ADVANCED WOUND CARE
Advanced Wound Care operates as an extension of AC Physical Therapy.
Advanced Wound Care is a specialized practice providing outpatient and in-home wound care services by MD referral ONLY.
No matter where the wound is located, its healing potential is dependent on several conditions.
It is critical that there is adequate blood supply. The rate of healing and healing potential is highly dependent on circulation.
The amount of draining a wound has must be well controlled in order to achieve the optimal healing environment.
New tissue grows best at the body’s normal temperature.
Wounds will not heal if there is infection present.
If a wound persists for an extended period of time it is likely that at least one of the aforementioned conditions is not being addressed. At Advanced Wound Care we work to optimize all of the conditions for the wound so that healing will take place.
Circulation can be enhanced in a number of different ways. First, exercise will increase the delivery of blood flow and thus increase the nutrition to the healing tissues. As physical therapists we are in a unique position to prescribe exercises that are specific to increase the delivery of blood flow to the wound.
In addition to exercise, as physical therapists we regularly use different modalities to enhance healing. Modalities we use include low light near infrared cold laser, ultrasound and electrical stimulation. All have demonstrated increased rates of healing. Articles associated with wound healing using these specific modalities are listed for further information.
Cold laser application that provides near infrared light is a great and pain-free modality that accelerates wound healing. You can read more on the cold laser we use at http://www.medxhealth.com/medx.html. In addition to improving the blood flow, it has demonstrated improved nerve function so those with peripheral neuropathy experience improved sensation and pain relief. This is a pain free intervention and is well tolerated even on the most painful wounds as it stimulates the body to release nitric oxide, the body’s natural pain reliever. Additional articles published by the NIH (National Institute of Health) can be found at http://www.ncbi.nlm.nih.gov/pubmed/16120414, http://www.ncbi.nlm.nih.gov/pubmed/21356170, http://www.ncbi.nlm.nih.gov/pubmed/21237670.
Ultrasound is used indirectly through an aqueous medium. It is not the first choice for treatment as requires a more intensive setup to apply and there are studies that indicate that the laser is a more effective treatment. http://www.ncbi.nlm.nih.gov/pubmed/15558402.
Electrical Stimulation (E-Stim) has been used for many years in wound healing. E-Stim is a very beneficial modality that serves to increase blood flow regionally thus enhancing wound healing directly in the region between the electrodes. This is a time tested and long standing form of treatment for wounds and is very effective. http://www.ncbi.nlm.nih.gov/pubmed/2568073 Effects of E-Stim and Laser on wound healing specifically were compared and published by the National Institutes of Health and both were shown to be very beneficial. More information on this study can be found at http://www.ncbi.nlm.nih.gov/pubmed/15558369. Estim, however, is not as well tolerated by patients as the laser is. As a result, it is not as often utilized and in particular is not an appropriate modality for those who have significant pain with their wound. Patients who have neuropathy and don’t have much sensation typically tolerate this well but they don’t receive the effects of sensation restoration that the laser provides and so the laser is again, the most appropriate modality currently available that serves to increase healing.
Effects of E-Stim and Laser on wound healing specifically were compared and published by the National Institutes of Health and both were shown to be very beneficial. More information on this study can be found at http://www.ncbi.nlm.nih.gov/pubmed/15558369.
The results….we most often utilize cold laser near infrared treatment to enhance circulation and accelerate wound healing.
All wounds drain or exude fluids. Drainage occurs because there is nothing preventing the fluid that is normally under the skin from coming out. It is also a way for the wound to rid itself of bacteria. The amount and type of drainage varies widely from wound to wound and person to person. It will also vary as the wound heals. What is most critical is determining the appropriate type of specialized wound dressing required to adequately manage the drainage and keep the wound healthy throughout the healing process. Evidence indicates that wounds heal best in a moist environment but balance of moisture is really the key. If a wound is too dry, granulation or new skin cells will not form but rather there will be a scab or hard dead tissue present. This dead tissue or scab will decelerate wound healing by blocking the growth of the new skin cells and prevent the edges of the wound from contracting or getting smaller. If however the problem is that there is too much drainage it can cause wounds to increase in size by breaking down the fragile intact skin around the wound. Finding a wound dressing that will manage and maintain moisture balance is the key.
Wounds heal most effectively at our normal body temperature of 98.6 degrees. This is because the newly forming skin cells are traditionally covered by the skin when there is no wound present. Skin has many functions but one of the most critical is temperature control. Skin helps our bodies achieve and maintain or internal temperature. Because these newly forming skin cells (granulation) are trying to grow without the presence of the temperature regulator (our skin) it is important to provide a bandage that will help to maintain a constant temperature. Furthermore, exposing the wound to the ambient air temperature will decelerate healing. Evidence indicates that it takes 4 hours for the wound to achieve normal body temperatures after exposure to ambient air. This is particularly important when deciding how frequently a wound dressing should be changed. Ideally if there is not too much drainage or presence of infection a wound should be left for several days without a dressing change. This is best determined by your wound care practitioner.
Simply stated a wound will not heal if there is infection present. This is our bodies way of making sure that infection does not get trapped inside. Signs of infection include but are not necessarily limited to increased redness, increased pain, increased drainage, odor and fever. Our skin normally has bacteria present on it so most wounds will have bacteria but that does not mean that the wound is infected. Using topical antibiotics can be helpful in controlling the bacterial population but overuse of these topicals can delay wound healing. As your wound care practitioner we strive to work closely with your physician to alert them of any complications or symptoms that indicate infection so the proper antibiotic can be prescribed.