Ultra-low microcurrent therapy: a novel approach for treatment of chronic resistant wounds

Effectiveness of Microcurrent Therapy for Treating Pressure Ulcers in Older People: A Double-Blind, Controlled, Randomized Clinical Trial

The aim of this study was to assess the effectiveness of microcurrent therapy for healing pressure ulcers in aged people. A multicentric, randomized clinical trial was designed with a sham stimulation control. The experimental group received an intervention following a standardized protocol for curing ulcers combined with 10 h of microcurrent therapy daily for 25 days. The sham group received the same curing protocol plus a sham microcurrent stimulation. The studied healing-related variables were the Pressure Ulcer Scale for Healing (PUSH) and the surface, depth, grade, and number of ulcers that healed completely. Three evaluations were conducted: pre-intervention (T1), 14 days following the start of the intervention (T2), and 1 day after the intervention was completed (T3). In total, 30 participants met the inclusion criteria (n = 15 in each group). The improvement in the PUSH at T2 and T3 was 16.8% (CI95% 0.5-33.1) and 25.3% (CI95% 7.6-43.0) greater in the experimental group versus the sham control, respectively. The reduction in the wound area at T2 and T3 was 20.1% (CI95% 5.2-35.0) and 28.6% (CI95% 11.9-45.3) greater in the experimental group versus the control, respectively. Microcurrent therapy improves the healing of pressure ulcers in older adults, both quantitatively and qualitatively.

The micro-current stimulation of knee acupoints in management of chondromalacia patella: a case report

[Purpose] A case report in which we treated injured patellar cartilage using non-invasive electrical stimulation; we also used MRI to document the morphology of the patellar cartilage before and after the treatment. [Participant and Methods] A police officer suffered from right anterior knee pain that noticeably affected his firearms marksmanship in kneeling position. After a MRI scan he was diagnosed with grade I chondromalacia patella involving the lateral patellar facet. He received therapeutic electrical stimulation on right knee acupoints for four weeks. [Results] He responded positively to the treatment and his numerical rating scale reduced from 6 to 0 for the right knee pain. The MRI revealed that the signs of grade I chondromalacia patella disappeared. [Conclusion] The patellar cartilage is largely avascular; the chondrocytes in cartilage have a low metabolic rate due to limited nutrient supply. Mild cartilage repair may occur spontaneously but is undoubtedly slow. Although this is a case report, we believe that the micro-current stimulation may help enhance the local metabolism and repair process in the affected cartilage.

Microcurrent Stimulation Triggers MAPK Signaling and TGF-β1 Release in Fibroblast and Osteoblast-Like Cell Lines

Wound healing constitutes an essential process for all organisms and involves a sequence of three phases. The disruption or elongation of any of these phases can lead to a chronic or non-healing wound. Electrical stimulation accelerates wound healing by mimicking the current that is generated in the skin after any injury. Here, we sought to identify the molecular mechanisms involved in the healing process following in vitro microcurrent stimulation-a type of electrotherapy. Our results concluded that microcurrents promote cell proliferation and migration in an ERK 1/2- or p38-dependent way. Furthermore, microcurrents induce the secretion of transforming growth factor-beta-1 (TGF-β1) in fibroblasts and osteoblast-like cells. Interestingly, transcriptomic analysis uncovered that microcurrents enhance the transcriptional activation of genes implicated in Hedgehog, TGF-β1 and MAPK signaling pathways. Overall, our results demonstrate that microcurrents may enhance wound closure through a combination of signal transductions, via MAPK's phosphorylation, and the transcriptional activation of specific genes involved in the healing process. These mechanisms should be further examined in vivo, in order to verify the beneficial effects of microcurrents in wound or fracture healing.

Poly (Lactic Acid) membrane and Sedum dendroideum extract favors the repair of burns in rats

Purpose:

To evaluate the healing potential of the electrospinning membranes of Poly (Lactic Acid) (PLA) associated with Sedum dendroideum extract in burn injuries in rats.

Methods:

Seventy-five rats were submitted to burn injury on their back skin: (C) untreated; (F) with daily topical application of S. dendroideum extract; (M) with electrospinning membranes of PLA; (MF10) with electrospinning membranes of PLA with 10% S. dendroideum extract; (MF25) with electrospinning membranes of PLA with 25% S. dendroideum extract. Tissue samples were taken after 2, 6 and 14 days of the burn injury and were subjected to histomorfometric analysis of quantification of fibroblasts, collagen fibers, blood vessels, and inflammatory infiltrate

Results:

The histomorphometric analysis showed an increase in the number of fibroblasts, collagen fibers and blood vessels in the burns treated with membranes of PLA, associated or not with the 10% and 25% extract. The extract of S. dendroideum promoted the increase of collagen fibers.

Conclusion:

The electrospinning PLA membrane, isolated or associated with the S. dendrodeum extract, favored the healing of burn injuries in this experimental model, with an increase of fibroblasts, collagen fibers, and blood vessels. S. dendroideum isolated only stimulated the collagenesis.

Electrical stimulation for treating pressure ulcers

BACKGROUND

Pressure ulcers (also known as pressure sores, decubitus ulcers or bedsores) are localised injuries to the skin or underlying tissue, or both. Pressure ulcers are a disabling consequence of immobility. Electrical stimulation (ES) is widely used for the treatment of pressure ulcers. However, it is not clear whether ES is effective.

OBJECTIVES

To determine the effects (benefits and harms) of electrical stimulation (ES) for treating pressure ulcers.

SEARCH METHODS

In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. We did not impose any restrictions with respect to language, date of publication or study setting.

SELECTION CRITERIA

We included published and unpublished randomised controlled trials (RCTs) comparing ES (plus standard care) with sham/no ES (plus standard care) for treating pressure ulcers.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of evidence using GRADE.

MAIN RESULTS

We included 20 studies with 913 participants. The mean age of participants ranged from 26 to 83 years; 50% were male. ES was administered for a median (interquartile range (IQR)) duration of five (4 to 8) hours per week. The chronicity of the pressure ulcers was variable, ranging from a mean of four days to more than 12 months. Most of the pressure ulcers were on the sacral and coccygeal region (30%), and most were stage III (45%). Half the studies were at risk of performance and detection bias, and 25% were at risk of attrition and selective reporting bias. Overall, the GRADE assessment of the certainty of evidence for outcomes was moderate to very low. Nineteen studies were conducted in four different settings, including rehabilitation and geriatric hospitals, medical centres, a residential care centre, and a community-based centre. ES probably increases the proportion of pressure ulcers healed compared with no ES (risk ratio (RR) 1.99, 95% confidence interval (CI) 1.39 to 2.85; I² = 0%; 11 studies, 501 participants (512 pressure ulcers)). We downgraded the evidence to moderate certainty due to risk of bias. It is uncertain whether ES decreases pressure ulcer severity on a composite measure compared with no ES (mean difference (MD) -2.43, 95% CI -6.14 to 1.28; 1 study, 15 participants (15 pressure ulcers) and whether ES decreases the surface area of pressure ulcers when compared with no ES (12 studies; 494 participants (505 pressure ulcers)). Data for the surface area of pressure ulcers were not pooled because there was considerable statistical heterogeneity between studies (I² = 96%) but the point estimates for the MD of each study ranged from -0.90 cm² to 10.37 cm². We downgraded the evidence to very low certainty due to risk of bias, inconsistency and imprecision. It is uncertain whether ES decreases the time to complete healing of pressure ulcers compared with no ES (hazard ratio (HR) 1.06, 95% CI 0.47 to 2.41; I² = 0%; 2 studies, 55 participants (55 pressure ulcers)). We downgraded the evidence to very low certainty due to risk of bias, indirectness and imprecision. ES may be associated with an excess of, or difference in, adverse events (13 studies; 586 participants (602 pressure ulcers)). Data for adverse events were not pooled but the types of reported adverse events included skin redness, itchy skin, dizziness and delusions, deterioration of the pressure ulcer, limb amputation, and occasionally death. We downgraded the evidence to low certainty due to risk of selection and attrition bias and imprecision. ES probably increases the rate of pressure ulcer healing compared with no ES (MD 4.59% per week, 95% CI 3.49 to 5.69; I² = 25%; 12 studies, 561 participants (613 pressure ulcers)). We downgraded the evidence to moderate certainty due to risk of bias. We did not find any studies that looked at quality of life, depression, or consumers' perception of treatment effectiveness.

AUTHORS' CONCLUSIONS

ES probably increases the proportion of pressure ulcers healed and the rate of pressure ulcer healing (moderate certainty evidence), but its effect on time to complete healing is uncertain compared with no ES (very low certainty evidence). It is also uncertain whether ES decreases the surface area of pressure ulcers. The evidence to date is insufficient to support the widespread use of ES for pressure ulcers outside of research. Future research needs to focus on large-scale trials to determine the effect of ES on all key outcomes.

Acupuncture and moxibustion stimulate fibroblast proliferation and neoangiogenesis during tissue repair of experimental excisional injuries in adult female Wistar rats

OBJECTIVE

To investigate the effects of acupuncture and moxibustion on the repair of excisional skin injuries on the back of adult female Wistar rats.

METHODS

90 animals were divided into three groups: C, control; A, acupuncture treatment (needled at traditional acupuncture points BL13, BL17 and ST36); M, moxibustion treatment (overlying same traditional acupuncture points). They were euthanased on days 7, 14 and 21 after injury for removal and preparation of tissue for analysis.

RESULTS

The treated groups (A and M) showed no changes regarding the structural analysis relative to the control (C) group. The total number of fibroblast cells in the A and M groups were significantly higher than those in the C group on days 14 and 21. The number of granulocytes was significantly less in the A and M groups compared with the C group on days 14 and 21. The total number of newly formed vessels increased on day 21 and was significantly higher in the A and M groups. The amount of birefringent collagen fibre detected on day 21 was significantly higher in the C group. The amount of glycosaminoglycan and hydroxyproline was similar between the groups. The amount of collagen I did not differ between the groups in any period, despite the increased amount detected over time. The amount of type III collagen did not differ between the groups but the detected amount decreased over the course of the experiment. The amount of transforming growth factor β1 (TGF-β1) and vascular endothelial growth factor (VEGF) in the A and M rats was similar but inferior to C rats across all experimental periods.

CONCLUSIONS

Acupuncture and moxibustion stimulated fibroblast proliferation and neoangiogenesis, and extended the period of collagen fibre reorganisation in the repair of excisional injuries in adult female rats.

Effects of microcurrent therapy on excisional elastic cartilage defects in young rats

The effects of microcurrent application on the elastic cartilage defects in the outer ear of young animals were analyzed. Sixty male Wistar rats were divided into a control (CG) and a treated group (TG). An excisional lesion was created in the right outer ear of each animal. Daily treatment was started after 24h and consisted of the application of a low-intensity (20μA) continuous electrical current to the site of injury for 5min. The animals were euthanized after 7, 14 and 28 days of injury and the samples were submitted to analyses. In CG, areas of newly formed cartilage and intense basophilia were seen at 28 days, while in TG the same observations were made already at 14 days. The percentage of birefringent collagen fibers was higher in CG at 28 days. The number of connective tissue cells and granulocytes was significantly higher in TG. Ultrastructural analysis revealed the presence of chondrocytes in TG at 14 days, while these cells were observed in CG only at 28 days. Cuprolinic blue staining and the amount of glycosaminoglycans were significantly higher in TG at 14 days and 28 days. The amount of hydroxyproline was significantly higher in TG at all time points studied. The active isoform of MMP-2 was higher activity in TG at 14 days. Immunoblotting for type II collagen and decorin was positive in both groups and at all time points. The treatment stimulated the proliferation and differentiation of connective tissue cells, the deposition of glycosaminoglycans and collagen, and the structural reorganization of these elements during elastic cartilage repair.

Biophysical Approaches for Oral Wound Healing: Emphasis on Photobiomodulation

Significance: Oral wounds can lead to significant pain and discomfort as well as affect overall general health due to poor diet and inadequate nutrition. Besides many biological and pharmaceutical methods being investigated, there is growing interest in exploring various biophysical devices that utilize electric, magnetic, ultrasound, pressure, and light energy. Recent Advances: Significant insight into mechanisms of these biophysical devices could provide a clear rationale for their clinical use. Preclinical studies are essential precursors in determining physiological mechanisms and elucidation of causal pathways. This will lead to development of safe and effective therapeutic protocols for clinical wound management. Critical Issues: Identification of precise events initiated by biophysical devices, specifically photobiomodulation-the major focus of this review, offers promising avenues in improving oral wound management. The primary phase responses initiated by the interventions that distinctly contribute to the therapeutic response must be clearly delineated from secondary phase responses. The latter events are a consequence of the wound healing process and must not be confused with causal mechanisms. Future Direction: Clinical adoption of these biophysical devices needs robust and efficacious protocols that can be developed by well-designed preclinical and clinical studies. Elucidation of the precise molecular mechanisms of these biophysical approaches could determine optimization of their applications for predictive oral wound care.

Electroacupuncture: applications in the treatment of chronic nonhealing wounds

Maximizing the effectiveness of any wound treatment requires that normal wound-healing dynamics are appreciated. In considering adjuvant wound therapies, the clinical evidence supporting a therapy must be fully understood. The biological changes associated with electroacupuncture can have a positive effect on wound healing, although limited clinical data are available.

Electrical stimulation vs. standard care for chronic ulcer healing: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

We conducted a systematic review to investigate the effect of electrical stimulation on ulcer healing compared to usual treatment and/or sham stimulation. This systematic review also aimed to investigate the effect of different types of electrical stimulation on ulcer size reduction.

MATERIALS AND METHODS

MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to October 2013 on randomised controlled trials (RCTs), in English and on human subjects, which assessed the effect of electrical stimulation on ulcer size as compared to standard care and/or sham stimulation. Data from included RCTs were pooled with use of fixed and random effects meta-analysis of the weighted mean change differences between the comparator groups. Heterogeneity across studies was assessed with the I(2) statistic.

RESULTS

Twenty-one studies were eligible for inclusion in the meta-analysis. In six trials (n = 210), electrical stimulation improved mean percentage change in ulcer size over total studies periods by 24·62%, 95% confidence interval (CI) 19·98-29·27, P < 0·00001 with no heterogeneity. In three trials (n = 176), electrical stimulation insignificantly improved mean weekly change in ulcer size by 1·64%, 95% (CI) -3·81 to 7·09, P = 0·56 with significant heterogeneity (I(2) = 96%, P < 0·00001). In six trials (n = 266), electrical stimulation decreased ulcer size by 2·42 cm(2), 95% (CI) 1·66-3·17, P < 0·00001, with significant heterogeneity. In one trial (n = 16), electrical stimulation also insignificantly improved the mean daily percentage change in ulcer size by 0·63%, 95% (CI) -0·12 to 1·37, P = 0·10, with significant heterogeneity.

CONCLUSIONS

Electrical stimulation appears to increase the rate of ulcer healing and may be superior to standard care for ulcer treatment.

Laserterapia e microcorrente na cicatrização de queimadura em ratos: terapias associadas ou isoladas?

Este estudo teve o objetivo de investigar se há diferenças entre as terapias associadas e isoladas do laser e microcorrentes no reparo de lesão por queimadura em ratos. Um total de 40 animais foi dividido aleatoriamente em quatro grupos: grupo controle (GC); grupo microcorrente (GM), grupo laser (GL) e grupo laser/microcorrente (GLM), tratados com laser associado a microcorrentes. Após lesões térmicas induzidas no dorso do animal, foi realizado um total de dez dias de tratamento. Amostras do tecido foram coletadas para estudo histopatológico semiquantitativo com Hematoxilina Eosina e Tricrômico de Masson. Foram utilizados os testes de Kruskal-Wallis e post-hoc de Dunn. Houve diferença significativa entre os grupos para a produção de fibroblastos (p=0,0003), colágeno (p=0,0153), neoangiogênese (p=0,0031) e anexos cutâneos (p=0,0004). Na análise histológica semiquantitativa, o GLM apresentou valores menores nos parâmetros histológicos de presença de colágeno, número de fibroblastos e anexos cutâneos (p<0,05) em relação às terapias isoladas, exceto para a neoangiogênese, cujos valores da terapia associada foram semelhantes aos grupos de terapia com modalidade única. Apesar do laser e da microcorrente separadamente terem efeitos benéficos para a cicatrização tecidual, a associação das modalidades parece ter diminuído a ação de reparo. No entanto, sugere-se que a associação destes recursos parece diminuir os efeitos do tratamento quando se comparam os grupos de modalidade única.

Effects of microcurrent stimulation on hyaline cartilage repair in immature male rats (Rattus norvegicus)

BACKGROUND

In this study, we investigate the effects of microcurrent stimulation on the repair process of xiphoid cartilage in 45-days-old rats.

METHODS

Twenty male rats were divided into a control group and a treated group. A 3-mm defect was then created with a punch in anesthetized animals. In the treated group, animals were submitted to daily applications of a biphasic square pulse microgalvanic continuous electrical current during 5 min. In each application, it was used a frequency of 0.3 Hz and intensity of 20 μA. The animals were sacrificed at 7, 21 and 35 days after injury for structural analysis.

RESULTS

Basophilia increased gradually in control animals during the experimental period. In treated animals, newly formed cartilage was observed on days 21 and 35. No statistically significant differences in birefringent collagen fibers were seen between groups at any of the time points. Treated animals presented a statistically larger number of chondroblasts. Calcification points were observed in treated animals on day 35. Ultrastructural analysis revealed differences in cell and matrix characteristics between the two groups. Chondrocyte-like cells were seen in control animals only after 35 days, whereas they were present in treated animals as early as by day 21. The number of cuprolinic blue-stained proteoglycans was statistically higher in treated animals on days 21 and 35.

CONCLUSION

We conclude that microcurrent stimulation accelerates the cartilage repair in non-articular site from prepuberal animals.

Effects of microcurrent application alone or in combination with topical Hypericum perforatum L. and Arnica montana L. on surgically induced wound healing in Wistar rats

OBJECTIVES

This study evaluated the wound healing activity of microcurrent application alone or in combination with topical Hypericum perforatum L. and Arnica montana L. on skin surgical incision surgically induced on the back of Wistar rats.

DESIGN

The animals were randomly divided into six groups: (1) no intervention (control group); (2) microcurrent application (10 μA/2 min); (3) topical application of gel containing H. perforatum; (4) topical application of H. perforatum gel and microcurrent (10 μA/2 min); (5) topical application of gel containing A. montana; (6) topical application of A. montana gel and microcurrent (10 μA/2 min). Tissue samples were obtained on the 2nd, 6th and 10th days after injury and submitted to structural and morphometric analysis.

RESULTS AND CONCLUSION

Differences in wound healing were observed between treatments when compared to the control group. Microcurrent application alone or combined with H. perforatum gel or A. montana gel exerted significant effects on wound healing in this experimental model in all of the study parameters (P<0.05) when compared to the control group with positive effects seen regarding newly formed tissue, number of newly formed blood vessels and percentage of mature collagen fibers. The morphometric data confirmed the structural findings. In conclusion, application of H. perforatum or A. montana was effective on experimental wound healing when compared to control, but significant differences in the parameters studied were only observed when these treatments were combined with microcurrent application.

Ultra-low microcurrent in the management of diabetes mellitus, hypertension and chronic wounds: report of twelve cases and discussion of mechanism of action

Oxidative stress plays a major role in the pathogenesis of both types of diabetes mellitus and cardiovascular diseases including hypertension. The low levels of antioxidants accompanied by raised levels of markers of free radical damage play a major role in delaying wound healing. Ultra-low microcurrent presumably has an antioxidant effect, and it was shown to accelerate wound healing. The purpose of the study is to investigate the efficacy of ultra-low microcurrent delivered by the Electro Pressure Regeneration Therapy (EPRT) device (EPRT Technologies-USA, Simi Valley, CA) in the management of diabetes, hypertension and chronic wounds. The EPRT device is an electrical device that sends a pulsating stream of electrons in a relatively low concentration throughout the body. The device is noninvasive and delivers electrical currents that mimic the endogenous electric energy of the human body. It is a rechargeable battery-operated device that delivers a direct current (maximum of 3 milliAmperes) of one polarity for 11.5 minutes, which then switched to the opposite polarity for another 11.5 minutes. The resulting cycle time is approximately 23min or 0.000732 Hz and delivers a square wave bipolar current with a voltage ranging from 5V up to a maximum of 40 V. The device produces a current range of 3 mA down to 100 nA. Twelve patients with long standing diabetes, hypertension and unhealed wounds were treated with EPRT. The patients were treated approximately for 3.5 h/day/5 days a week. Assessment of ulcer was based on scale used by National Pressure Ulcer Advisory Panel Consensus Development Conference. Patients were followed-up with daily measurement of blood pressure and blood glucose level, and their requirement for medications was recorded. Treatment continued from 2-4 months according to their response. Results showed that diabetes mellitus and hypertension were well controlled after using this device, and their wounds were markedly healed (30-100%). The patients either reduced their medication or completely stopped after the course of treatment. No side effects were reported. The mechanism of action was discussed.