- Email: [email protected]
Ace Your Certification
Journal of the American College of Clinical Wound Specialists (2014) 5, 23–4
COLUMN
Ace Your Certification Jayesh Shah, MD, CWS, FACCWS, FAPWCA, UHM, FACHM NE Baptist Wound Healing Center, NE Baptist Hospital, 8811 Village Drive, San Antonio, TX 78217, USA 1. Ultrasound therapy for wounds appears to a. Modulate fibroblast activity b. Modulate inflammatory response c. Modulate Cytokine Production d. Induces hypoxic inducible factor-1 activation e. All of the above 2. Ultrasound therapy helps with wound healing by all of the above except a. Formation of beefy red granulation tissue b. Promoting vasodilation and angiogenesis c. Alteration in bacterial load during treatment of chronic wounds d. Correction of Hypoxia 3. Following statements about Ultrasound therapy are true a. Low frequency Ultrasound has the potential of delivering energy with less attenuation than high frequency Ultrasound. b. Low frequency Ultrasound treatment may be useful in the management of venous leg ulcers. c. RCT’s of low frequency, noncontact US treatment suggest an effect on neuropathic, superficial diabetic foot ulcers. d. All of the above 4. Following statements about Ultrasound debriders are true except a. Ultrasound debriders can be useful when nonpainful, selective debridement is required particularly in a nonsurgical setting. b. The clinical debridement of necrotic and infected tissue with nonsurgical low-frequency, contact Ultrasound devices is selective and superior to debridement with a Scalpel.
c. Debridement with Contact, Low-frequency devices allow a good wound bed preparation d. Noncontact Ultrasound can be useful as an adjunct to sharp debridement to improve the characteristics of the granulation tissue and allow a more rapid wound closure or delayed primary closure. 5. TIMEO2 principle of wound bed preparation includes a. Tissue debridement b. Infection c. Moisture d. Edge effect e. Correction of Hypoxia f. All of the above
Answers 1. e, 2. d, 3. d, 4. b, 5. f Question 1. Answer (e) Ultrasound appears to modulate fibroblast activity1,2 the inflammatory response,1,2 and cytokine production.3 It also induces hypoxia inducible factor-1.4 Question 2. Answer (d) Ultrasound may enhance the formation of a stronger granulation tissue.5 Low frequency ultrasound treatment may be helpful in the clinical management of ischemic wounds by promoting vasodilation and angiogenesis.6,7 Ultrasound may be useful in the alteration of the bacterial load during the treatment of chronic wounds.8 Question 3. Answer (d)
E-mail address: [email protected] 2213-5103/$ - see front matter. http://dx.doi.org/10.1016/j.jccw.2014.07.001
Ultrasound is able to exert a biologic effect by low or high frequency, Intensity of Ultrasound delivery since absorption,
24
Journal of the American College of Clinical Wound Specialists, Vol 5, No 1
which is frequency dependent, is the major cause of intensity attenuation. By increasing the frequency, the wavelength shortens and absorption increases. Low frequency ultrasound has the potential of delivering energy with less attenuation than high-frequency Ultrasound. Low frequency Ultrasound shows a deeper tissue penetration that high frequency Ultrasound. In recent years low-frequency Ultrasound devices have been increasing used for wound healing, serving as debriders or as healing promoters.9 Question 4. Answer (b) Ultrasound debriders can be useful when nonpainful, selective debridement is required particularly in a nonsurgical setting, Noncontact ultrasound can be useful adjunct to sharp debridement to improve the characteristics of the granulation tissue and allow a more rapid wound closure or delayed primary closure. The clinical debridement of necrotic and infected tissue with nonsurgical lowfrequency, contact Ultrasound devices is selective and as effective as debridement with a scalpel.10,11 Question 5. Answer (f) TIME Principle of wound bed preparation includes Tissue Debridement, Infection Management, Moisture Control and Edge Effect.12 Correction of hypoxia is also necessary for wound bed preparation.13
References 1. Zhou S, Schmeltz A, Seuferein T, Yiping L, Jinshin Z, Bachem MG. Molecular mechanisms of low intensity pulsed ultrasound in human skin fibroblasts. J Biol Chem 2004;279(52):54463–9.
2. Lai J, Pittelkow MR. Physiological effects of ultrasound mist on fibroblasts. Int J Dermatol 2007;46:567. 3. Byl NN, Mckenzie AL, West JM, Whitney JD, Hunt TK, Scheuerstuhl HA. Low dose ultrasound effects on wound healing: a controlled study with Yucatan pigs. Arch Phys Med Rehabil 1992; 73(7):656–64. 4. Tang Chih-Hsin, Lu Dah-Yuu, Tan Tzu-Wei, Fu Wen-Mei, Yang Rong-Sen. Ultrasound induces hypoxia-inducible factor-1 activation and inducible nitric-oxide synthase expression through the integrin/integrin-linked kinase/Akt/mammalian target of rapamycin pathway in osteoblasts. J Biol Chem 2007;282:25406–15. 5. Thawer HA, Houghton PE. Effects of ultrasound delivered through a mist of saline to wounds in mice with diabetes mellitus. J Wound Care 2004;13:171–6. 6. Reher P, Doan N, Bradnock B, Meghji S, Harris M. Effects of ultrasound on the production of IL-B, basic FGF and VEFG. Cytokine 1999;11:416. 7. Altand OD, Dalecki D, Suchkova VN, Francis CW. Low-intensity ultrasound increases endothelial cell nitric oxide synthase activity and nitric oxide synthesis. J Thromb Haemost 2003;2:637. 8. Serena T, Lee K, Lam K, Attar P, Meneses P, Ennis W. The impact of noncontact, nonthermal, low-frequency ultrasound on bacterial counts in experimental and chronic wounds. Ostomy Wound Manage 2009;55:22. 9. Vickie R Driver, Matteo Fabbi, Recent advances in the use of ultrasound in wound care. In: Chandan K Sen, ed. Advances in Wound Care; 550–555; vol. 1. 10. Schultze CH, Hulskamp T, Schikorski M, Thies E. Effective, gentle, low pain wound debridement with low frequency ultrasound applied using mobile equipment. http://wundbehandlung/dokuments/ opencms/opencms/wundbehandlung/dokumente/Effectiveexgentle_low. pain_wound_debridement_with_low-frequency_ultrasound_applied_ using_mobile_equipment.pdf. 11. Sussman C, Dyson M. Therapeutic and diagnostic ultrasound. In: Sussman C, Bates-Jensen B, editors. Wound Care, A Collaborative Practice Manual for Health Professionals. Vol. 25. Lippincott Williams and Wilkins; 2006. p. 617. 12. Shah JB. Venous Insufficiency Ulcer. In: Shah et al, eds. Wound Care Certification Study Guide; 115–124 [Chapter 14]. 13. Shah Jayesh B. Correction of Hypoxia, A Critical Element for Wound Bed Preparation Guidelines: TIMEO2 Principle of Wound Bed Preparation. J Am Col Certif Wound Spec Jun 2011;3(2):26–32.
COLUMN
Ace Your Certification Jayesh Shah, MD, CWS, FACCWS, FAPWCA, UHM, FACHM NE Baptist Wound Healing Center, NE Baptist Hospital, 8811 Village Drive, San Antonio, TX 78217, USA 1. Ultrasound therapy for wounds appears to a. Modulate fibroblast activity b. Modulate inflammatory response c. Modulate Cytokine Production d. Induces hypoxic inducible factor-1 activation e. All of the above 2. Ultrasound therapy helps with wound healing by all of the above except a. Formation of beefy red granulation tissue b. Promoting vasodilation and angiogenesis c. Alteration in bacterial load during treatment of chronic wounds d. Correction of Hypoxia 3. Following statements about Ultrasound therapy are true a. Low frequency Ultrasound has the potential of delivering energy with less attenuation than high frequency Ultrasound. b. Low frequency Ultrasound treatment may be useful in the management of venous leg ulcers. c. RCT’s of low frequency, noncontact US treatment suggest an effect on neuropathic, superficial diabetic foot ulcers. d. All of the above 4. Following statements about Ultrasound debriders are true except a. Ultrasound debriders can be useful when nonpainful, selective debridement is required particularly in a nonsurgical setting. b. The clinical debridement of necrotic and infected tissue with nonsurgical low-frequency, contact Ultrasound devices is selective and superior to debridement with a Scalpel.
c. Debridement with Contact, Low-frequency devices allow a good wound bed preparation d. Noncontact Ultrasound can be useful as an adjunct to sharp debridement to improve the characteristics of the granulation tissue and allow a more rapid wound closure or delayed primary closure. 5. TIMEO2 principle of wound bed preparation includes a. Tissue debridement b. Infection c. Moisture d. Edge effect e. Correction of Hypoxia f. All of the above
Answers 1. e, 2. d, 3. d, 4. b, 5. f Question 1. Answer (e) Ultrasound appears to modulate fibroblast activity1,2 the inflammatory response,1,2 and cytokine production.3 It also induces hypoxia inducible factor-1.4 Question 2. Answer (d) Ultrasound may enhance the formation of a stronger granulation tissue.5 Low frequency ultrasound treatment may be helpful in the clinical management of ischemic wounds by promoting vasodilation and angiogenesis.6,7 Ultrasound may be useful in the alteration of the bacterial load during the treatment of chronic wounds.8 Question 3. Answer (d)
E-mail address: [email protected] 2213-5103/$ - see front matter. http://dx.doi.org/10.1016/j.jccw.2014.07.001
Ultrasound is able to exert a biologic effect by low or high frequency, Intensity of Ultrasound delivery since absorption,
24
Journal of the American College of Clinical Wound Specialists, Vol 5, No 1
which is frequency dependent, is the major cause of intensity attenuation. By increasing the frequency, the wavelength shortens and absorption increases. Low frequency ultrasound has the potential of delivering energy with less attenuation than high-frequency Ultrasound. Low frequency Ultrasound shows a deeper tissue penetration that high frequency Ultrasound. In recent years low-frequency Ultrasound devices have been increasing used for wound healing, serving as debriders or as healing promoters.9 Question 4. Answer (b) Ultrasound debriders can be useful when nonpainful, selective debridement is required particularly in a nonsurgical setting, Noncontact ultrasound can be useful adjunct to sharp debridement to improve the characteristics of the granulation tissue and allow a more rapid wound closure or delayed primary closure. The clinical debridement of necrotic and infected tissue with nonsurgical lowfrequency, contact Ultrasound devices is selective and as effective as debridement with a scalpel.10,11 Question 5. Answer (f) TIME Principle of wound bed preparation includes Tissue Debridement, Infection Management, Moisture Control and Edge Effect.12 Correction of hypoxia is also necessary for wound bed preparation.13
References 1. Zhou S, Schmeltz A, Seuferein T, Yiping L, Jinshin Z, Bachem MG. Molecular mechanisms of low intensity pulsed ultrasound in human skin fibroblasts. J Biol Chem 2004;279(52):54463–9.
2. Lai J, Pittelkow MR. Physiological effects of ultrasound mist on fibroblasts. Int J Dermatol 2007;46:567. 3. Byl NN, Mckenzie AL, West JM, Whitney JD, Hunt TK, Scheuerstuhl HA. Low dose ultrasound effects on wound healing: a controlled study with Yucatan pigs. Arch Phys Med Rehabil 1992; 73(7):656–64. 4. Tang Chih-Hsin, Lu Dah-Yuu, Tan Tzu-Wei, Fu Wen-Mei, Yang Rong-Sen. Ultrasound induces hypoxia-inducible factor-1 activation and inducible nitric-oxide synthase expression through the integrin/integrin-linked kinase/Akt/mammalian target of rapamycin pathway in osteoblasts. J Biol Chem 2007;282:25406–15. 5. Thawer HA, Houghton PE. Effects of ultrasound delivered through a mist of saline to wounds in mice with diabetes mellitus. J Wound Care 2004;13:171–6. 6. Reher P, Doan N, Bradnock B, Meghji S, Harris M. Effects of ultrasound on the production of IL-B, basic FGF and VEFG. Cytokine 1999;11:416. 7. Altand OD, Dalecki D, Suchkova VN, Francis CW. Low-intensity ultrasound increases endothelial cell nitric oxide synthase activity and nitric oxide synthesis. J Thromb Haemost 2003;2:637. 8. Serena T, Lee K, Lam K, Attar P, Meneses P, Ennis W. The impact of noncontact, nonthermal, low-frequency ultrasound on bacterial counts in experimental and chronic wounds. Ostomy Wound Manage 2009;55:22. 9. Vickie R Driver, Matteo Fabbi, Recent advances in the use of ultrasound in wound care. In: Chandan K Sen, ed. Advances in Wound Care; 550–555; vol. 1. 10. Schultze CH, Hulskamp T, Schikorski M, Thies E. Effective, gentle, low pain wound debridement with low frequency ultrasound applied using mobile equipment. http://wundbehandlung/dokuments/ opencms/opencms/wundbehandlung/dokumente/Effectiveexgentle_low. pain_wound_debridement_with_low-frequency_ultrasound_applied_ using_mobile_equipment.pdf. 11. Sussman C, Dyson M. Therapeutic and diagnostic ultrasound. In: Sussman C, Bates-Jensen B, editors. Wound Care, A Collaborative Practice Manual for Health Professionals. Vol. 25. Lippincott Williams and Wilkins; 2006. p. 617. 12. Shah JB. Venous Insufficiency Ulcer. In: Shah et al, eds. Wound Care Certification Study Guide; 115–124 [Chapter 14]. 13. Shah Jayesh B. Correction of Hypoxia, A Critical Element for Wound Bed Preparation Guidelines: TIMEO2 Principle of Wound Bed Preparation. J Am Col Certif Wound Spec Jun 2011;3(2):26–32.