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Definition of Estim for Wounds
- Electrial stimulation for wounds has been difined as "the use of capacitive coupled electrial circit to transfer energy to a wound"
- Capacitively coupsed ES invoels the transfer of electric surrent through an applied surface electrode pad that is in wed contact with the external skin surface and/or wound bed
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Inflammatory Process
- 3-7 days
- Vasoconstriction followed by localized vasodilation and arrival of cells
- Polymorphonuclear cells and macrophages
- Process of migration of these cells to the site or injury by way of chemical signal is called chemotaxis
- Rid he injury site of associated tissue debirs when wound is clean second phase begins
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Proliferative Phase
- Formation of new blood vessels
- Prduction of extracellular matrix: Granulation tissue
- Main cell is the fibroblast
- Wound Contraction
- Epithelial cells regenerate and migrate from the margin to the center of the wound
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Remodeling phase
- up to 2 yrs
- Amount of collagen increases and gradual converstion in teh type of collagen
- Scar becomes more organized
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Current within the wound
- A flow of current with a positive polarity occures within the wound
- Triggers wound healing
- Associated with moist wound healing process
- wounds that dry out cease demonstrating a post injury current
- Possitive wound potential serves as an indictor of healing
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Galvonataxis
- Describes the proceess in which cells possessing a positve or negative charge are attracted to an electrica field of opposite polarity
- the positively or negatively charged cells taht normally response to injury may be attracted to the positvie or negative pole of the simulating electrode
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Postive Current
- Attracts: O2 7 acids
- Repels: alkalines, base metals, alkaloids
- Tissue Changes: Harends
- Edema: Dehydrates
- Vasomotor: Vasocontriction
- Produces: Ischemia
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Negative Current
- Attracts: H+ and Alkalines
- Repels: Acids, Acid radicals, hologens
- Tissue Changes: softens
- Edema: Hydrates
- Vasomotor: Vasodilations
- Produces: hypermia
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Antimicrobial Effects
- ES has an bacteriocial Effect of various pathogenic organisms that are commonly found to infect wounds
- Cathode: Pseudomonas aeruginosa
- Staphyloccoccus aureus
- NEG ELECTRODE IS THE ACTIVE ELECTRODE IF INFECTIONS IF PRESENT
- Anode: Staphyloccus aureua
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Effects on Blood Flow
- ES enhances blood circulation
- Cirucaltory system allow oxyen and nutrients to reach tissue needed for all phases of healing
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Necrotic Tissue Theory
- ES facilitates autolytic debridement via the galvanotaxis theory.
- Positive polarity attracts negatively charged neutrophiles and macrophages to promote autolysis
- Polar effects produce a change in Ph (alkaline) to solubilize the necrotic wound tissue - Alkaline recation occur at cathode.
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Indications for EStim for Wounds
- Pressure (decubitus)
- Venous insufficiency
- Arteral insufficiency
- Diabetic Wounds
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Contraindications/Precautions for EStim for Wounds
- Osteomyelitis
- Actively bleeding wounds
- Presence of Metal Ions
- Adverse Site Responses
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Types of Current Used for Wounds
- Low insetensity direct current
- Pulesed current HIGH VOLT PULSED CURRENT
- Alternating Current
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Periwound Electrode Placement
- Results in less current density within the wound
- More advantageous when trying to activate sensory nerves in skin (pain control)
- Less potential for disurbance of the wound bed
- A reduced chance of crosscontamination between the wound and the electrodes
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