Choosing an adjunctive therapy for the treatment of chronic wounds.

Adjunctive therapies such as ultrasound, laser, ultraviolet light, superficial heating, pulsed electromagnetic fields, and electrical stimulation have all been indicated in the treatment of chronic wounds. The purpose of this article is to outline the issues a healthcare professional must consider when choosing the best adjunctive therapy for a chronic wound. It summarizes the effects of therapeutic modalities on the wound healing process, analyzes the clinical research evidence, discusses practical considerations, and reviews indications, contraindications, precautions, and safety considerations. Finally, an algorithm is presented to help guide the clinician in selecting a modality. In summary, research evidence exists in the literature that suggests these adjunctive therapies can directly stimulate new tissue growth, augment wound tissue strength, improve local circulation and oxygenation, reduce edema, and/or inhibit bacterial growth. Electrical stimulation and ultrasound are the only therapeutic modalities that currently have sufficient clinical research evidence to support their use in the treatment of chronic wounds. Practical issues such as cost, time and training required, and patient and therapist safety concerns, will ultimately influence the selection of these modalities.