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CHAPTER OBJECTIVES

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At the end of this chapter, the learner will be able to:

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  1. Describe skin battery, current of injury, and electrotaxis and their relationship to the use of electrical stimulation for wound healing.

  2. Select specific patient situations when electrical stimulation might be indicated in wound management.

  3. Describe the cellular and tissue effects of electrical stimulation on wounds and integrate this information for selection of application parameters.

  4. Demonstrate two application techniques for electrical stimulation and explain the advantages and disadvantages of both methods.

  5. Identify the precautions and contraindications for electrical stimulation in wound management.

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INTRODUCTION

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Health benefits related to the application of electrical current to biologic tissue were first documented in ancient Rome where currents generated by torpedo fish were used to treat chronic pain.1,2 It is reported that the use of electricity as a medical intervention started when a freed slave accidently stepped on a torpedo fish and received an electric shock. The shock apparently “cured” the man of chronic pain associated with what is now believed to have been gout.2 Since that time, electrical stimulation (ES) or “e-stim” technology has been utilized in both diagnostic and treatment procedures in multiple areas of patient care including general medicine, cardiology, surgery, and physical therapy.1,2 General indications include electrocautery of bleeding vessels, muscle stimulation/reeducation, pain control, improved blood flow, and the transcutaneous delivery of medications.3 Literature also documents that ES promotes wound healing by creating changes in epidermal polarity,4 cellular migration and function, blood flow, edema, and wound contraction,5-7 as well as by decreasing bioburden and improving autolysis.4 Meta-analysis review confirms that through these changes, ES can increase wound healing by as much as 22% per week.8,9 ES for wound healing is supported by multiple health professional organizations including the National Pressure Ulcer Advisory Panel, the European Pressure Ulcer Advisory Panel,10,11 the Wound, Ostomy and Continence Nurses Society,12 and the American Physical Therapy Association’s Section on Clinical Electrophysiology and Wound Management.13

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This chapter discusses the therapeutic application of electrical current for wound healing using terminology presented in TABLE 14-1. ES equipment consists of an electric or battery-powered base unit with adjustments for parameters (eg, voltage, polarity, treatment time), electrodes that conform to the wound or periwound surface, and lead wires that connect electrodes to the base unit. Although no ES device is approved by the FDA specifically for wound management,14 general units that are used “off label” are of various sizes ranging from bulky, box-type units that can provide a variety of current types to small, handheld units designed for portability. TABLE 14-2 provides a partial list of ES vendors (FIGURES 14-1, 14-2). Electrodes used for wound management include self-adhesive gel, carbon, and aluminum foil paired with an alligator clip and saline moistened gauze (FIGURES 14-3A-C...

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