Skip to main content
SpringerLink
Log in
Book cover

Innovations and Advances in Wound Healing pp 249–262Cite as

Adjunctive Therapy

  • Chapter

Abstract

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.

Keywords

  • Adjunctive therapy
  • Wound healing
  • Pain

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Further Reading

  • Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117:42S–58.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Calcutt NA, Backonja MM. Pathogenesis of pain in peripheral diabetic neuropathy. Curr Diab Rep. 2007;7:429–34.

    CrossRef  PubMed  Google Scholar 

  • Cornell RS, Ducic I. Painful diabetic neuropathy. Clin Podiatr Med Surg. 2008;25:347–60.

    CrossRef  PubMed  Google Scholar 

  • Course outline for wound care education. WoundEducators.com. 2009.

  • David GG. Wound healing and diabetes mellitus. Clin Plast Surg. 2003;30:37–45.

    CrossRef  Google Scholar 

  • Eaglstein WH. Wound healing and aging. Dermatol Clin. 1986;4:481–4.

    CAS  PubMed  Google Scholar 

  • Ehrlich HP, Hunt TK. Effects of cortisone and vitamin A on wound healing. Ann Surg. 1968;167:324–8.

    CrossRef  PubMed Central  CAS  PubMed  Google Scholar 

  • Ehrlich P, Tarver H, Hunt TK. Inhibitory effect of vitamin E on collagen synthesis and wound repair. Ann Surg. 1972;175:235–40.

    CrossRef  PubMed Central  CAS  PubMed  Google Scholar 

  • Ehrlich P, Tarver H, Hunt TK. The effects of vitamin A and glucocorticoids upon repair and collagen synthesis. Ann Surg. 1973;177:222–7.

    CrossRef  PubMed Central  CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician. 2002;66:1655–62.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Han SK, You HJ. Wound coverage using advanced technology in Korea. J Korean Med Assoc. 2011;54:594–603.

    CrossRef  Google Scholar 

  • 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.

    CrossRef  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • Hansen SL, Young DM, Boudreau NJ. HoxD3 expression and collagen synthesis in diabetic fibroblasts. Wound Repair Regen. 2003;11:474–80.

    CrossRef  PubMed  Google Scholar 

  • Hunt TK. Disorders of wound healing. World J Surg. 1980;4:271–7.

    CrossRef  CAS  PubMed  Google Scholar 

  • Hunt TK. Vitamin A, and wound healing. J Am Acad Dermatol. 1986;15:817–21.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    CrossRef  PubMed Central  CAS  PubMed  Google Scholar 

  • John LB, John SM, Linda GP. Impairments to wound healing. Clin Plast Surg. 2003;30:47–56.

    CrossRef  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    CrossRef  PubMed Central  PubMed  Google Scholar 

  • Kosiak M. Etiology and pathology of ischemic ulcers. Arch Phys Med Rehabil. 1959;40:62–9.

    CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  PubMed  Google Scholar 

  • Kruse I, Edelman S. Evaluation and treatment of diabetic foot ulcers. Clin Diab. 2006;24:91–3.

    CrossRef  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • LaVan FB, Hunt TK. Oxygen and wound healing. Clin Plast Surg. 1990;17:463–72.

    CAS  PubMed  Google Scholar 

  • Lee PWR, Green MA, Long WB, et al. Zinc and wound healing. Surg Gynecol Obstet. 1976;143:549–54.

    CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • Lerman OZ, Galiano RD, Armour M, et al. Cellular dysfunction in the diabetic fibroblast. Am J Pathol. 2003;162:303–12.

    CrossRef  PubMed Central  CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  PubMed  Google Scholar 

  • Marko RS, David C, Igor K. Comprehensible evaluation of prognostic factors and prediction of wound healing. Artif Intell Med. 2003;29:25–38.

    CrossRef  Google Scholar 

  • Mustoe TA, Shaughnessy K, Kloeters O. Chronic wound pathogenesis and current treatment strategies: a unifying hypothesis. Plast Reconstr Surg. 2006;117:35S–41.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    CrossRef  CAS  Google Scholar 

  • Patel GK. The role of nutrition in the management of lower extremity wounds. Int J Low Extrem Wounds. 2005;4:12–22.

    CrossRef  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • Pirani CL, Levenson SM. Effect of vitamin C deficiency on healed wounds. Proc Soc Exp Biol Med. 1953;82:95–9.

    CrossRef  CAS  PubMed  Google Scholar 

  • Pitei DL. Plantar pressures are elevated in the neuroischemic and the neuropathic diabetic foot. Diab Care. 1999;22:1966–70.

    CrossRef  CAS  Google Scholar 

  • Pories WJ, Henzel JH, Rob CG, et al. Acceleration of healing with zinc sulfate. Ann Surg. 1967;165:432–6.

    CrossRef  PubMed Central  CAS  PubMed  Google Scholar 

  • Posthauer ME. The role of nutrition in wound care. Adv Skin Wound Care. 2006;19:43–52.

    CrossRef  PubMed  Google Scholar 

  • Powanda MC, Moyer ED. Plasma proteins and wound healing. Surg Gynecol Obstet. 1981;153:749–55.

    CAS  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • Robson MC. Cytokine manipulation of the wound. Clin Plast Surg. 2003;30:57–65.

    CrossRef  PubMed  Google Scholar 

  • Robson MC, Stenberg BD, Heggers JP. Wound healing alterations caused by infection. Clin Plast Surg. 1990;17:485–92.

    CAS  PubMed  Google Scholar 

  • Sabato AF, Marineo G, Gatti A. Scrambler therapy. Minerva Anestesiol. 2005;71(7–8):479–82.

    CAS  PubMed  Google Scholar 

  • Schultz GS, Sebald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11:S1–28.

    CrossRef  PubMed  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217–28.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    CrossRef  PubMed Central  PubMed  Google Scholar 

  • 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.

    CrossRef  PubMed  Google Scholar 

  • 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.

    PubMed Central  PubMed  Google Scholar 

  • Tsang MW, Wong WK, Hung CS, et al. Human epidermal growth factor enhances healing of diabetic foot ulcers. Diabetes Care. 2003;26:1856–61.

    CrossRef  CAS  PubMed  Google Scholar 

  • Ueno C, Hunt TK, Hopf HW. Using physiology to improve surgical wound outcomes. Plast Reconstr Surg. 2006;117:59S–71.

    CrossRef  CAS  PubMed  Google Scholar 

  • Van Deursen R. Mechanical loading and off-loading of the plantar surface of the diabetic foot. Clin Infect Dis. 2004;39:S87–91.

    CrossRef  PubMed  Google Scholar 

  • Van Schie CH. A review of the biomechanics of the diabetic foot. Int J Low Extrem Wounds. 2005;4:160–70.

    CrossRef  PubMed  Google Scholar 

  • 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.

    CrossRef  Google Scholar 

  • 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.

    CrossRef  CAS  PubMed  Google Scholar 

  • 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.

    PubMed Central  PubMed  Google Scholar 

  • 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.

    CrossRef  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Professor of Plastic Surgery, Director of Diabetic Wound Center, Director of Cell Therapy Laboratory, Korea University College of Medicine and Korea University Guro Hospital, Seoul, Republic of Korea (South Korea)

    Seung-Kyu Han

Authors
  1. Seung-Kyu Han
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

Copyright information

© 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

Download citation

  • DOI: 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

  • eBook Packages: MedicineMedicine (R0)

search

Navigation