Diary of a Wound Healing


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Diary of a Wound Healing

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The following patient photographic diary shows the healing of a wound using a combined treatment approach of standard care for wound healing, and as an adjunct, a Magcell Microcirc (pulsed electromagnetic field therapy) and a low level laser therapy pen; both of which were carried out by the patient at home between 9th January 2020 to 9th February 2020 each for 15 minutes daily.

Clearly, as three approaches have been utilised, it is not possible to say which of the three, or the combination of all, aided the wound healing. Additionally, this type of wound, with the help of modern dressings, could have reached the same stage within the same time scale. The caveat here, perhaps, is that the patient was diagnosed with Lipoedema in 2017 (Stage 1-2) which has worsened in the last three years due to not wearing compression garments. At the time of diagnosis, Mrs S refused compression due to frequent menopausal hot flushes. Mrs S is now awaiting GP referral to the local Lymphoedema Service to be re-measured for compression to avoid further deterioration of her condition. Lipoedema could have been a delayed healing response.

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Normal Wound Healing

A 'normal' healing process takes an average of 24 days and the final healing to eventually 'no raised scarring' can take a further 21 days-2yrs.

NB. The intention of this article is to promote awareness of the possible potential of magcell (and *laser) in the wound healing environment and perhaps a wound healing clinic would like to carry out further investigations to indicate the role of these non-invasive modalities in the wound healing process. If of interest, please email info@physioequipment.co.uk.

Patient Background

Mrs S, aged 58 lives with Lipoedema characterised by bilateral, symmetrical, fatty tissue excess, mainly in the hip region, upper and lower leg areas. Legs bruise easily and can be painful. Lipoedema can have a severe impact on physical and mental health. It is often misdiagnosed as Lymphoedema or obesity.

When first diagnosed with Lipoedema in 2017, Mrs S was assessed as a Stage I-II Lipoedema patient and was measured up for compression hosiery but declined, because Mrs S was suffering with frequent hot flushes.

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Caruana M. Lipedema: A Commonly Misdiagnosed Fat Disorder. Plast Surg Nurs. 2020;40(2):106?109. doi:10.1097/PSN.0000000000000316

In September 2018, Mrs S developed a sizeable, 12 cm blood clot in her left leg, which went undiagnosed for several days because it did not conform to classic presentation of Deep Vein Thrombosis, a D-dimer blood test was negative. The clot was discovered during ultrasound. Rivaroxaban (20mg) was prescribed for three months and Mrs S continued to experience cramping in the affected area.

In mid-December 2019, Mrs S visited her surgery with a dark yellow thick-skinned blister, which had appeared at the site of the previous blood clot. This was attended to at the local surgery and the blister began to heal.

On the 30th December, 2019, Mrs S woke again in the early hours with horrendous pain and was feeling generally unwell. She removed the dressing and saw what she described as looking like ‘the gates of hell’ had burst through her leg, an oozing broken crater, which was very painful.

At clinic, Mrs S was told that the wound was likely to be a leg ulcer and the wound was treated in clinic conservatively. A seven-day-course of Flucloxacillin 500mg (4 x daily) was prescribed and Mrs S attended the wound clinic every other day for ten days for dressing changes and this was then reduced to once a week. It should be noted that Mrs S was not always compliant with keeping the dressings on as she found them uncomfortable.

Magcell Information

Magcell Microcirc is a hand held device, based on pulsed electromagnetic field therapy (PEMF) which permeates a 3-5 cm depth and is proven to encourage and increase blood flow to the area (Funk et al, 2014):

“MAGCELL® MICROCIRC significantly increases micro-circulation (p < 0,001) while nitric oxide (NO) has a blood vessel dilatory effect. The application of the rotating MagCell-SR to the HUVEC cultures leads to a rapid onset and a significant increase of Nitric Oxide (NO) release after 15 minutes. Thus, frequencies between 4 and 12 Hz supplied by the device improve microcirculation significantly. Therefore, this device can be used in all clinical situations where an improvement of the microcirculation is useful like in chronic wound healing deficits.”

Low level laser therapy (LLLT) Information

"Low level laser therapy (LLLT) is the use of low energy laser light in injuries and wounds in order to improve wound healing, reduce inflammation and alleviate pain. The laser light is monochromatic, coherent and in the red or near infrared spectrum (600 nm – 1000 nm). It is applied at low power density (1 mW to 500 mW/cm2) (“low energy laser”).

In contrast to other medical laser applications LLLT is not a thermal method (i.e. surgical lasers), but produces photochemical effects in the tissue in a similar way to photosynthesis in plants. LLLT is simple to use, effective and cost-efficient and free of side effects. Treatment takes a few minutes and depending on the indication is repeated at longer or shorter intervals and in accordance with healing success. The success of LLLT is based on the following general action principles: tissue regeneration, inhibition of inflammation, alleviation of pain, improvement in circulation, reduction in swelling" Low-Level-Laser-Therapy (LLLT) in Chronic Wounds - Ludwig-Maximilian University Munich, Germany

Trial

From 9th January to 9th February, Mrs S, kept a photographic diary of the wound healing. Healthcare Professional permissions were sought, contraindications checked and full instructions on usage provided for the use of both home treatment modalities Magcell and Laser by Christine Talbot, SRN, MLD DLT Lymphoedema Practitioner.

A signed and dated consent form has been received by the patient to use the copyrighted photographs.

Adjunct home treatment - NB treatment was only carried out with these modalities on 12 of the 31 days due to ill health.

Magcell Microcirc

Product: Magcell Microcirc, Therapy - PEMF, Treatment: Daily, Duration (15 mins, 3 x 5')

Laser pen

Product: Red Laser Pointer, Therapy: LLLT, Treatment: Daily, Duration: 15 minutes

Patient Photographic Diary

Narrative to photos has been provided with thanks to: Christine Talbot, SRN. MLD/DLT Lymphoedema Practitioner and Sue Hansard, BA. RGN. Lymphoedema Nurse Specialist

wound one

1st January, 2020 - 12:42

Pre-Treatment

Wound measuring 4 cm x 1.5 cm diameter and 2.5 mm deep. Note erythema and exudate. The wound bed is sloughy.

Photo Reference: 2064

wound one

9th January, 2020, 18:25 

Day One - Shows the extent of healing within the margins of original pen demarcation at the onset of treatment.

Photo Reference: 2112

wound three

10th January, 2020: 18:25

Day Two - Further shrinkage from the outer circumference. Erythema still evident, but wound bed beginning to dry as exudate reduces

Photo Reference: 2123

wound four

11th January, 2020 - 08:03, 11:05, 17:59

Day Three - Wound appears clean and dry. Wound margins beginning to contract. Wound bed granulating. Still some erythema present.

Photo References: 2131, 2134, 2142

wound five

12th January, 2020 - 13:44, 21:58

Day Four - Erythema reducing, wound margins contracting towards centre. Wound dry as epithelialization occurs.

Photo References: 2151, 2153, 2155

wound six

14th January, 2020 - 12:44, 22.46

Day Six - Shows further granulation and tissue repair

Photo References: 2171, 2179

wound seven

15th January, 2020 - 11:33, 23:09

Day Seven: Consistent continuation of external and internal healing processes as tissues remodel

Photo References: 2183, 2187

wound eight

18th January, 2020 - 11:28

Day Ten: The wound continues to granulate and is now more superficial, as epithelialisation continues its process of remodelling.

Photo Reference: 2203

wound nine

22nd January, 2020, 10:43

Day Fourteen: Shows significant, ongoing healing processes, becoming more superficial

Photo Reference 2248

wound ten

27th January, 2020, 21:24

Day Nineteen (2): Wound edges now normalising. No erythema. Healthy pink granulation and epithelium to centre.

Photo Reference 2273

3rd feb

3rd February, 2020, 11:23

Day Twenty-Three: Healing is almost complete.

Photo Reference 2308

 

wound eleven

9th February, 2020, 13:33

Day Thirty: Surface wound, minimal closure left with fading demarcation, the central wound bed is healthy, and granulating well.

Photo Reference 2349

Christine Talbot, SRN Lymphoedema Practitioner also commented "The dramatic and visual physical outcome was hugely beneficial to the psychological approach of self-management utilising the Magcell and the Laser in restoring personal independence”

During the 4 weeks Mrs S stated that she felt "less pain in the wound and found the magcell and laser treatments non-invasive and comfortable".

As previously mentioned, it is hoped that further exploration into the benefits of Magcell and laser could be undertaken in the near future for wound healing.

Read more Magcell patient feedback here: Stimulating the Self Healing Process

Detailed Magcell Information

MAGCELL® is a portable hand device for electrode-free electrotherapy. Magnetic alternating fields are produced over rotation by permanent magnets. A sinusoidal pulsating electromagnetic field (PEMF) is generated over the special magnet arrangement and device function principle. However, with a value of 0,105 tesla field strength it is many times higher than for commercially available magnetic field therapy devices with coils or mats, which generally operate with field strengths of maximum 100 gauss or 0.01 tesla. By contrast MAGCELL®-therapy units produce field strengths, which are generally stronger by factor 10 than these devices.

According to induction law induced time-variable magnetic fields induce electric fields. The physical effects of MAGCELL® derive from the electric fields produced in living cells and tissue based on induction law. Depending on tissue conductivity the field incites an electric current. Taking into account the specific conductivity for various body tissue and liquids, this electric current can be calculated. Its strength, or more precisely, current density (= current strength per area, A/m²) determines biological effectiveness.

All calculated current densities exceed 10 mA/m² and are thus within the range of effects internationally confirmed and classified as ‘good‘: above the ‘subtle biological effects‘ and within the range of ‘confirmed macro effects‘ (10-100 mA/m²). Induced current densities are much higher again in blood and body fluids. The term ‘electrode-free electrotherapy‘ for MAGCELL® derives from the distinctly strong induced current densities and exceeding of the threshold value of 10 mA/m²: both of which are not found on equipment using coils or mats.

Body fluids (e.g. joint fluid) play a key role in the relevant therapy indications for MAGCELL® devices. The cells in this fluid or adjacent tissue are exposed to the established current densities. MAGCELL® exceeds by far the recognised effective current densities so that treatment is effective even at a tissue depth of 3-5 cm. MAGCELL® also induces above-threshold current densities in the blood, which are crucial for clinical therapy effects, for instance in respect of blood flow stimulation and immunomodulatory processes. The same applies for interstitial liquids, which moreover are found in virtually all organs and tissue. In bones and fatty tissue with low conductivity current densities are well below the effectiveness threshold of 10 mA/m², so a therapeutic effect in this tissue can scarcely be envisaged.

Clinical Proof

BLOOD FLOW STIMULATION: Source Funk et al. (2014)

MAGCELL® MICROCIRC significantly increases micro-circulation (p < 0.001) while nitric oxide (NO) has a blood vessel dilatory effect. The authors recommend the therapy for clinical situations where an improvement in micro circulation is identified, like for instance in the case of chronic tissue repair.

blood flow

OSTEOARTHRITIS: Source Wuschech et al (2015)

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In a randomised controlled study on the effect of MAGCELL® ARTHRO for knee arthritis with osteoarthritis level 2.8±0.8 (American College of Rheumatology criteria) at the primary clinical end point (WOMAC total score) median increase of 0.7 P (non-significant) was recorded in the placebo group between T0 and T1 (18 days), yet in the MAGCELL®-group a significant local decrease of 21.8 P. During the study no undesirable incidents or side effects occurred related to therapy.

WOMAC PAIN SCORE

The WOMAC individual scores for pain, stiffness and daily activity also resulted in significant local improvements in the MAGCELL®-group compared to a slight median increase (nonsignificant) in the placebo group. A highly significant result (p < 0.001) in favour of the MAGCELL®-group was recorded for the individual parameter pain reduction compared to the placebo in the difference between the beginning and end of treatment.

Read Lipoedema sufferer results of Magcell for osteoarthritis for knee

 

NERVE CONDUCTIVITY VELOCITY (NCV) N. 

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A double-blind placebo-controlled phase III study* substantiated the results of a previously conducted phase II study**: MAGCELL® improves the symptoms of sensory neuro-toxicities on hands and feet caused by chemotherapies. For the primary clinical endpoint - the nerve conduction velocity of the n. peronaeus - a significant improvement compared to the placebo group could be observed in the treatment group at the end of the study (T3).

*  Rick et al. (2016) ** Geiger et al. (2015)

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Secondary endpoints were the Common Toxicity Criteria (CTCAE) score and the Pain Detect End Score at T3. Significant improvement was achieved in terms of the patients’ subjectively perceived neurotoxicity (CTCAE score), but not of neuropathic pain. From data in the randomized study presented here, a positive effect on the reduction of neurotoxicity can be assumed for the MFT device. Patients with sensory neurotoxicity in the lower limbs, especially, should therefore be offered this therapy.

 

BENIGN PROSTATIC HYPERPLASIA: Source Tenuta et al. (2020)

The treatment (2 x 5 min. daily) resulted in a significant volume reduction of the prostate after only 28 days of therapy (V1) compared to the start of treatment (V0).

That the therapy effect is sustainable is shown by the fact that even after 4 months (V2) there was a significantly reduced prostate volume compared to the start of treatment (V0).

The survey on quality of life (IPSS questionnaire: urination/quality of life) also showed significantly better results at both points in time (V1 and V2) than V0.

Overall, there was a rapid improvement in symptoms without changes in gonadal hormones or sexual function, with high compliance and without side effects.

Best results were achieved in moderate to severe symptoms (LUTS) and patients without metabolic syndrome (MetS).

BENIGN PROSTATIC HYPERPLASIA IN THE CANINE MODEL: Source Leoci et at, 2014)

CONCLUSIONS

DOG

The efficacy of PEMF on BPH in dogs, with no side effects, suggests the suitability of this treatment in humans and supports the hypothesis that impairment of blood supply to the lower urinary tract may be a causative factor in the development of BPH. Prostate 74:1132–1141, 2014. © 2014 The Authors. The Prostate published by Wiley Periodicals, Inc..

Magcell® References

Funk H.W., Knels L., Augstein A., Marquetant R., Dertinger H.F. (2014): Potent Stimulation of Blood Flow of Volunteers after Local Short-Term Treatment with Low-Frequency Magnetic Fields from a Novel Device. Evidence-Based Complementary and Alternative Medicine 2014. Article ID 543564, 9 pages

Funk R.H.W. (2018): Coupling of pulsed electromagnetic fields (PEMF) therapy to molecular grounds of the cell. Am J Transl Res 10(5):1260-1272. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992548.

Geiger G., Mikus E., Dertinger H., Rick O. (2015): Low frequency magnetic field therapy in patients with cytostatic-induced polyneuropathy: A phase II pilot study. Bioelectromagnetics 36(3): 251-254. doi: 10.1002/bem.21897.

Hitrov N.A., Portnov V.V. (2008): MAGCELL® ARTHRO in der Behandlung von Arthrose im Kniegelenk. Die Naturheilkunde 3, 25-27. - English translation (Hitrov N.A., Portnov V.V. (2008): MAGCELL® ARTHRO in the treatment of osteoarthritis of the knee joint. Naturopathy 3, 25-27.)

Leoci R., Aiudi G., Silvestre F., Lissner E., Lacalandra G.M. (2014): Effect of Pulsed Electromagnetic Field Therapy on Prostate Volume and Vascularity in the Treatment of Benign Prostatic Hyperplasia: A Pilot Study in a Canine Model. The Prostate 74: 1132-1141.

Reimschüssel A., Bodenburg P. (2009): Niederfrequente elektromagnetische Felder. Erfolgreich in der Therapie der Myoarthritis des Kiefergelenkes. Die Naturheilkunde 5, 28. - English translation: Reimschüssel A., Bodenburg P. (2009): Low-frequency electromagnetic fields. Successful in the therapy of myoarthritis of the temporomandibular joint. Naturopathy 5, 28.

Rick O., von Hehn U., Mikus E., Dertinger H., Geiger G. (2017): Magnetic Field Therapy in Patients With Cytostatics-Induced Polyneuropathy: A Prospective Randomized Placebo-Controlled Phase-III Study. Bioelectromagnetics 38(2): 85-94:. doi: 10.1002/bem.22005.

Tenuta et al, (2020) Therapeutic use of pulsed electromagnetic field therapy reduces prostate volume and lower urinary tract symptoms in benign prostatic hyperplasia. Andrology. 2020 Feb 23. doi: 10.1111/andr.12775. [Epub ahead of print]

Wuschech H., von Hehn U., Mikus E., Funk R.H. (2015): Effects of PEMF on patients with osteoarthritis: Results of a prospective, placebo-controlled, double-blind study. Bioelectromagnetics 36(8), 576–585.

Laser References

Low-Level-Laser-Therapy (LLLT) in Chronic Wounds: Experience of using LLLT at the Wound Centre, Schwabing Hospital – Academic Teaching Hospital of the Ludwig-Maximilian University Munich, Germany

Mosca, R. C., et al. (2019). "Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach." Adv Skin Wound Care 32(4): 157-167.

Machado, R. S., et al. (2017). "Low-level laser therapy in the treatment of pressure ulcers: systematic review." Lasers Med Sci 32(4): 937-944.

Tchanque-Fossuo, C. N., et al. (2016). "A systematic review of low-level light therapy for treatment of diabetic foot ulcer." Wound Repair Regen 24(2): 418-426.

Kuffler, D. P. (2016). "Photobiomodulation in promoting wound healing: a review." Regen Med 11(1): 107-122.