by a research team from the University of Pennsylvania School of Medicine, Philadelphia, Pa., in collaboration with an inter-disciplinary panel of wound care clinicians. Working from a consensus statement based on a literature review, the authors developed preliminary algorithms, which were reviewed by a national advisory panel. The draft guideline was prepared, and the authors now seek national peer review to address whether it is clinically relevant, useful and represents current practice. The entire diagnostic draft guideline was published in the April issue of Ostomy/Wound Management; the entire treatment draft guideline in the May issue. After peer review and pilot testing, the guideline will be modified and validated in prospective clinical trials.

Physical modalities in wound management: UVC, therapeutic heating and electrical stimulation.

In spite of efforts to create an optimum wound environment for healing, there are times that a wound may not heal, may heal very slowly, or may worsen. In these cases, a series of treatments with an appropriate physical agent can be added to the patient's care plan to augment tissue reparative processes. Three modalities that have received support in the literature for use in wound healing are ultraviolet "C" radiation (UVC), therapeutic heating, and electrical stimulation. Treatment goals for UVC are hyperplasia and enhanced re-epithelialization or desquamation of the leading edge of periulcer epidermal cells, granulation tissue formation, sloughing of necrotic tissue, and bactericidal effects. Treatment goals for therapeutic heating are increased blood perfusion with subsequent increased delivery of oxygen to the tissues (avoiding the dessication of wound tissues). The treatment goal for electrical stimulation is to attract negatively or positively charged cells into the wound area, such as neutrophils, macrophages, epidermal cells and fibroblasts that in turn will contribute to wound healing processes by way of their individual cellular activities.

Chronic dermal ulcer healing enhanced with monophasic pulsed electrical stimulation.

The purposes of this randomized, double-blind, multicenter study were to compare healing of chronic dermal ulcers treated with pulsed electrical stimulation with healing of similar wounds treated with sham electrical stimulation and to evaluate patient tolerance to the therapeutic protocol. Forty-seven patients, aged 29 to 91 years, with 50 stage II, III, and IV ulcers were randomly assigned to either a treatment group (n = 26) or a control (sham treatment) group (n = 24). Treated wounds received 30 minutes of pulsed cathodal electrical stimulation twice daily at a pulse frequency of 128 pulses per second (pps) and a peak amplitude of 29.2 mA if the wound contained necrotic tissue or any drainage that was not serosanguinous. A saline-moistened nontreatment electrode was applied 30.5 cm (12 in) cephalad from the wound. This protocol was continued for 3 days after the wound was debrided or exhibited serosanguinous drainage. Thereafter, the polarity of the treatment electrode on the wound was changed every 3 days until the wound progressed to a stage II classification. The pulse frequency was then reduced to 64 pps, and the treatment electrode polarity was changed daily until the wound was healed. Patients in the control group were treated with the same protocol, except they received sham electrical stimulation. After 4 weeks, wounds in the treatment and control groups were 44% and 67% of their initial size, respectively. The healing rates per week for the treatment and control groups were 14% and 8.25%, respectively. The results of this study indicate that pulsed electrical stimulation has a beneficial effect on healing stage II, III, and IV chronic dermal ulcers.

Acceleration of wound healing with high voltage, monophasic, pulsed current.

The purpose of this study was to determine whether high voltage electrical stimulation accelerates the rate of healing of dermal ulcers. Sixteen patients with stage IV decubitis ulcers, ranging in age from 20 to 89 years, participated in the study. The patients were assigned randomly to either a Treatment Group (n = 9) or a Control Group (n = 7). Patients in the Treatment Group received daily electrical stimulation from a commercial high voltage generator. Patients in the Control Group had the electrodes applied daily but received no stimulation. The ulcers of patients in the Treatment Group healed at a mean rate of 44.8% a week and healed 100% over a mean period of 7.3 weeks. The ulcers of patients in the Control Group increased in area an average of 11.6% a week and increased 28.9% over a mean period of 7.4 weeks. The results of this study suggest that high voltage stimulation accelerates the healing rate of stage IV decubitis ulcers in human subjects.

Supervised versus independent student laboratories.

The purpose of this study was to determine if classroom laboratory time could be reduced in a basic physical agents course. Fifty-seven junior physical therapy students were randomly assigned to three laboratory sections. All students received identical lectures, demonstrations, course materials, and laboratory manuals. The control group, Section 1, received supervision and assistance during laboratory practice. Students in Section 2 and Section 3 worked independent of instructor supervision but could receive assistance from the instructor in an adjacent room. Students in Section 2 were provided with feedback following periodic assessment by the instructor. Attitudinal questionnaire responses indicated that the students preferred the supervised laboratory section. The presence of the instructor during classroom laboratory practice of basic physical agents did not affect student performance. Comparison of written and practical examination results indicated no significant differences in student performance. Classroom laboratory time for faculty and students was reduced when students worked independently.