Microcirculatory Flux and Pulsatility in Arterial Leg Ulcers is Increased by Intermittent Neuromuscular Electrostimulation of the Common Peroneal Nerve

The muscle pump activator device: From evidence to lived experiences

A chronic wound is one that fails to progress through a normal timely sequence of repair, or in which the repair process fails to restore anatomic and functional integrity after 3 months. The most common chronic wounds include venous, ischaemic and mixed leg ulcers, diabetic foot ulcers and pressure injuries. Chronic wounds place immense physical and psychosocial burden on patients and exact heavy costs for healthcare systems, with many patients continuing to live with chronic wounds even after all management options have been exhausted. The muscle pump activator (MPA) device can be used to bridge this therapeutic gap. By stimulating the common peroneal nerve to activate venous muscle pump of the leg and foot, the MPA device increases blood flow to the lower leg and foot to improve conditions for healing. Currently, evidence in the literature exist to show that the MPA device improves wound outcomes over standard compression therapy, decreases edema and increases wound healing rates. In this review, we also present a series of chronic wound patients treated with the MPA device in multicentre clinics to demonstrate the ability of the MPA device to improve wound outcomes, reduce pain and edema and improve patient quality of life.

Arterial Leg Ulcers in the Octogenarian

Arterial leg ulcers are a debilitating sequela of chronic ischemia, and their management, particularly in the octogenarian, is an immense challenge. ALUs are frequently a manifestation of end-stage peripheral arterial disease, and their presence portends a high morbidity and mortality. Management primarily relies on restoration of flow, but in the geriatric population, interventions may carry undue risk and pathologies may not be amenable. Adjunctive therapies that improve quality of life and decrease morbidity and mortality are therefore essential, and understanding their benefits and limitations is crucial in developing a multimodal treatment algorithm of care for the uniquely challenging octogenarian population.

The impact of a new intervention for venous leg ulcers: A within-patient controlled trial

A major obstacle to the development of new treatments for venous leg ulcers is the difficulty in generating evidence for their effectiveness. Randomised controlled trials using complete healing as the endpoint are seldom powered to be successful, owing to the heterogeneity of cohorts. A novel approach to the evaluation of treatments is presented, using a self-controlled trial model and two metrics of short-term healing rate as alternate endpoints: rate of wound margin advance, and percentage area reduction over 4 weeks. Two different treatment regimens are compared: multi-layer compression alone, versus multi-layer compression combined with activation of the venous leg pump by neuromuscular stimulation. With 60 patients, adding neuromuscular stimulation to multilayer compression resulted in a significant two-fold increase in the rate of wound healing over a 4-week period, both in terms of wound margin advance and in terms of percentage area reduction. The use of these short-term intermediate endpoint metrics together with a self-controlled study design offers potential for distinguishing between the relative efficacies of interventions more rapidly, with greater sensitivity, and with fewer subjects than a conventional RCT cohort model.

Effectiveness of Neuromuscular Electrical Stimulation for Enhanced Recovery After Total Hip Replacement Surgery: A Randomized Controlled Trial

Background

The aim of this study was to investigate the feasibility of using a novel neuromuscular electrical stimulation (NMES) device for enhanced recovery after total hip replacement surgery.

Methods

Sixty patients undergoing total hip replacement for osteoarthritis of the hip were randomized and divided into 2 groups: 1 group received postoperative treatment with the NMES device, and the other group did not receive NMES. The primary outcome measures were postoperative pain, lower limb swelling, and length of stay (LOS) postsurgery. Secondary outcomes included wound drainage at 24 hours and acceptability by the intervention of the device.

Results

Data from 60 participants were analyzed (NMES (n = 30), control group (n = 30)). Patients in the NMES group demonstrated a general trend of beneficial postoperative pain, calf swelling, and average length of stay from postoperative to discharge. However, wound drainage largely remained static for both groups. The overall comfort rate of the device was 93.3%.

Conclusions

The results of this study suggest that the geko^TM NMES device is partly useful for enhanced recovery after total hip replacement surgery. In addition, the device should be considered tolerable and safe. A larger study is required with this device in the future to determine its effectiveness on compelling data.