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Wound Procedures and Devices

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by

Wanda Newton

on 20 November 2013

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Transcript of Wound Procedures and Devices

Wound Procedures and Devices
Evidence
Over 2,064 Published Journal Articles, including more than 1000 peer-reviewed articles by 2013
51 Randomized Controlled Trial Publications 
More than 62 Medical Textbook Citations by 2008
KCI /Smith and Nephew Websites
Sample Payment Policy
Medically Necessary:
Electrical stimulation* or electromagnetic therapy is considered medically necessary as a treatment of arterial ulcers, diabetic ulcers, venous stasis ulcers, and Stage III or Stage IV pressure ulcers, when a 30-day trial of conventional wound management has failed and when the procedure is performed in a medically supervised setting.
* Electrical stimulation can be categorized as follows, based on the type of current:  alternating current (AC), high voltage pulsed current (HVPC), and low intensity direct current (LIDC).

KCI Wound Vac
http://global.smith-nephew.com/master/29290.htm
NPWT
Draws wound edges together
Provides direct and complete wound bed contact
Evenly distributes negative pressure
Removes exudate and infectious materials
Microstrain
is the microdeformation at the cellular level, which leads to cell stretch.
CONT.
Microstrain:
Reduces edema
Promotes perfusion
Increases cellular proliferation and migration 
Promotes granulation tissue formation
Mechanism of Action
Barrier to Healing
Negative Pressure benefits
Excess barrier burden
Inadequate protection against infection
Excess exudate
Excess edema (interstitial fluid)
Absence of moisture
Lack of adequate blood flow
Lack of cellular activity
Removes infectious materials
Provides protected wound healing envirnment
Removes exudate
Reduces edema (interstitial fluid)
Provides moist wound healing environment
Promotes perfusion
Promotes cellular migration and proliferation during granulation tissue formation
Electrical Stimulation
one electrode (positive or negative polarity) is applied to sterile, conductive material, such as saline moistened gauze, placed in the wound. The conductive surface of the other electrode is applied nearby on intact dry skin.
or 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.
Application
pulse frequency is set to 100 pulses/second and the voltage is set to
deliver a current that produces a moderately strong but comfortable tingling sensation (in sensate skin) or a just-- visible muscle contraction (in insensate skin, as in patients with spinal cord injuries). The voltage required is typically between 50 and 150 volts.
Cont.
Polarity
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 Kloth,L
Treatments are typically given for 1 hour a day, 5 to 7 days a week
Frequency/Duration
Inflammation phase

Stimulator settings:

Polarity - negative
Pulse rate - 100 - 128 pps
Intensity - 100-150 volts
Duration - 60 minutes
Frequency 5-7 x per week, once daily
Electrical Stimulation
Cont.
Epithelialization phase

Stimulator settings:
Polarity - alternate every three days ie 3 days negative followed by 3 days positive
Pulse rate - 64 PPS
Intensity - 100-150 volts
Duration - 60 minutes
Frequency 5-7 x per week, once daily
Wound Healing Phase Diagnosis: Epithelialization phase

Indications for use: “The MIST Therapy System produces a low energy ultrasound-generated mist used to promote wound healing through wound cleansing and maintenance debridement by the removal of yellow slough, fibrin, tissue exudates and bacteria.”

Celleration, Inc.
MIST Therapy
Full transcript