125 patients with open wounds on the volar aspect of the hand were included in the study. A study to determine the effect of laser and pulsed short wave therapy on the healing of open wounds in the hand.
CHAPTER 1: INTRODUCTION 1
CHAPTER 2
CHAPTER 3: ELECTROTHERAPY 29
CHAPTER 6 DISCUSSION 111
CHAPTER 7
Mean percentage of residual wound area and standard deviation per week for all groups within. Mean percentage of residual wound area and standard deviation per week for all groups in all.
Plate 2 Photograph showing Tegaderm trace 67 Plate 3 Photograph showing normal saline soak of the hand 70
APPENDIX 2 Wound healing raw data for aU groups APPENDIX 3 Pain measurement raw data for all groups
INTRODUCTION
CHAPTER 1
- History of wound management
- Types of wound healing
- Healing by first intention (primary repair)
- Healing by second intention (secondary repair)
- Healing by third intention (delayed primary repair)
- Pathophysiology of wound healing
- Inflammatory phase
- Migratory phase
- Proliferative or contraction phase
- Maturation or late phase
- Formulation of study
Diagrammatic representation of the overlapping phases of wound healing during the first three months after injury. Macrophage function in wound healing is required for debridement, stimulation, and regulation of the repair sequence.
CHAPTER 2
LITERATURE REVIEW
- Healing of open wounds
- Documentation
- Wound dressings
- Bandages
- Moist dr e ssings
- Bacteriology
- Wound debridement
- Wound cleansing agents
- Pain
- Electrotherapy
- Pulsed shortwave therapy (PST)
- Laser
- Ultraviolet radiation (lNR)
- Infrared radiation
- Assessment
- Adjunctive therapies
The harmful effects of malnutrition are visible at various stages of the wound healing process. In 1985, Barker et al assessed the efficacy of pulsed shortwave therapy in the treatment of lateral ligament sprains of the ankle.
ELECTROTHERAPY
CHAPTER 3
Pulsed shortwave therapy (PST)
- Production of PST
- Physiological effects
- Therapeutic effects
- Dangers and contraindications
- Technique of application
- Dosage
Some depolarization of the cell membrane is often associated with cell dysfunction, and electrical potentials are developed during wound healing. Therefore, when the next pulse is generated, there is still a residual non-thermal effect to which the effect of the second pulse will be added. The electrical potential across a normal cell membrane is maintained at 60-90 millivolts (mV) due to the relative position of ions on either side of the cell membrane.
No significant heat is generated by the very short pulses, therefore there is no danger of a burn due to concentration of the field by metal or moisture (Figure 6). Various methods can be used, but the contraplanar method, according to which electrodes are placed on each side of the area to be treated, is the most appropriate in the treatment of hands. Both electrodes must be of the same size and the distribution of the electric field in the tissues will depend on the size and position of the electrodes used (Figure 7).
The shape of the tissues will also influence the distribution of the electric field.
Laser
- Production of laser
- Physiological effects
- Therapeutic effects
- Dangers and contraindications
- Technique of application
- Dosage
Soft lasers have a very superficial effect and are primarily used to treat the skin. Since the GaAAs laser device falls in the red part of the visible spectrum, its color is . brilliant red. The amount of absorption in the different layers is dependent on skin thickness, blood flow, water content, amino acid content and the presence of chemophores.
Scattering refers to a directional change in light propagation due to the complex geometry of the tissue involved (Figure 11. The explanations of the physiological effects of the laser at the cellular level are still largely theoretical. Using the grid technique, the surface area of tissue to be treated is determined .
The tip of the laser probe must be in contact with the surface of the skin to achieve maximum clinical effect.
Ultraviolet radiation (UVR)
- Physiologi c al effects
- Therapeutic effects
- Dangers and contraindications
- Technique of application
- Dosage
At the same time, however, visible and infrared electromagnetic waves are produced, and ultraviolet forms only part of the total spectrum (Figure 17). A pump and cooling fan are built into the body of the Kromayer lamp to cool the water. The water circulates between two quartz windows at the front of the Kromayer head, allowing the ultraviolet to escape.
The characteristic photon wavelengths emitted by mercury atoms are in the green-blue-violet end of the visible spectrum and in the ultraviolet. Sudden overactivity of the basal layer of the epidermis causes a noticeable thickening, especially of the stratum corneum (the outer layer). The purpose of the ultraviolet is to destroy bacteria, remove the sludge and promote recovery.
The purpose of ultraviolet radiation is to destroy bacteria, remove debris and speed up the healing of infected wounds.
Infrared radiation (IRR)
- Production of IRR
- Physiological effects
- Therapeutic effects
- Dangers and contraindications
- Technique of application
- Dosage
The depth of penetration of electromagnetic radiation depends on its wavelength and the nature of the material. The angle of the incident ray to the normal is equal to the angle of the reflected ray to the normal. The penetration of radiation is proportional to the cosine of the angle of incidence of the radiation.
In practice, this means that the closer a patient is to the source, the greater the intensity of the radiation received. A few minutes before applying the treatment, the light lamp is turned on to stabilize. The lamp is positioned so that it is opposite the center of the area to be treated and the rays strike the skin at a right angle, ensuring maximum absorption.
The intensity of the radiation is usually controlled by changing the distance of the lamp from the skin.
CHAPTER 4
PATIENTS AND METHODS
- Board approval and patient consent
- Sample selection
- Selection criteria
- Exclusion criteria
125 patients with open wounds (full thickness) to the volar aspect of the hand participated in the study. The volar aspect of the hand is the most common site of work-related hand injuries. All patients were assessed for zone of injury, and zones of flexor tendon injury (Figure 25) were used to match the wounds for zone of injury.
Patients who had sustained a crush injury with open wounds on the volar aspect of the hand were included in the study. Patients with an Hb level less than 10 g/4 were excluded from the study and referred to the doctor for possible further medical treatment. These patients were excluded from the study as it was considered that the patient was already at risk due to the low Hb level and this would affect the rate of wound healing.
Those patients who were administered antibiotic therapy were excluded from the study, as it was thought that the antibiotics would affect the healing process, and thus the results obtained from the study.
Photograph of a wound swab
Randomisation
Assessment of patients
- Wound dimensions Wound size was assessed as follows
- Trace
Photograph showing Tegaderm trace
- Area of wound
- Photography
- Wound granulation
- Pain measurement
- Technique
- Sterile Procedure
- Saline soak
The original size of the wound at week O = 33.79 mg (as measured on the Mettler balance). The numerical rating scale (NRS) has 11 points, with O being no pain and 10 being the worst pain experienced. When using the NRS, the provider simply asks the patients to rate the intensity of their pain with zero being no pain and 10 being the worst possible pain.
Pain intensity was assessed once a week using the NRS and this was done while the patient was attending treatment. The saline bottle was microwaved for 2 minutes to warm the solution for the patient's comfort. This was used to irrigate the wounds and encourage active range of motion exercises of the affected arm.
Photograph showing normal saline soak of the hand
Wound dressings
A minimal dressing was used to ensure that only the wound area was covered and to encourage as much active joint range of motion as possible. This dressing is used as the primary wound contact layer and paraffin is present to reduce product adhesion to the granulating wound surface.
Photograph showing Jelonet wound dressing
Frequency of treatment
Technique of application of electrotherapy modalities
Photograph showing the application of PST
Dosage
Laser
- Technique of application
Photograph showing the application of laser
Dosage
Each wound was irradiated for 30 seconds per square centimeter (sec/cm2), using continuous mode, and calculated using the following equation.
Ultraviolet radiation .1 Technique of application
Photograph showing the application of UVR
Dosage
Infrared radiation .1 Technique of application
Photograph showing the application of IRR
RESULTS
CHAPTER 5
Age Distribution
ZONE I ZONE II WNEID ZONE IV ZONE V
- Male: Female ratio
- Traces
- Photographs
- Measurement of wound healing
- PAIN MEASUREMENT
The example on plate 10 (a) is a series of photographs taken from a patient in the PST group in Zone II. When analyzing the data for wound healing rates in all groups in zone I per week for 4 weeks, no statistical difference was found between the different treatment groups. Repeated measures analysis of variance using MANOV A test criteria and exact F statistics for the hypothesis of no TIME effect in zone I showed significant changes over time with a p-value of 0.0001 for all groups.
Analysis of wound healing for all groups in zone IV by week showed no statistical significance at week 1, week 2, week 3 or 4. MANOVA test criteria and exact F-statistics for the hypothesis of no TIME effect yielded a p-value of 0.0001, showing a significant change for all groups. Analysis of variance tests for wound healing in zone V at each week yielded the following.
The graphical illustration of pain measurement in all groups in area I is shown in Figure 33.
PAIN STD.DEV PAIN STD.DEV PAIN STD.DEV PAIN STD.DEV PAIN STD.DE'.
- DISCUSSION
The dependent variable of pain measurement at week 0 week 1, week 2 and week 3 showed no significance between treatment groups. Pain measurement at week 0 and week 1 was not significantly different for the different treatment groups. PAIN STD.DEV PAIN STD.DEV PAIN STD.DEV PAIN STD.DEV PAIN STD.DEV.
A graphical illustration of the mean pain measurement of the different treatment groups in zone IV is shown in Figure 36. The dependent variable of the pain measurement at week 0, week 1, week 2 and week 3 showed no significance between the treatment groups. The pain measurement at week 0, week 1 and week 2 was not significantly different for the different treatment groups.
पालन एसटीडी.देव पालन एसटीडी.देव पैन एसटीडी.देव पैन एसटीडी.देव पैन एसटीडी.देव
CHAPTER6
- Age distribution
- Male: Female ratio
- Wound healing
- Traces
- Photographs
- Wound healing in the different zones .1 Zone I
- Pain measurement
- Pain measurement in the different zones
- Comparison of treatment groups
- Limitations
- CONCLUSION AND RECOMMENDATIONS
- CONCLUSION
- RECOMMENDATIONS .1 Patient education
In this area, the PST group showed greater wound healing compared to the other groups. The PST group provided the best wound healing overall compared to the other treatment groups in all areas. PST provided more pain relief than the other groups in zone I at each of the 4 weeks.
In the other groups, pain control was achieved in the following descending order: IRR, laser, UVR, control. The PST group achieved the best wound healing and provided the most pain relief compared to the other treatment groups. McCulloch (1998) states in the Journal of Wound Care that “the physical therapist is a highly valued member of the wound care team in the United States.
The other modalities require the wound to be exposed for administration of the treatment modality.
Proceedings of the IXth International Congress of World Confederation of Physical Therapy, Stockholm, Sweden, 23-28. May. The effects of Diapulse on wound healing: a double-blind randomized controlled trial in humans. Goujon C, Divol J, Mouoin G Preliminary results of mid.laser treatment of chronic leg ulceration (Abstract).
Effects of low power density laser radiation on healing on open skin wounds in rats. Comparison of ultrasound/ultraviolet-C and laser for the treatment of pressure ulcers in patients with spinal cord injury. A pilot study to compare the effectiveness of continuous and pulsed magnetic energy for the relief of low back pain.
Scabies formation and the rate of epithelization of superficial wounds in the skin of the young domestic pig.
WEEKO WEEKI
WEEKO WEEKI
