Authors (including presenting author) :
Li SF(1), Tsim KM(1), Lai CY(2), Leung LT(2), Chan TF(2)
Affiliation :
(1) Physiotherapy Department of Our Lady of Maryknoll Hospital
(2) High Dependency Unit of Our Lady of Maryknoll Hospital
Introduction :
The incidence of pressure injury will increase patient’s suffering and prolong hospital length of stay. The management for pressure injury is complex and causes a significant financial burden on the healthcare system. An 85-year-old lady, Ms. X diagnosed with intestinal obstruction (IO) was transferred to high dependency unit (HDU) with stage 4 community-acquired sacral pressure injury. Her past medical history included hypertension (HT), type 2 diabetes mellitus (DM), sigmoid cancer, ischemic heart disease and mixed dementia. Despite applying conventional wound dressing technique (Appendix 1) for nearly one month, no significant improvement of the sacral wound was noted. It might be due to malnutrition from IO and poor circulation and reduced immune system from DM. Knowing that pulsed electromagnetic field (PEMF) therapy has been shown to accelerate wound healing and increase microcirculation in persons with diabetes. Therefore, PEMF therapy was used as an adjunctive therapy to conventional wound dressing technique in our case-study.
Objectives :
To apply PEMF therapy to promote sacral wound healing of a type 2 diabetes mellitus (DM) patient with intestinal obstruction (IO) as an adjunctive therapy to conventional nursing wound dressing technique.
Methodology :
This was a pre-and post-interventional study, conducted from 17 September, 2021 to 22 October, 2021. The program included 17 sessions of PEMF therapy with pre-set ulcus cruris protocol (duration: 30 minutes, intensity: 39mT/10, max pulse 10 ms and min pause 30 ms) which was delivered to patient’s sacral wound site for 5 weeks by physiotherapist. Conventional nursing wound dressing technique was continued in-between the study period. Pressure Ulcer Scale for Healing (PUSH) Tool 3.0 (NPUAP 1998) has been adopted to evaluate the progress in pressure injury healing. Pressure injury was assessed each week with the PUSH Tool 3.0 and clinical pictures were recorded.
Result & Outcome :
PEMF therapy promoted wound healing together with conventional nursing wound care management. Before applying PEMF therapy (from 26 Aug to 16 Sept, 2021), the PUSH scores increased from 15 to 17 in 3 weeks, which indicated the trend of deterioration in pressure ulcer healing. The PUSH scores decreased significantly from 17 to 13 in 5 weeks (from 17 Sept to 22 Oct, 2021) after completing 17 sessions of PEMF therapy with pre-set ulcus cruris protocol together with conventional nursing wound dressing technique, which showed an improvement in pressure ulcer healing. In this case study, the necrotic tissue was absent. The deepest depth of undermining was reduced by 62.5% (from 4cm to 1.5cm). The wound became clean and contained granulation tissue after this course of wound management. To conclude, it seemed that PEMF therapy could accelerate the pressure injury wound healing together with conventional nursing wound dressing management.
