In which situation should adjunctive wound therapies be considered?

Wounds that are not healing with standard treatment

Which phase of wound healing involves granulation and contraction?

Proliferation

* Granulation and contraction of the wound occur during the proliferation phase.

____ involves clot formation.

Hemostasis

Inflammation is responsible for ___.

phagocytosis

___ strengthens the tissues after healing has occurred.

Remodeling

What does NPWT stand for?

Negatrive Pressure Wound Therapy

NPWT applies:

subatmospheric pressure, or suction, to the wound bed to remove excess fluids, reduce edema, and promote granulation tissue formation

__ is particularly effective for complex wounds that require enhanced contraction and healing support.

NPWT

Clinical Applications

NPWT is indicated for:

• Pressure ulcers
• Diabetic foot ulcers
• Surgical wounds
• Dehisced surgical wounds

• Traumatic wounds
• Skin grafts and flaps
• Tunneling and/or undermining wounds

Contraindications to NPWT include, but are not limited to:

• Exposed vital organs
• Excessive necrotic tissue
• Unexplored fistulas
• Wound malignancy
• Untreated osteomyelitis

Pulsed irrigation delivered at 10 to 15 psi

can reduce bacteria by up to 85% and promote faster healing (Hamm, 2019).

PLWS uses a hand-held device with a trigger to control the irrigation pressure range (4 to 15 psi) for safe use.

True or Fals

True

Pulsed lavage is indicated for various wounds, including:

• Chronic wounds
• Acute wounds
• Infected wounds

Contraindications

PLWS should not be used in the following situations, as it may cause harm or worsen the wound condition.

• Exposed blood vessels, organs, or nerves
• Uncontrolled bleeding
• Malignant wounds
• Dry gangrene or stable eschar
• Untreated osteomyelitis

PLWS may be used by skilled practitioners with caution in the following situations:

• Bleeding disorders
• Deep, tunneling wounds
• Recent surgical sites

PLWS may be used by skilled practitioners with caution in the following situations

• Bleeding disorders
• Deep, tunneling wounds
• Recent surgical sites

What is the benefit of low-frequency ultrasound therapy (LFU) in wound care?

Promoting blood flow and disrupting biofilm

Pulsed Lavage with Suction (PLWS)-

assists in debridement and infection control by pulsating irrigation and suctioning debris, exudate, and bacteria to create an environment more conducive to wound healing

Which is an example of mechanical adjunctive therapy used to treat wounds?

Negative pressure wound therapy (NPWT)

* Negative pressure wound therapy is effective for wounds with moderate to heavy exudate and requires controlled suction, not culture living allografts, platelet-rich plasma, or hyperbaric oxygen therapy.

Before initiating NPWT, what should be done to the wound?

Ensure the wound is clean and moist.

___ devices can use gauze or foam dressings, depending on the manufacturer, and the use of a moisture barrier around the wound will prevent the NPWT from adhering well enough to provide appropriate suction. Protect periwound with something that will not prevent adhesion.

NPWT

____ _____ is an energy-based treatment that enhances cellular activity, improves blood flow, and disrupts bacterial biofilm.

Electrical stimulation

Cellular (bioactive) CTPs

Contain living, viable cells such as fibroblasts or keratinocytes that secrete growth factors and cytokines to stimulate angiogenesis, granulation, and epithelialization.

Acellular (structural) CTPs

Contain nonviable tissue matrices that function as collagen-rich scaffolds, providing a structural framework that supports cellular migration, neovascularization, and new tissue formation.

Enhance healing through bioactive signaling, viable cells release growth factors and cytokines that trigger new tissue growth and angiogenesis.

Cellular (bioactive) therapies:

Support healing by providing a structural extracellular matrix rich in collagen that facilitates cellular migration and tissue regeneration.

Acellular (structural) scaffolds:

Full-thickness skin grafts (FTSG)

Involves both the epidermis and entire dermis. These grafts are more durable, provide better cosmetic outcomes, and have a reduced risk of contraction (Yang et al., 2022).

Split-thickness skin grafts (STSG)

Includes the epidermis and part of the dermis and are effective for larger wounds.

Epidermal grafts (EG)

Least invasive option, as only the epidermal layer is harvested with minimal donor site injury. This method capitalizes on the body's innate ability to regenerate tissue, making it a valuable option for various types of wounds

Contraindications

Autologous skin grafts are contraindicated in the presence of

• Active infection
• Poor vascularization
• Autoimmune disorders
• Severe comorbidities such as uncontrolled diabetes

Mechanism of Action

These preparations release platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF), which promote

• Fibroblast proliferation
• Angiogenesis
• Epithelial repair

____ contains only the recombinant PDGF growth factor without any living cells.

Acellular

_____ consists of recombinant human PDGF, a protein produced using biotechnological methods.

Material Composition

____ is a recombinant form of human Platelet-Derived Growth Factor--BB (rhPDGF--BB). It promotes granulation tissue formation by stimulating fibroblast proliferation and recruiting cells essential to wound repair, preparing the wound for re-epithelialization

Becaplermin

Becaplermin is an expensive treatment. Verify payer coverage, prior authorization, and patient cost before use.

Additional considerations include (Smith & Nephew, n.d.; FDA, 2019):

• Dressing changes may be difficult to manage:
  • Apply once daily in a thin layer (approximately 1/16 inch) directly to the wound surface.
  • The initial dressing remains in place for 12 hours,
  • After 12 hours, remove the dressing, gently rinse with saline, and apply a new moist dressing without additional gel for the remaining 12 hours of the day
• Store in the refrigerator at 36°F to 46°F (2°C to 8°C).
• Use with caution in patients with a history of malignancy.

___ _ _ approved for diabetic foot ulcers that have failed conservative treatment for a specified period. Bessie does not have diabetes or a diabetic foot ulcer, making all other choices inappropriate.

Becaplermin is only

How do the growth factors and collagen in CTPs support healing in radiation-damaged tissues?

By promoting tissue regeneration, angiogenesis, and collagen production

___ contain growth factors and collagen that stimulate cellular regeneration, collagen production, and angiogenesis. Scar tissue is not the goal of using a CTP and is primarily focused on tissue regeneration, not antibacterial functions.

CTPs

What is the primary mechanism of action of cellular (bioactive) therapies in wound healing?

They stimulate regeneration through bioactive components.

stimulate cellular regeneration through bioactive components like growth factors. They do not prevent wound infection, nor do they remove necrotic tissue to provide a clean wound bed.

Cellular (bioactive) therapies

HBOT

hyperbaric oxygen therapy

___ has been found to help lower the number of major amputations in people with diabetes who have chronic foot ulcers

HBOT

During HBOT, the patient breathes 100% oxygen while their entire body is in a specially designed hyperbaric chamber pressurized to __ ____ __ .

1.4 atmosphere absolute (ATA) or higher

Improved Collagen Production

Oxygen is vital for collagen synthesis, and higher concentrations of oxygen support new tissue formation.

Antibacterial Effects

High oxygen levels create an inhospitable environment for anaerobic bacteria, reducing the risk of infection.

Reduced Swelling and Inflammation

Edema and inflammation are reduced during treatment as a result of constricting blood vessels.

Enhanced Oxygen Delivery

Increased oxygen levels support angiogenesis and boost the function of

white blood cells.

Indications

HBOT is used for wound-related conditions such as:

• Wagner Grade 3 or higher diabetic foot ulcers (DFUs) that meet specific criteria
• Preservation of failing grafts and flaps
• Soft tissue radionecrosis

• Osteoradionecrosis
• Necrotizing fasciitis and gas gangrene
• Refractory osteomyelitis
• Crush injuries

___ enhances wound healing by delivering oxygen directly to the wound bed, supporting tissue repair. It does not boost white blood cell function nor remove biofilm or manage moisture in the wound.

TOT * Transdermal Oxygen Therapy

What does LFU stand for in wound care abbreviations?

low-frequency ultrasound

Abbreviation:

TOT

Transdermal Oxygen Therapy

Abbreviation:

ES

Electrical Stimulation

_____ ______ promotes wound healing by delivering pure oxygen directly to the wound bed at near-atmospheric pressure, which increases oxygen tension, enhances collagen synthesis, stimulates angiogenesis, and combats bacterial growth.

Transdermal or topical oxygen therapy (TOT)

A ___ ___ __diabetic foot ulcer is a serious, deep-tissue injury, typically involving a deep abscess, osteomyelitis (bone infection), or joint sepsis. This grade marks a critical stage of infection that often requires surgical intervention and, if conventional care fails, prompt consideration of hyperbaric oxygen therapy

Wagner Grade 3

___ ___ ___, growth factors (like PDGF), and amniotic tissues are considered biological adjunct wound therapies, as they are derived from living organisms to support, replace, or repair damaged skin. These, alongside collagen matrices and acellular dermal matrices, stimulate tissue regeneration in chronic wounds, particularly when basic care is insufficient.

Bioengineered skin substitutes

Bioengineered skin substitutes

They are derived from living organisms to support, replace, or repair damaged skin

What is the Primary Goal of Hyperbaric Oxygen Therapy (HBOT) in wound care.

Is to accelerate healing in chronic, ischemic wounds by delivering high concentrations of oxygen (100%) to damaged tissues.

Contraindications for pulsed lavage with suction (PLWS) include:

Applying the treatment directly over exposed vital structures, such as blood vessels, nerves, tendons, or bone. It should also be avoided in cases of active, profuse bleeding, or on malignant wounds.

What is a common contraindication for autologous platelet-rich plasma (PRP) therapy?

1. active infections

2. Cancer (specifically at the injection site)

3. Low platelet count (thrombocytopenia)

4. Severe anemia.

*Other factors include using antiplatelet or anticoagulant medication, pregnancy, and chronic liver disease.

Autologous

Derived from same person or source. Person acts donor and source.

How does Electrical stimulation (ES) accelerates wound healing?

By mimicking the body’s natural "current of injury," stimulating cellular activity, increasing blood flow, and reducing bacterial load. It enhances tissue regeneration by attracting cells like fibroblasts and keratinocytes to the wound site, promoting collagen synthesis, speeding up re-epithelialization, and improving angiogenesis.