Applications of Noncontact low frequency ultrasound (NLFU) in wounds treatment By: Amir (Mansour) zahedi Supper visor: dr. Ali Yadollahpour

Physical therapy procedures for the treatment of wounds introduction Electrical fields Electrical fields Magneto Therapy Magneto Therapy Leaser Therapy Leaser Therapy Electromagnetic fields Ultrasound Therapy

WHAT IS ULTRASOUND? Ultrasound is a sound wave that has a frequency greater than 20 KHz. It is generated by applying an alternate current to a piezoelectric Crystal (found in the transducer in the sound head). This crystal contracts and expands at the same frequency at which current changes polarity. The sound field generated by this crystal in turn makes the molecules in the sound field vibrate and oscillate. The crystal commonly used in US units is synthetic plumbium zirconium titanate (PZT). The quality of the crystal is what makes your US expensive.

Type of ultrasound

Improving outcomes with noncontact low-frequency ultrasound : A glimpse of NLFU in action for wounds

Necrotic tissue present Non-resolving inflammation cusses for Stalled Wounds Necrotic tissue present Non-resolving inflammation Bacterial contamination or infection High levels of proteases Impaired perfusion and decreased tissue oxygenation Recurrent physical trauma Systemic problems: -Diabetes -Auto-immune disease -Cancer and cancer treatments -Other atypical skin disorders

Complications of wounds The most common wound complications are: Infections: Wound infection presents with pus drainage, foul odor, fever, dull throbbing pain, mild swelling and heat at wound site. Inflammation: Inflamed wounds are hot, red, painful, swollen and hard to move. Scarring: Regenerated cells have different characteristics and fibrous tissue that can heal the wound, but may leave a scar behind. Loss of function: Many wounds can be disabling and life threatening if a major organ, blood vessel or nerve was damaged. Either way, while the wound is still fresh or healing, the affected limb or area will lose its functionality until all lost or damaged tissue is repaired

Low frequency, low intensity ultrasound 40 kHz NLFU based therapy Low frequency, low intensity ultrasound 40 kHz Delivered through saline mist Non-Thermal Noncontact/painless delivery

Osmotic Activity MECHANISMS OF ACTION Promotes both autolytic and mechanical debridement Aids in cleansing, debridement and edema reduction Constant outflow of fluid helps to mechanically lift necrotic tissue Lymphatic fluid delivers plasminogen to the wound site helping to break down necrotic tissue through fibrinolysis Osmotic Activity

pH Modulation Lowering pH decreases protease activity Can help reduce inflammation Optimizes conditions for fibroblast migration, proliferation, organization of collagen Increases oxygen diffusion Can help to overcome oxygen transport issues Low pH inhibits bacterial growth

Penetrates deep into the wound bed and accelerates the body’s normal healing process by:

MIST effects a wide range of bacteria , including: E.coli S. aureus MRSA VRE Pseudomonas

Reducing Inflammation Deep Tissue Injury (DTI) A significant factorin tissue damage for DTI is the inflammatory response. MIST sound waves reduce inflammation deep below the surface to promote healing and reduces tissue loss

Phases of Wound Healing Wound Healing Physiology Phases of Wound Healing Hemostasis(0-3 hours) Inflammatory (0-3 days) Proliferative (3-21 days) Remodeling/Maturation (21 days–1.5 yrs)

results The results show that therapeutic ultrasound stimulates the production of angiogenic factors such as IL-8, bFGF and VEGF. This may be one of the mechanisms through which therapeutic ultrasound induces angiogenesis and healing. Both ultrasound machines produced similar results, and the optimum intensities were 0.1 and 0.4 W/cm2 (SATA)with 1 MHz ultrasound, and 15 and 30 mW/cm2 (SATA)with 45 kHz ultrasound. More recently, the nonthermal effects of US, which are achieved at intensities of <0.3-1W/cm2,

A. Position leading edge of the applicator 0.5-1.5 cm from the wound bed in a perpendicular fashion. For best results, the Treatment Wand should be parallel to the floor B. Press and release the black Control Button to begin treatment Green indicator light will flash when ultrasound is being delivered, and 2 short tones will sound C. Deliver MIST treatment by slowly moving Treatment Wand in a horizontal and vertical pattern over the wound bed If treatment needs to be paused, press the black Control Button and turn off saline to avoid dripping. To continue treatment, turn saline on and depress black Control Button

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