As mentioned in earlier chapters, many of chronic wounds are delayed or fail to heal through conventional treatment because attenuated activities of cells responsible for wound healing contribute to the impairment of tissue restoration. Severely impaired activities of cells crucial for wound healing are important factors in non- or delayed-healing wounds. In this chapter, various adjunctive treatment modalities that are used to increase cell activities are described. Information of nutritional support, electrical stimulation, ultrasound, oxygen therapy, monochromatic infrared energy, ultraviolet light, pain scrambler therapy, and a foot massager device is provided. It is important to emphasize that adjunctive therapy alone is unlikely to result in improved healing rates. Adjunctive therapy must be used in conjunction with other standard principles of chronic wound management, including debridement, infection control, pressure off-loading, and revascularization. In addition, research regarding the use of these adjunctive therapies to facilitate wound healing is still limited. Further controlled studies are needed to determine the most effective treatment parameters.
- Adjunctive therapy
- Wound healing
This is a preview of subscription content, access via your institution.
Tax calculation will be finalised at checkout
Purchases are for personal use onlyLearn about institutional subscriptions
Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117:42S–58.
Beuker BJ, Van Deursen RW, Price P, et al. Plantar pressure in off-loading devices used in diabetic ulcer treatment. Wound Repair Regen. 2005;13:537–42.
Bradley M, Cullum N, Nelson EA, et al. Systematic review of wound care management: (2) dressings and topical agents used in the healing of chronic wounds. Health Technol Assess. 1999;l3:1–35.
Calcutt NA, Backonja MM. Pathogenesis of pain in peripheral diabetic neuropathy. Curr Diab Rep. 2007;7:429–34.
Cornell RS, Ducic I. Painful diabetic neuropathy. Clin Podiatr Med Surg. 2008;25:347–60.
Course outline for wound care education. WoundEducators.com. 2009.
David GG. Wound healing and diabetes mellitus. Clin Plast Surg. 2003;30:37–45.
Eaglstein WH. Wound healing and aging. Dermatol Clin. 1986;4:481–4.
Ehrlich HP, Hunt TK. Effects of cortisone and vitamin A on wound healing. Ann Surg. 1968;167:324–8.
Ehrlich P, Tarver H, Hunt TK. Inhibitory effect of vitamin E on collagen synthesis and wound repair. Ann Surg. 1972;175:235–40.
Ehrlich P, Tarver H, Hunt TK. The effects of vitamin A and glucocorticoids upon repair and collagen synthesis. Ann Surg. 1973;177:222–7.
Embil JM, Papp K, Sibbald G, et al. Recombinant human platelet-derived growth factor-BB (becaplermin) for healing chronic lower extremity diabetic ulcers: an open-label clinical evaluation of efficacy. Wound Repair Regen. 2000;8:162–8.
Freedman JE, Farhat JH, Loscalzo J, et al. alpha-tocopherol inhibits aggregation of human platelets by a protein kinase C-dependent mechanism. Circulation. 1996;94:2434–40.
Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician. 2002;66:1655–62.
Gu JH, Han SK, Chang H, et al. Study of wound healing factors in diabetic foot patients. J Korean Soc Plast Reconstr Surg. 2007;34:543–50.
Han SK, You HJ. Wound coverage using advanced technology in Korea. J Korean Med Assoc. 2011;54:594–603.
Han SK, Choi KJ, Kim WK. Clinical application of fresh fibroblast allografts for the treatment of diabetic foot ulcers: a pilot study. Plast Reconstr Surg. 2004;114:1783–9.
Han SK, Yoon TH, Lee DG, et al. Potential of human bone marrow stromal cells to accelerate wound healing in vitro. Ann Plast Surg. 2005;55:414–9.
Han SK, Chun KW, Gye MS, et al. The effect of human bone marrow stromal cells and dermal fibroblasts on angiogenesis. Plast Recontr Surg. 2006a;117:829–35.
Han SK, Shin SH, Kang HL, et al. Augmentation rhinoplasty using injectable tissue-engineered soft tissue – a pilot study. Ann Plast Surg. 2006b;56:251–5.
Han SK, Kim DW, Jeong SH, et al. Potential use of blood bank platelet concentrates to accelerate wound healing of diabetic ulcers. Ann Plast Surg. 2007;59:532–7.
Hansen SL, Young DM, Boudreau NJ. HoxD3 expression and collagen synthesis in diabetic fibroblasts. Wound Repair Regen. 2003;11:474–80.
Hunt TK. Disorders of wound healing. World J Surg. 1980;4:271–7.
Hunt TK. Vitamin A, and wound healing. J Am Acad Dermatol. 1986;15:817–21.
Hunt TK, Zederfeldt B. Nutritional and environmental aspects in wound healing. In: Dunphy JE, Van Winkle Jr W, editors. Repair and regeneration. The scientific basis for surgical practice. New York: McGraw-Hill; 1969. p. 217–28.
Hunt TK, Ehrlich HP, Garcia JA, et al. Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man. Ann Surg. 1969;170:633–41.
John LB, John SM, Linda GP. Impairments to wound healing. Clin Plast Surg. 2003;30:47–56.
Kim SH, Kim JW, Kim JB, et al. Multifactorial factors of diabetic foot on diabetes mellitus comparative clinical study. J Korean Soc Plast Reconstr Surg. 2002;29:83–90.
Ko YK MD, Lee HY MD, Lee WY. Clinical experiences on the effect of scrambler therapy for patients with postherpetic neuralgia. Korean J Pain. 2013;26:98–101.
Kosiak M. Etiology and pathology of ischemic ulcers. Arch Phys Med Rehabil. 1959;40:62–9.
Kravitz SR, McGuire JB, Sharma S. The treatment of diabetic foot ulcers: reviewing the literature and a surgical algorithm. Adv Skin Wound Care. 2007;20:227–37.
Kruse I, Edelman S. Evaluation and treatment of diabetic foot ulcers. Clin Diab. 2006;24:91–3.
Kuroyanagi Y, Yamada N, Yamashita R, et al. Tissue-engineered product: allogenic cultured dermal substitute composed of spongy collagen with fibroblasts. Artif Organs. 2001;25:180–6.
LaVan FB, Hunt TK. Oxygen and wound healing. Clin Plast Surg. 1990;17:463–72.
Lee PWR, Green MA, Long WB, et al. Zinc and wound healing. Surg Gynecol Obstet. 1976;143:549–54.
Lee CH, Han SK, Choi WI, et al. Effect of human bone marrow stromal cells and dermal fibroblasts on collagen synthesis and epithelization. Ann Plast Surg. 2007;59:713–9.
Lerman OZ, Galiano RD, Armour M, et al. Cellular dysfunction in the diabetic fibroblast. Am J Pathol. 2003;162:303–12.
Liu K, Yang Y, Mansbridge J. Comparison of the stress response to cryopreservation in monolayer and three-dimensional human fibroblast cultures: stress proteins, MAP kinases, and growth factor gene expression. Tissue Eng. 2000;6:539–54.
Marineo G, Iorno V, Gandini C, et al. Scrambler therapy may relieve chronic neuropathic pain more effectively than guideline-based drug management: results of a pilot, randomized, controlled trial. J Pain Symptom Manage. 2012;43(1):87–95.
Marko RS, David C, Igor K. Comprehensible evaluation of prognostic factors and prediction of wound healing. Artif Intell Med. 2003;29:25–38.
Mustoe TA, Shaughnessy K, Kloeters O. Chronic wound pathogenesis and current treatment strategies: a unifying hypothesis. Plast Reconstr Surg. 2006;117:35S–41.
O’Meara S, Cullum N, Majid M, et al. Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds (4) diabetic foot ulceration. Health Technol Assess. 2000;4:1–237.
Papanas N, Maltezos E. Growth factors in the treatment of diabetic foot ulcers: new technologies, any promises? Int J Lower Extrem Wounds. 2007;6:37–53.
Patel GK. The role of nutrition in the management of lower extremity wounds. Int J Low Extrem Wounds. 2005;4:12–22.
Philipov JP, Pascalv MD, Aminkov BY, et al. Changes in serum carboxyterminal telopeptide of type I collagen in an experimental model of canine osteomyelitis. Calcif Tissue Int. 1995;57:152–4.
Pirani CL, Levenson SM. Effect of vitamin C deficiency on healed wounds. Proc Soc Exp Biol Med. 1953;82:95–9.
Pitei DL. Plantar pressures are elevated in the neuroischemic and the neuropathic diabetic foot. Diab Care. 1999;22:1966–70.
Pories WJ, Henzel JH, Rob CG, et al. Acceleration of healing with zinc sulfate. Ann Surg. 1967;165:432–6.
Posthauer ME. The role of nutrition in wound care. Adv Skin Wound Care. 2006;19:43–52.
Powanda MC, Moyer ED. Plasma proteins and wound healing. Surg Gynecol Obstet. 1981;153:749–55.
Quirinia A, Viidik A. The influence of age on the healing of normal and ischemic incisional skin wounds. Mech Ageing Dev. 1991;58:221–32.
Robson MC. Cytokine manipulation of the wound. Clin Plast Surg. 2003;30:57–65.
Robson MC, Stenberg BD, Heggers JP. Wound healing alterations caused by infection. Clin Plast Surg. 1990;17:485–92.
Sabato AF, Marineo G, Gatti A. Scrambler therapy. Minerva Anestesiol. 2005;71(7–8):479–82.
Schultz GS, Sebald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11:S1–28.
Sheehan P, Jones P, Giurini JM, et al. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective. Plast Reconstr Surg. 2006;117:239S–44.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217–28.
Smith TJ, Marineo G. Treatment of postherpetic pain with scrambler therapy, a patient-specific neurocutaneous electrical stimulation device. Am J Hosp Palliat Care. 2013. doi:10.1177/1049909113494002. [Epub ahead of print]PMID:23838448.
Smith TJ, Coyne PJ, Parker GL, et al. Pilot trial of a patient-specific cutaneous electrostimulation device (mc5-a calmare®) for chemotherapy-induced peripheral neuropathy. J Pain Symptom Manage. 2010;40(6):883–91.
Starkweather AR, Coyne P, Lyon DE, et al. Decreased low back pain intensity and differential gene expression following Calmare®: results from a double-blinded randomized sham-controlled study. Res Nurs Health. 2015;38:29–38. doi:10.1002/nur.21632. PMID:25572279.
Tamir E, McLaren AM, Gadgil A, et al. Outpatient percutaneous flexor tenotomies for management of diabetic claw toe deformities with ulcers: a preliminary report. Can J Surg. 2008;51:41–4.
Tsang MW, Wong WK, Hung CS, et al. Human epidermal growth factor enhances healing of diabetic foot ulcers. Diabetes Care. 2003;26:1856–61.
Ueno C, Hunt TK, Hopf HW. Using physiology to improve surgical wound outcomes. Plast Reconstr Surg. 2006;117:59S–71.
Van Deursen R. Mechanical loading and off-loading of the plantar surface of the diabetic foot. Clin Infect Dis. 2004;39:S87–91.
Van Schie CH. A review of the biomechanics of the diabetic foot. Int J Low Extrem Wounds. 2005;4:160–70.
Viswanathan V, Snehalatha C, Seena R, et al. Early recognition of diabetic neuropathy: evaluation of a simple outpatient procedure using thermal perception. Postgrad Med J. 2008;78:541–2.
Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. Diabetes Care. 1998;21:822–7.
Wu SC, Driver VR, Wrobel JS, et al. Foot ulcer in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3:65–76.
Yoon ES, Han SK, Kim WK. Advantages of the presence of living dermal fibroblasts within Restylane for soft tissue augmentation. Ann Plast Surg. 2003;51:587–92.
© 2016 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Han, SK. (2016). Adjunctive Therapy. In: Innovations and Advances in Wound Healing. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46587-5_11
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-46586-8
Online ISBN: 978-3-662-46587-5