Physical modalities in wound management: ultrasound, vasopneumatic devices and hydrotherapy

The modalities discussed in this manuscript have proven effective in augmenting repair in venous, arterial, pressure and insensitivity ulcers. However, if used inappropriately, these same physical modalities can have significant negative effects on healing. This article will review three commonly used modalities, ultrasound, vasopneumatic devices and hydrotherapy, in an effort to promote proper use of these modalities and to prevent their misuse. The treatment goals for ultrasound are stimulation of fibroblasts and macrophages, degranulation of mast cells, promotion of angiogenesis, reduction of the inflammatory phase of repair and acceleration of healing. The treatment goal of vasopneumatic devices, such as intermittent compression therapy, is to reduce venous hypertension and edema by assisting venous blood flow back toward the heart. The treatment goals of hydrotherapy are to debride loosely attached devitalized tissue, remove surface contaminants, oils and cellular debris, and promote circulation in ischemic limbs. The use of inappropriate modalities or selection of excessive treatment parameters not only can delay healing but also can cause significant harm. Each agent needs to be used judiciously with attention given to potential adverse reactions.