The PTs’ scope of practice also lends to the preparation of the wound bed by eliminating nonviable tissue or to simply stimulate the wound bed. These methods include all forms of debridement: autolytic, enzymatic, mechanical, and sharp.* A therapist can use scalpel, scissors, and/or tweezers to perform sharp* debridement for removal of necrotic tissue over several sessions, if necessary, when surgical debridement by the physician is not an option due to the patient’s condition but a large amount of dead tissue exists. Depending on the specific wound, selective debridement can be conducted by the PT to achieve desired results. (Some forms of sharp* or other forms of ongoing debridement, such as enzymatic, may still be warranted after surgical debridement is performed by a physician.)
E-stim is another modality used primarily by therapists to enhance chronic wound healing. There are various forms of e-stim, which has been studied on chronic lower-leg wounds and pressure ulcers. E-stim has the ability to restart or accelerate the repair process by imitating the natural electrical current within injured tissue. Additionally, e-stim has been suggested to reduce infection, improve cellular immunity, increase perfusion, and accelerate wound healing. Other studies have demonstrated that e-stim aids in perfusion as well as improving venous flow. In 1994, the Agency for Healthcare Research & Quality issued a statement recommending the use of e-stim for pressure ulcers that have proven unresponsive to conventional therapy. Various governmental and private payer policies recognize e-stim as “medically necessary” for the management of chronic ulcers when used as an adjunctive therapy on wounds that are not progressing for a certain timeframe (30-days). Their covered indications include venous ulcers, diabetic ulcers, arterial ulcers, and stage III and IV pressure ulcers. In addition, the National Pressure Ulcer Advisory Panel continues to support e-stim as a useful therapy for nonhealing wounds such as recalcitrant stage II, III, and IV pressure ulcers.