A Review of Mechanical Adjuncts in Wound Healing: Hydrotherapy, Ultrasound, Negative Pressure Therapy, Hyperbaric Oxygen, and Electrostimulation

Abstract

Chronic or non-healing wounds may develop in the setting of many diseases and are the source of considerable morbidity as well as health costs. These wounds demand an aggressive, multifactorial approach including surgical debridement, revascularization, antibiotics and dressings. In addition several adjuvant treatment methods have been developed to further stimulate healing. Whirlpool, although used frequently, has not been proven to be of benefit. However, pulsed lavage does show a promising future. Ultrasound has demonstrated beneficial effects but further controlled studies are needed. Subatmospheric pressure therapy is associated with few complications and is fast becoming a mainstay of adjuvant therapy. Hyperbaric oxygen therapy has been shown to be effective for many types of wounds. Unfortunately, cost and access to chambers may prohibit its use on a routine basis. Finally, electrostimulation may be one of the up and coming therapies for the future. Though, more studies are needed to determine the mode of delivery for various types of wounds.

The Electrical Response to Injury: Molecular Mechanisms and Wound Healing

“…69 See also additional reviews and literature surveys. [70][71][72][73][74][75] The voltages applied are higher than the endogenous human skin wound EF, which is in the range of 100-300 mV/mm. 76 This is because the high resistance of the skin means there will be a significant drop of voltage between the electrodes and the cells migrating at the wound edge to heal the wound.…”

Effect of sildenafil citrate on secondary healing in full thickness skin defects in experiment

“…There are number of studies of electrostimulation and ultrasound therapy being benefi cial on secondary wound healing (22)(23)(24)(25)(26)(27)(28). Hydrotherapy, hyperbaric oxygen therapy, lasers, negative pressure therapy and a number of growth factors are reported to be useful in multiple studies.…”

Extracorporeal Shock Wave Therapy in the Treatment of Non-Healing Diabetic Ulcer: A Pilot Study

“…The delivery of shock waves has been shown to improve blood supply, increase cell proliferation and induce neovascularization via stimulation of endothelial nitric oxide synthase, vascular endothelial growth factor and proliferating cell nuclear antigen [12,13]. ESWT improves myocardial perfusion and cardiac function in a porcine model of chronic myocardial ischemia [14] and may help reduce the ischemic zone of flaps by increasing tissue perfusion and suppression of the inflammatory response [15].…”