Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:

Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_764_Библиотеки_им_академика_М_И_Перельмана

.pdf
Скачиваний:
0
Добавлен:
30.08.2026
Размер:
47 Мб
Скачать
14 Latest Applications ofNegative Pressure Wound Therapy
https://t.me/medicina_free
153
14.2.2 Fat Grafting andNPTW
Regarding NPWT’s new therapeutic lines, it could be employed with fat grafting to create a synergistic interaction of regenerative cells and improve the quality of the underlying tissue. Fat grafting is a simple and increasingly widespread technique, with low morbidity and high availabil­ity for thickening tissues.
The combination of both techniques accord­ing to an animal study [35] could increase the granulation tissue formation and improve neoan­giogenesis. However, so far there is not much lit­erature available on the subject, just animal studies [35] and clinical reports [36].
New lines of management are being devel­oped as NPWT instillation even though further studies with a vast number of patients and long­term follow-up are necessary. More studies with a larger number of patients are required to vali­date these applications, but the current results are encouraging.
14.3 Conclusions
NPWT wound dressing is nowadays the standard of care in complex wounds.
NPWT is a safe, well-tolerated treatment that has demonstrated clinical benets to reduce the risk of infection and accelerate the wound heal­ing process. It represented a change in paradigm in the wound’s treatment improving the quality of life of patients and reducing the long-term cost for the health system. Prophylactic use of NPWT is still not a standard procedure, but its early results look promising to avoid complications. No doubt more indications will appear in the near future to take advantage of the benets offered by NPWT.
References
1. Morykwas M, Argenta L, Shelton-Brown E, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: ani­mal studies and basic foundation. Ann Plast Surg. 1997;38(553):62.
2. Gomez TW, Gomez JW, Gopal R. Clinical applica­tions and benets of using closed-incision negative pressure therapy for incision and surrounding soft tissue management: a novel approach for comorbid wounds. Cureus. 2020;12(7):e9469.
3. Zaver V, Kankanalu P. Negative pressure wound therapy. In: StatPearls. https://www.ncbi.nlm.nih.gov/
books/NBK576388/.
4. Agarwal P, Kukrele R, Sharma D. Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT) for difcult wounds: a review. J Clin Orthop Trauma. 2019;10(5):845–8. https://doi.org/10.1016/j.
jcot.2019.06.015.
5. Xia C, Yu A, Qi B, Zhou M, Li Z, Wang W.Analysis of blood ow and local expression of angiogenesis­associated growth factors in infected wounds treated with negative pressure wound therapy. Mol Med Rep. 2014;9(5):1749–54.
6. Banwell P, Teot L.Topical negative pressure (TNP): the evolution of a novel wound therapy. J Wound Care. 2003;12(1):22–8.
7. Huang C, Leavitt T, Bayer L, Orgill D.Effect of nega­tive pressure wound therapy on wound healing. Curr Probl Surg. 2014;51(7):301–31.
8. Kloth L. 5 questions and answers about negative pressure wound therapy. Adv Skin Wound Care. 2002;15:226–9.
9. Desai KK, Hahn E, Pulikkotill B, Lee E. Negative pressure wound therapy. An Algorithm Clin Plast Surg. 2012;39(3):311–24. https://doi.org/10.1016/j.
cps.2012.05.002.
10. Armstrong D, Boulton A, Bus S. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–75. https://doi.org/10.1056/
NEJMra1615439.
11. Lipsky B, Berendt A, Cornia P, Pile J, Peters E, Armstrong D.Infectious Diseases Society of America clinical practice guideline for the diagnosis and treat­ment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132–73.
12. Isaac A, Armstrong D. Negative pressure wound therapy and other new therapies for diabetic foot ulceration: the current state of play. Med Clin North Am. 2013;97(5):899–909. https://doi.org/10.1016/j.
mcna.2013.03.015; Epub 2013 May 4.
13. Ji S, Liu X, Huang J, Bao J, Chen Z, Han C, et al. Consensus on the application of negative pres­sure wound therapy of diabetic foot wounds. Burns Trauma. 2021;9(3002):tkab018.
14. Lavery L, Murdoch D, Kim P, Fontaine J, Thakral G, Davis K.Negative pressure wound therapy with low pressure and gauze dressings to treat diabetic foot wounds. J Diabetes Sci Technol. 2014;8(2):346–9.
https://doi.org/10.1177/1932296813519012.
15. Lee K, Ben-Nakhi M, Park E, Hong J.Cyclic nega­tive pressure wound therapy: an alternative mode to intermittent system. Int Wound J. 2015;12(6):686–92.
https://doi.org/10.1111/iwj.12201.
16. Randall K, Booth B, Miller A, Russell C, Laughlin R. Use of an acellular regenerative tissue matrix in
154
https://t.me/medicina_free
L. Torrano et al.
combination with vacuum-assisted closure therapy for treatment of a diabetic foot wound. J Foot Ankle Surg. 2008;47(5):430–3.
17. Chiummariello S, Del Torto G, Iera M, Arleo S, Alfano C. Negative pressure dressing in split­thickness skin grafts: experience with an alterna­tive method. Wounds. 2013;25(11):324–7; pmid:
25867632.
18. Rys P, Borys S, Hohendorff J, Zapala A, Witek P, Monica M, etal. NPWT in diabetic foot wounds—a systematic review and meta-analysis of observational studies. Endocrine. 2020;68(1):44–55. https://doi.
org/10.1007/s12020- 019- 02164- 9.
19. Driver VR, Blume PA.Evaluation of wound care and health-care use costs in patients with diabetic foot ulcers treated with negative pressure wound therapy versus advanced moist wound therapy. J Am Podiatr Med Assoc. 2014;104(2):147–53.
20. Wurtzer P, Winter R, Stemmer S, Lumenta D. Risk factors for recurrence of pressure ulcers after defect reconstruction. Wound Repair Regen. 2018;26(1):664–8.
21. Papp AA.Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruc­tion. Int Wound J. 2019;16:394–400.
22. Madden JJ, Hoffman AN, Kim JS, Thayer WP, Nanney LB.Flap reconstruction for pressure ulcers: an outcomes analysis. Plast Reconstr Surg Glob Open. 2017;5(1):1–8. https://doi.org/10.1097/
GOX.0000000000001187.
23. Boissiere F, Gandol S, Riot S, Kerfant N, Jenzeri A, Hendriks S, etal. Flap venous congestion and sal­vage techniques: a systematic literature review. Plast Reconstr Surg Glob Open. 2021;9(1):e3327.
24. Yu P, Yu N, Yang X, Jin X, Lu H, Qi Z.Clinical ef­cacy and safety of negative-pressure wound therapy on aps: a systematic review. J Reconstr Microsurg. 2017;33(5):358–66.
25. Kim TH, Park JH.A novel negative pressure wound therapy (NPWT) monitoring system for postop­erative ap management. Medicine (Baltimore). 2021;100(44):e27671.
26. Number of surgical procedures (per 100,000 popula­tion). Lancet Commission on Global Surgery. [cited 2022 Jun 13]. data.worldbank.org/indicator/SH.SGR.
PROC.P5.
27. Blackham AU, Farrah JP, Mccoy TP, etal. Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy. Am J Surg. 2013;205(6):647. https://doi.
org/10.1016/j.amjsurg.2012.06.007.
28. Emori T, Gaynes R. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev. 1993;6:428–42.
29. Webster J, Liu Z, Norman G, Jc D, Chiverton L, Scu P, etal. Negative pressure wound therapy for surgi­cal wounds healing by primary closure (review). Cochrane Database Syst Rev. 2019;3:151. https://doi.
org/10.1002/14651858.CD009261.pub4/full/es.
30. Sahebally SM, McKevitt K, Stephens I, Fitzpatrick F, Deasy J, Burke JP, etal. Negative pressure wound therapy for closed laparotomy incisions in general and colorectal surgery: a systematic review and meta­analysis. JAMA Surg. 2018;153(11):1–9.
31. Tuuli MG, Liu J, Tita ATN, Longo S, Trudell A, Carter EB, etal. Effect of prophylactic negative pres­sure wound therapy vs standard wound dressing on surgical-site infection in obese women after cesar­ean delivery: a randomized clinical trial. JAMA. 2020;324(12):1180–9.
32. Antognoli LE, Singh DP, Choudhry S, Turcotte J, Holton LH.Rinse but don’t repeat: single application V.A.C.VERAFLO salvages infected breast prostheses. Plast Reconstr Surg Glob Open. 2021;9(10):e3896.
33. Meybodi F, Sedaghat N, Elder E, French J, Adams K, Hsu J, etal. Salvaging the unsalvageable: negative pressure wound therapy for severe infection of pros­thetic breast reconstruction. Plast Reconstr Surg Glob Open. 2021;9:1–6.
34. Reish RG, Damjanovic B, Austen WG, Winograd J, Liao EC, Cetrulo CL, et al. Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. Plast Reconstr Surg. 2013;131(6):1223–30.
35. Kao H, Hsu H, Chuang W, Chang K, Chen B, Guo L.Experimental study of fat grafting under negative pressure for wounds with exposed bone. Br J Surg. 2015;102:998–1005.
36. Moreira G, De Souza C, Camargos C, Amorim B, Esteban C, Ii AV, et al. Fat grafting associated with negative pressure wound therapy. Acta Cir Bras. 2019;34(9):9–11.
Electrical Stimulation inWound
https://t.me/medicina_free
Care
EliaRicci
15
The denition of electrostimulation (ESTIM) in wound care is given by Kloth [1]: It is an adjunc­tive therapy designed to deliver low levels of electrical current to tissues in and around the open wound. Electrostimulation is not only of modern times; the rst report is attributed to Scribonius Largus in 63AD [2], where he used electric rays (Torpedo marmorata) and rays (Rajiformes) for the treatment of headache and non-healing ulcers. From this derives the term “torpid ulcers.” From the rst observations of electricity in living beings with the experiment on frogs by Luigi Galvagni in 1790, an era of research began. In the rst half of the 1800s with the neurophysiology studies of Dubois-Reymond [3], the understanding of electrical nerve trans­mission began, especially through the determina­tion of the induced tetanus contraction. In 1834, the same author reports to have found a perile­sional current of less than 1 mA. In 1885, Guillame Duchenne published how alternating currents induce effective muscle contractions and theorized their use in paralysis. Since then, the diffusion in the medical eld of treatment and registration systems, just think of ECG, EMG, etc., has found enormous development.
Today, electrostimulation is widely used,
mainly in rehabilitation, and it has a very high
E. Ricci (*) Difcult Wound Healing Unit, Policlinico di Monza, Vercelli, Italia, Italy
level of evidence in terms of EBM in the vulno­logical eld (Table15.1), but its use is still lim­ited in common clinical practice. Houghton in 2017, [4] after an extensive review of the avail­able studies, points out that there is a strong, well-constructed literature in favor of ESTIM, while the works that express doubts would be of a lower quality level; he also underlines how, in the diabetic foot, there is a scarcity of literature.
There are some confounding factors: First, there are different types of current that lead to different types of treatment, they are often small producers who have little means to penetrate the market, and nally, the so-called addition thera­pies require an extended cultural growth at the base.
Table 15.2 [5] highlights different types of current; the lack of knowledge on different types of currents already leads to a confusion in the learning phase and therapeutic decision. Figure15.1 graphically shows the different types of current. Obviously, different types of electric current through the methods of administration lead to different types of treatment. Collins [6] denes the different types of treatment; the pro­posed classication is reported in Table 15.3. Unfortunately, this attempt at rationalization has not been reected in the literature, and the cur­rent works often generate further confusion.
The activities of ESTIM at the cellular and ultrastructural level, described in the literature, are multiple: increase of chemotaxis, VEGF,
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. Maruccia et al. (eds.), Pearls and Pitfalls in Skin Ulcer Management,
https://doi.org/10.1007/978-3-031-45453-0_15
155
156
ELECTRICAL CURRENTS
https://t.me/medicina_free
Table 15.1 ESTIM evidence in wound care
Year Society Pathology EBM 2000 Consortium for spinal cord medicine Decubitus A 2005 AAWC Lower limb 1 2006 Wound healing society (USA) Decubitus 1 2006 Wound healing society (USA) Lower limb 1 2006 Wound healing society (USA) Arterial ulcers 2 2006 Wound healing society (USA) Diabetic foot 1 2006 AMWT (GER) Lower limb 1b 2007 RNAO (Canada) Decubitus A 2014 NPUAP-EPUAP-PPPIA Decubitus A
Table 15.2 Various types of currents (Taradaj modied) modied
Current Wave Energy Pulsed Monophasic
Biphasic Symmetrical
Asymmetrical Balanced
Unbalanced
Alternated Symmetrical
Asymmetrical Balanced
Unbalanced
Direct
E. Ricci
Fig. 15.1 Different types of current
Volts
blood ow, granulation tissue, macrophage and broblast activity, wound contraction through an improvement of myobroblasts, and muscle tone. There is also a reduction in pain and bacterial growth. All these activities, the cause of which is not clearly dened, would derive from the admin­istration of energy at the local level.
The concept of the presence of electrical activity in the eld of skin lesions has been known since Galvagni’s studies; the skin is formed by the epidermal layer, which has a neg­ative electric charge, and the dermis that has a positive electric charge. A skin lesion puts the
DC AC
two different charges in contact and therefore can develop a sort of battery with direct current emission; this is able to originate a signal per­ceived at a systemic level [7]. Studies now dated [810] have shown this activity and have shown that, in case of chronicity, the electrical signal is reduced [11]. Therefore, we can conclude that the electrical component is present at the local level of wound, not veried but certainly possi­ble eld of study, is the role of advanced dress­ings in maintaining electrolytes and therefore ionic charges at the local level, compared to drying.
Stochastic (random)
Time
15 Electrical Stimulation inWound Care
https://t.me/medicina_free
Table 15.3 Different types of ESTIM from Collins modied
Type Acronyms Features Low-Intensity Direct Current LIDC Low voltages and low current producing a
monophasic waveform
Low-Intensity Pulsed Direct Current
High-Voltage Pulsed Current HVPC High voltages producing a pulsed
Decubitus Direct Current Treatment
Simulated Biphasic ES SSES Synthesized biphasic square waveform Asymmetric Biphasic Electrical
Stimulation
Symmetric Biphasic Electrical Stimulation
Frequency Rhythmic Electrical Modulation System
Table 15.4 ESTIM treatment systems found in the literature
Type Acronyms Devices Low-Intensity Direct Current LIDC PosiFect RD™ DC device (BioFisica)
Low-Intensity Pulsed Direct Current LIDPC UltraStim (north coast) High-Voltage Pulsed Current HVPC Multifunction devices (Gymna, EMS
Decubitus Direct Current Treatment DDTC BST (LifeWave) Simulated Biphasic ES SSES Bioactive experimental dressing Asymmetric Biphasic Electrical
Stimulation Symmetric Biphasic Electrical
Stimulation Frequency Rhythmic Electrical
Modulation System
LIDPC Low voltages and low current producing a
pulsed waveform
waveform consisting of pairs of short pulses separated by long intervals
DDTC Application of a wave form that had been
processed from electrical activity previously observed and measured around healing wounds
USELESS Asymmetric biphasic square waveform
result of programmed selection by clinicians
SBES Symmetric biphasic square waveform
result of programmed selection by clinicians
FORWARD Producing negative square wave pulses
preset to the maximum value of patient sensitivity
Wound EL (WoundEL health care)
physio, Chattanooga HPV)
USELESS ABES PosiFect RD (BioFisica)
SBES
FORWARD FREMS (FremsLife)
157
Electrostimulation takes place through the placement of two electrodes that can be near the lesion or in contact with it. Connected through connectors or wireless to the source, they emit well-dened and preset signals with the different modes mentioned above: continuous, pulsed or alternating, and stochastic. An old Israeli engi­neer friend, Michel Afargan, described the differ­ent ways of applying ESTIM as the different chords we can nd with music, each with differ­ent but still perceptible effects. The electric cur­rent is obviously determined by a ux of electrons; these move through the electrodes
(positive ions move toward the cathode, and neg­ative ions move toward the anode) [12]. Sun reports that different materials and electrode shapes can affect the therapeutic effect [13]. Recommended in the guidelines of many scien­tic associations [1419], it refers to ESTIM in general.
For educational purposes, we will distinguish ESTIM into three large groups: treatments based on direct currents, treatments based on alternat­ing or pulsed currents, and treatments based on stochastic currents. We will use the classication dened by Collins for this purpose [6]. Table15.4
158
https://t.me/medicina_free
E. Ricci
shows some of the devices available for electro­stimulation; it is certainly incomplete, but the data are not easily available.
15.1 Direct Currents
15.1.1 Low-Intensity Direct Current (LIDC)
These are microcurrents that simulate the so­called “Galvagni skin battery” and vary between 75 and 800μA [20]. A group of Greek research­ers [21] places the maximum effectiveness between 200 and 800μA and nds no difference between continuous and pulsed currents. According to Ismiarto [22], LIDCs act through the activation of broblasts and the increase of growth factors, thus having a local effect on the lesion and surrounding tissues.
15.2 Alternating andPulsed Currents
the wound bed and reverse the poles to promote the development of granulation tissue by attract­ing positively charged broblasts. In the nal stage, apply the positive pole on the ulcer to attract the epidermal cells with negative charge [25]. Goldman has demonstrated an increase in TpCO2 with HPVC [26]; this would be deter­mined by a mixed effect of vasodilation and neo­angiogenesis. In support, Burdge reports a reduction in amputations and a distalization of the level [27].
15.2.3 Simulated Biphasic ES (SSES)
The synthesis of this type of ESTIM can be found in a review by Martinez-Rodriguez [28]; ten RCTs are analyzed that demonstrate an efcacy of this type of ES in the treatment of decubitus, diabetic foot, lower limb ulcers, and surgical aps. Signicant data were found in ve out of ten studies and with positive trends in a further four.
15.2.1 Low-Intensity Pulsed Direct Current (LIPDC)
Microcurrents (300 to 600 μA) are used, trans­mitted in pulsed mode directly to the wound bed. Wood, in a now-dated RCT, reports a statistical signicance (P < 0.0001) in the treatment of pressure injuries versus placebo [23].
15.2.2 High-Voltage Pulsed Current (HVPC)
This type of current, together with the direct cur­rents, is the one most studied by Kloth; his stud­ies have shown a correlation between the positioning of anode and cathode and the migra­tion of specic cell types in the healing process [24]. In fact, it proposes to position the positive pole on the lesion to attract negatively charged cells (neutrophils and macrophages) to cleanse
15.2.4 Asymmetric Biphasic Electrical Stimulation
This type of therapy takes place through small systems that are generally wearable by the patient. Asra [29] reports a superiority over direct currents and a greater comfort of therapy. In a study conducted by Baker [30] in a blind RCT, statistically signicant healing results were reported against placebo.
15.2.5 Symmetric Biphasic Electrical Stimulation (SBES)
Rajendran [31] generally explores ESTIM sys­tems, in particular symmetrical biphasic stimulation, but does not arrive at conclusive data, while dening a positive trend.
Even these types of treatment would have a
prevalence of local effects, restoring a situation
15 Electrical Stimulation inWound Care
https://t.me/medicina_free
159
of acute wound bed through the mechanisms described in the above activities.
15.3 Stochastic Currents
These currents are asymmetrical as can be seen in Fig.15.1. The importance of what is dened as stochastic resonance begins with Collins’ studies [32]; it is hypothesized that this type of signal acts as a “noise” disorder, which allows the spread of nerve signals that, given the minimum voltage, could not spread normally. Further stud­ies [33, 34] conrmed this assumption. Therefore, ESTIMs based on stochastic currents would act as perceived nerve signals at the level of the CNS [7]. In fact, this could be the famous “neuro­trophin” hypothesized by Charcot in the rst half of the 1800s on pressure injuries.
15.3.1 Decubitus Direct Current Treatment (DDTC)
The rst studies are due to Adunsky and Ory showing statistical signicance in pressure inju­ries in an RCT [35]. The studies conducted by the present author with Afargan [7, 36] have demon­strated the effective action, not based on local factors but on the transmission of a systemic sig­nal. Fraccalvieri [37] hypothesizes its use in long-lasting non-healing lesions. Figure 15.2
shows a clinical case treated with DDTC and solved in 8weeks.
15.3.2 Frequency Rhythmic Electrical Modulation System (FREMS)
This type of ESTIM is managed by a program­mable computer; it is a system that is mainly used for the treatment of osteoarticular pathologies in the psychiatric sector. The activity of FREMS would be mainly on the vascular compartment [38, 39]; other authors have used it in the treat­ment of chronic skin lesions [40, 41] for repara­tive purposes or for the treatment of pain [42].
At this point, I am certain that I have not dis­pelled the doubts of the readers, and I would like to start with an assumption that the ESTIM in the treatment of chronic skin lesions works. It is an adjunctive therapy, ancillary, or dene it as you want, but it is based on solid scientic bases (Table 15.1), and it is recommended in the guidelines of numerous scientic associations [1318]. It is not a dressing, and therefore, since this is always necessary, it is sometimes dened as therapy; in reality, the dressings are not always deterministic at the level of activation of the reparative process. Our knowledge at the ultrastructural level is still limited, but my per­sonal hope is that this type of therapy will nd the right place in the therapeutic handbook of chronic skin lesions.
Fig. 15.2 Pressure sores after radiotherapy for neoplastic lesion. Wound aged 5years, healed in 8weeks
160
https://t.me/medicina_free
E. Ricci
References
1. Kloth LC. Electrical stimulation technologies for wound healing. Adv Wound Care (New Rochelle). 2014;3(2):81–90.
2. Largo S.Ricette mediche. Padova: S.A.R.G.O.N. edi­trice; 2012.
3. Finkelstein G. Mechanical neuroscience: Emil du Bois-Reymond’s innovations in theory and practice. Front Syst Neurosci. 2015;9:133.
4. Hougton PE. Electrical stimulation therapy to pro­mote healing of chronic wounds: a review of reviews. Chronic Wound Care Manag Res. 2017;4:25–43.
5. Taradaj J, Ricci E.Adjunctive therapies in pressure ulcers. In: Science and practice of pressure ulcer man­agement. Springer; 2018.
6. Collins C, Roberts G, Zhao M, Mani R. The use of electrical stimulation of chronic wounds: a review of the evidence. JWT. 2009;6:10–9.
7. Ricci E, Afargan M.The effect of stochastic electri­cal noise on hard-to-heal wounds. J Wound Care. 2010;19(3):96–103.
8. Foulds IS, Baker AT. Human skin battery poten­tials and their possible role in wound healing. Br J Dermatol. 1983;109(5):515–22.
9. Becher RO. Electrical control of growth processes. Med Times. 1967;95:657–69.
10. Palenske J, Morhenn VB. Changes in the skin’s capacitance after damage to the stratum corneum in humans. J Cutan Med Surg. 1999;3(3):127–31.
11. Barker A, Jaffee L, Vanable J.The glabrous epider­mis of cavies contains a powerful battery. Am J Phys. 1982;242:R258–66.
12. Kloth LC. Electrical stimulation technologies for wound healing. Adv Wound Care. 2013;3(2):81–90.
13. Sun Y-S. Electrical stimulation for wound-healing: simulation on the effect of electrode congura­tions. Biomed Res Int. 2017;2017:1–9. https://doi.
org/10.1155/2017/5289041.
14. Registered Nurses’ Association of Ontario. Assessment and management of pressure injuries for the interprofessional team. 3rd ed. Toronto, ON: Registered Nurses’ Association of Ontario; 2016.
15. National Pressure Ulcer Advisory Panel; European Pressure Ulcer Advisory Panel; Pan Pacic Pressure Injury Alliance. Prevention and treatment of pressure ulcers: quick reference guide. Haesler E. Osborne Park: Cambridge Media; 2014.
16. Qaseem A, Humphrey LL, Forciea MA, Starkey M, Denberg TD, Clinical guidelines Committee of the American College of Physicians. Treatment of pres­sure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):370–9.
17. Registered Nurses’ Association of Ontario. Nursing best practice guidelines: assessment and manage­ment of foot ulcers for people with diabetes. 2nd ed. Toronto, ON: Registered Nurses’ Association of Ontario; 2013.
18. Health Quality Ontario. Management of chronic pres­sure ulcers: an evidence-based analysis. Ont Health Technol Assess Ser. 2009;9(3):1–203.
19. National Clinical Guideline Centre. Pressure ulcer management. In: The prevention and management of pressure ulcers in primary and secondary care. London: National Institute for Health and Care Excellence; 2014.
20. Cerley PJ.Electrotherapy for acceleration of wound healing, low intensity direct current. Arch Phys Med Rehabil. 1985;66:443–6.
21. Balakatounis KC, Angoules AG.Low-intensity elec­trical stimulation in wound healing: review of the efcacy of externally applied currents resembling the current of injury. Eplasty. 2008;8:e28.
22. Ismiarto YD, Luth KA, Mahyudin M, Benedict A.Does low intensity direct current affect open frac­ture wound healing? Med Glas. 2021;18(1):153.
23. Wood JM, Evans PE III, Schallreuter KU, et al. Multicenter study on the use of pulsed low­intensity direct current for healing chronic stage II and stage III decubitus ulcers. Arch Dermatol. 1993;129(8):999–1009.
24. Kloth LC, Feedar DA.Acceleration of wound healing with high voltage monophasic pulsed current. Phys Ther. 1988;71(4):503–8.
25. Kloth LC.How to use electrical stimulation for wound healing. Nursing. 2002;32(12):17.
26. Goldman R, Brewley B, Zhou L. Electrotherapy to reverse expanding cutaneous gangrene in end stage renal disease. Adv Skin Wound Care. 2003;16(7):363–6.
27. Burdge JL, Hartman JF, Wright ML.The role of high voltage pulsed electrical stimulation in limb salvage for diabetic patients. Abstract 38–4, 2008, Symposium on Advances in Wound Care and WHS.
28. Martínez-Rodríguez A, Bello O, Fraiz M, Martinez­Bustelo S.The effect of alternating and biphasic cur­rents on humans’ wound healing: a literature review. Int J Dermatol. 2013;52(9):1053–62.
29. Ashra M, Alonso-Rasgado T, Baguneid M, Bayat A. The efcacy of electrical stimulation in lower extremity cutaneous wound healing: a systematic review. Exp Dermatol. 2017;26:171–8.
30. Baker LL, Rubayi S, Villar F, Demuth S. Effect of electrical stimulation waveform on healing of ulcer in human beings with spinal cord injury. Wound Repair Regen. 1996;4:21–8.
31. Rajendran SB, Challen K, Wright KL, Hardy JG.Electrical stimulation to enhance wound healing. J Funct Biomater. 2021;12:40–57.
32. Collins JJ, Imhoff TT, Grigg P.Noise enhanced tactile sensation. Nature. 1996b;383:770.
33. Bertha Vázquez-Rodríguez B, Avena-Koenigsberger A, Sporns O, et al. Stochastic resonance at critical­ity in a network model of the human cortex. Nature. 2017;7:13020.
34. Krauss P, Metzner C, Schilling A, Schütz C, et al. Adaptive stochastic resonance for unknown and vari­able input signals. Nature. 2017;7:2450.
15 Electrical Stimulation inWound Care
https://t.me/medicina_free
161
35. Adunsky A, Ory A. Decubitus direct current treat­ment (DDTC): results of a randomized double blinded placebo controlled study. Arch Gerontol Geriatr. 2005;41(3):261–9.
36. Ricci E.Risultati clinici del trattamento con BST.Acta Vulnologica vol. 7 suppl. VIII Congr. Naz. AIUC: 34, Firenze 2009.
37. Fraccalvieri M, Salomone M, Zingarelli EM, Rivarossa F, Bruschi F. Electrical stimulation for difcult wounds: only an alternative procedure? Int Wound. 2015;12(6):669–73.
38. Ricci E, Bardelli B, Ferrero S, etal. Neurostimulator for the treatment of critical limb ischemia in patients technically inoperable. 13th EPUAP Cong. 01-03 September 2010, Birmingham. Vol cong 87.
39. Ricci E, Amione P. Electrical treatment in wound care. III WUWHS Conf. 04-07 giugno 2008 Toronto, vol. congr.
40. Margara A, Boriani F, Obbialero FD, Bocchiotti MA. Frequency rhythmic electrical modulation system in the treatment of diabetic ulcers. Prelim Encourag Rep Chirurgia. 2008;21(6):311–4.
41. Ovidi F, Apollonio A, Capotorti E. Treatment of chronic skin ulcers with FREMS™ (Frequency Rhythmic Electrical Modulation System): clinical reports. Acta Vulnologica. 2009;7(1):21–6.
42. Janković A, Binić I. Frequency rhythmic electrical modulation system in the treatment of chronic painful leg ulcers. Arch Dermatol Res. 2008;300(7):377–83.
Phototherapy inWound Care
https://t.me/medicina_free
FabrizioMalan
16
The technological evolution of recent years has brought back a method that is actually quite ancient: the use of light for therapeutic purposes.
In old times, exposure to sunlight was consid­ered an essential defense to ght diseases and to maintain a good state of health.
There are different options of treatment with a light-based therapy:
• Photobiomodulation (PBM): based on a blue
light spectrum (400–430 nm) with low capac-
ity to penetrate the skin, it acts on an endogen
chromophobe (EME group)
• Fluorescence: always based on a blue light
spectrum (400–460 nm) associated with an
exogen chromophobe that works as a photoin-
ductor and photoconverter
• Photodynamic therapy (PDT): based on a red
light spectrum (630 nm) associated with a
photosensitized agent in a gel form, it is able
to reach the deepest layers of the epidermidis
In fact, the bactericidal and virucidal capacity of sunlight is known; less known is that this effect is mainly due to the blue component of the visi­ble part of the solar spectrum. The sun’s rays in the blue region are those that in greatest quantity reach the earth’s surface, even 10 times higher than that of UV rays, largely “ltered” by atmo-
F. Malan (*) Città della Salute, Torino, Italy e-mail: fmalan@cittadellasalute.to.it
spheric ozone. The germicidal activity of blue light, corresponding to a wavelength range between 405 and 470nm, has been the subject of growing scientic interest in recent years, due to the current problem of resistance to antibiotics by numerous bacterial species and the alarming shortage of new classes of antibiotics available on the market [1, 2].
Iella Ryberg Finsen was awarded the Nobel Prize in Medicine in 1903 for demonstrating the antibacterial capacity and stimulation of healing of concentrated light rays on wounds.
LASER has brought important advances in the use of light by dramatically expanding its eld of application. The use of LASER became a sign of avant-garde and modernity for many health pro­fessionals even beyond the optimal indications.
Another signicant step forward in the use of light for therapeutic purposes was made with the introduction of light-emitting diodes (LEDs) as a light source. LEDs can also allow the emission of a substantially monochromatic light with thera­peutic effects practically superimposable to those of low-intensity LASERs but with much lower costs and superior handling.
Since 2014, phototherapy that uses “low doses” of light for therapeutic purposes was dened as photobiomodulation by the scientic community, meaning a use of light that involves a non-thermal process with endogenous chromo­phores eliciting photo-physical and photochemi­cal events at various biological scales.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 M. Maruccia et al. (eds.), Pearls and Pitfalls in Skin Ulcer Management,
https://doi.org/10.1007/978-3-031-45453-0_16
163