Adjunctive modalities apply when wound care basics aren’t enough

Clinicians discuss adjunctive modalities to treat a wound.

Have you ever felt like you may have run out of options to heal a wound?

We have all been there in our wound care careers. Before you throw in the towel or pull your hair out in frustration, take a step back and make sure you started the process in the correct manner.

First, ensure you have successfully addressed all the basics of wound healing:

  • Removed the cause
  • Provided moist wound healing
  • Removed the necrotic tissue and epibole
  • Managed the bioburden
  • Ensured adequate tissue perfusion
  • Ensured adequate nutrition

Then review treatments that can accelerate the healing process. You have to build your treatment plan on a solid foundation of basic approaches before considering more expensive, adjunctive modalities. 

Unfortunately, too often clinicians tend to skip over these basics, especially effectively treating the underlying cause. Then they get frustrated when they don’t see results.

Power of adjunctive modalities and therapies

So what do you do when you have implemented solid, evidenced-based basic wound care but your results still are hampered?

Enter adjunctive modalities and therapies — treatments designed to stimulate and accelerate the natural healing process of the body through different mechanisms.  

However, if they are not supported by basic wound care principles they end up being a waste of time and a financial drain on the patient, facility and system.

See below for examples of adjunctive modalities and therapies.

Negative pressure wound therapy

This modality uses negative pressure (suction) to stimulate cell growth, blood flow, tissue proliferation. It also decompresses tissue by removal of interstitial fluid and edema to improve capillary perfusion. 

It can also remove excess exudate which contains, bacteria, proteolytic enzymes, debris and other contaminants that can impair healing.

Electrical stimulation

This adjuntive modality uses electrical current to mimic the body’s own natural “current of injury,” which commonly dissipates in chronic wounds.

This modality stimulates things like:

  • Epidermal proliferation
  • Increased blood flow
  • Fibroblast proliferation
  • Collagen synthesis
  • Kills bacteria
  • Lysis of necrotic tissue

Ultrasound

This modality uses sound energy at a level above human hearing to induce different reactions in the tissue.

First, it is a thermal modality that can increase tissue temperature. This also improves blood flow, which increases oxygen and nutrient delivery and the removal of waste products. 

Second, it can effectively reduce pain at the wound site.

Lastly, it has shown microbicidal effects reducing infection risks and biofilm. 

Pulsed electromagnetic energy

This adjunctive modality uses a form of electromagnetic energy to induce a magnetic field within the wound that can be converted into heat or cause cellular reactions. 

It can be used to:

  • Decrease necrotic tissue (enhancing autolysis)
  • Decrease edema and pain
  • Improve granulation and angiogenesis
  • Increase collagen synthesis and epidermal migration

There are two forms — pulsed radio frequency stimulation (non-thermal) and short-wave diathermy (thermal).

Hyperbaric oxygen therapy

This modality involves having the patient breath 100% oxygen versus the normal 21% on room air at pressures greater than sea level (usually 2-2.5 atmospheres). 

This increases the amount of dissolved oxygen in the blood, which can improve tissue perfusions in wounds with compromised blood flow and oxygen perfusion. 

This will impact all phases of healing since they are oxygen dependent for optimal benefits.

Cellular tissue-based products

These products are made of bovine, porcine, avian or marine cells and tissue. 

They can provide a temporary or permanent covering for wounds that can be challenging to heal. 

The products can be cellular, which means they contain living cells like fibroblasts and keratinocytes. Or they can be acellular — a porous matrix providing matrix-cell interactions to stimulate growth fact or production.

Always do your research

This list focuses on the most prominent and evidence-based approaches being used today.

However, it does not include all adjunctive modalities and therapies being used or new ones to be developed as more research is done. 

As I mentioned earlier, if you do not effectively implement the basics of wound healing your adjunctive modalities will fail to produce the results you expect. 

Take our Skin and Wound Management course today.

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Bill Richlen, PT, WCC, DWC, is a clinical instructor for the Wound Care Education Institute. As a licensed physical therapist, Richlen has experience in advanced wound care consultations in long-term care, outpatient, skilled rehabilitation and home health. He has served as a clinical instructor for physical therapy students, been the director of several large rehabilitation departments, and has been providing multi-disciplinary wound care education to nurses and therapists for more than 17 years. His expertise in diverse settings enhance his role as a clinical instructor. His dynamic and captivating teaching style keeps attendee’s attention throughout each course.

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