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Girgis B, Carvalho D, Duarte JA. The effect of high-voltage monophasic pulsed current on diabetic ulcers and their potential pathophysiologic factors: A systematic review and meta-analysis. Wound Repair Regen 2023; 31:171-186. [PMID: 36507861 DOI: 10.1111/wrr.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022]
Abstract
The present review was conducted to determine the efficacy of high-voltage monophasic pulsed current (HVMPC) in treating diabetic ulcers, assess its effect on skin lesions with each of the pathophysiologic factors potentially contributing to diabetic ulcers, evaluate its safety, and identify treatment parameters. Electronic search of PubMed, Scopus, PEDro and Google Scholar databases was conducted. The revised tool for assessing risk of bias in randomised trials (RoB 2), the risk of bias in non-randomised studies-of interventions (ROBINS-I) and the Joanna Briggs Institute (JBI) critical appraisal tool were used to assess risk of bias and methodological quality. Overall quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principles. Thirty-two studies matched the eligibility criteria, and included 1061 patients with 1103 skin lesions of selected aetiologies; 12 randomised controlled trials were included in quantitative synthesis. HVMPC plus standard wound care (SWC) likely increased the probability of complete wound healing of pressure ulcers (PrUs) compared with sham/no stimulation plus SWC; relative risk (RR) 2.08; 95% CI: [1.42, 3.04], p = 0.0002; I2 = 0%, p = 0.61; eight studies, 358 ulcers. Although conclusive evidence regarding the effect of HVMPC on diabetic ulcers was not found, collateral evidence might suggest a potential benefit. Direct evidence, with moderate certainty, may support its efficacy in treating PrUs, albeit few adverse reactions were reported. Other observations, moreover, might indicate that this efficacy may not be limited to PrUs. Nonetheless, several aspects remain to be clarified for safe and effective application of electrical stimulation for wound healing.
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Affiliation(s)
- Beshoy Girgis
- CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar S. João, Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
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Zulbaran-Rojas A, Park C, El-Refaei N, Lepow B, Najafi B. Home-Based Electrical Stimulation to Accelerate Wound Healing-A Double-Blinded Randomized Control Trial. J Diabetes Sci Technol 2023; 17:15-24. [PMID: 34328024 PMCID: PMC9846397 DOI: 10.1177/19322968211035128] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Electrical stimulation (E-Stim) may offer a unique adjunctive treatment to heal complicated diabetic foot ulcers (DFU). Our primary goal is to examine the effectiveness of daily home-based E-Stim therapy to speed-up wound healing. METHODS Patients with chronic DFUs and mild to severe peripheral arterial disease (PAD) were recruited and randomized to either control (CG) or intervention (IG) groups. The IG received 1-hour home-based E-Stim therapy on daily basis for 4 weeks (4W). E-Stim was delivered through electrical pads placed above the ankle joint using a bio-electric stimulation technology (BEST®) platform (Tennant Biomodulator® PRO). The CG was provided with an identical but non-functional device for the same period. The primary outcome included wound area reduction at 4W from baseline (BL). RESULTS Thirty-eight patients were recruited and 5 were removed due to non-compliance or infection, leaving 33 participants (IG, n = 16; CG, n =17). At 4W, the IG showed a significant wound area reduction of 22% (BL: 7.4 ± 8.5 cm2 vs 4W: 5.8 ± 8.0 cm2, P = 0.002). Average of wound area was unchanged in the CG (P = 0.982). The self-report adherence to daily home-therapy was 93.9%. CONCLUSIONS Daily home-based E-Stim provides early results on the feasibility, acceptability, and effectiveness of E-Stim as an adjunctive therapy to speed up wound healings in patients with chronic DFU and mild to severe PAD.
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Affiliation(s)
- Alejandro Zulbaran-Rojas
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Catherine Park
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Nesreen El-Refaei
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Brian Lepow
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Bijan Najafi
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
- Bijan Najafi, PhD, MSc, Michael E. DeBakey
Department of Surgery, Interdisciplinary Consortium on Advanced Motion
Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy,
Baylor College of Medicine, 7200 Cambridge St., Houston, TX 77030, USA.
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Chen L, Ruan Y, Ma Y, Ge L, Han L. Effectiveness and safety of electrical stimulation for treating pressure ulcers: A systematic review and meta-analysis. Int J Nurs Pract 2022; 29:e13041. [PMID: 35244315 DOI: 10.1111/ijn.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/26/2021] [Accepted: 01/16/2022] [Indexed: 12/01/2022]
Abstract
AIM This study aims to synthesize qualitative evidence on the effectiveness and safety of electrical stimulation for treating pressure ulcers. BACKGROUND Electrical stimulation is often used clinically to treat pressure ulcers, but its effectiveness and safety and some potential problems are not clear. DESIGN This is a qualitative systematic review. DATA SOURCES The data sources are four English databases (PubMed, EMBASE, The Cochrane Library and Web of Science) and four Chinese databases (CNKI, SinoMed, VIP and WANFANG). METHODS Two reviewers independently examined the records according to the eligibility criteria and extracted the data of each included study. We used the Review Manager 5.3 software to perform data analysis. RESULTS Seventeen randomized controlled trials including 740 patients were included in this study. Meta-analysis of eight randomized controlled trials demonstrated that electrical stimulation significantly reduced the ulcer surface in contrast with standard wound care alone or pulsed sham electrical stimulation. Nine studies showed that electrical stimulation increased the risk of pressure ulcers being completely healed than the controlled group. Three studies reported that adverse reactions were rare. CONCLUSIONS This study demonstrated that electrical stimulation was a relatively effective and safe adjunctive therapy for pressure ulcers treatment.
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Affiliation(s)
- Lian Chen
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Ruan
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Lin Han
- School of Nursing, Lanzhou University, Lanzhou, China.,Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
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Wu M, Rubin AE, Dai T, Schloss R, Usta OB, Golberg A, Yarmush M. High-Voltage, Pulsed Electric Fields Eliminate Pseudomonas aeruginosa Stable Infection in a Mouse Burn Model. Adv Wound Care (New Rochelle) 2021; 10:477-489. [PMID: 33066719 DOI: 10.1089/wound.2019.1147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: The incidence of severe infectious complications after burn injury increases mortality by 40%. However, traditional approaches for managing burn infections are not always effective. High-voltage, pulsed electric field (PEF) treatment shortly after a burn injury has demonstrated an antimicrobial effect in vivo; however, the working parameters and long-term effects of PEF treatment have not yet been investigated. Approach: Nine sets of PEF parameters were investigated to optimize the applied voltage, pulse duration, and frequency or pulse repetition for disinfection of Pseudomonas aeruginosa infection in a stable mouse burn wound model. The bacterial load after PEF administration was monitored for 3 days through bioluminescence imaging. Histological assessments and inflammation response analyses were performed at 1 and 24 h after the therapy. Results: Among all tested PEF parameters, the best disinfection efficacy of P. aeruginosa infection was achieved with a combination of 500 V, 100 μs, and 200 pulses delivered at 3 Hz through two plate electrodes positioned 1 mm apart for up to 3 days after the injury. Histological examinations revealed fewer inflammatory signs in PEF-treated wounds compared with untreated infected burns. Moreover, the expression levels of multiple inflammatory-related cytokines (interleukin [IL]-1α/β, IL-6, IL-10, leukemia inhibitory factor [LIF], and tumor necrosis factor-alpha [TNF-α]), chemokines (macrophage inflammatory protein [MIP]-1α/β and monocyte chemoattractant protein-1 [MCP-1]), and inflammation-related factors (vascular endothelial growth factor [VEGF], macrophage colony-stimulating factor [M-CSF], and granulocyte-macrophage colony-stimulating factor [G-CSF]) were significantly decreased in the infected burn wound after PEF treatment. Innovation: We showed that PEF treatment on infected wounds reduces the P. aeruginosa load and modulates inflammatory responses. Conclusion: The data presented in this study suggest that PEF treatment is a potent candidate for antimicrobial therapy for P. aeruginosa burn infections.
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Affiliation(s)
- Mengjie Wu
- Department of Orthodontics, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Center of Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrey Ethan Rubin
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tianhong Dai
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rene Schloss
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
| | - Osman Berk Usta
- Center of Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Golberg
- Porter School of Environment and Earth Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Martin Yarmush
- Center of Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
- Shriners Burn Hospital for Children, Boston, Massachusetts, USA
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Farber PL, Isoldi FC, Ferreira LM. Electric Factors in Wound Healing. Adv Wound Care (New Rochelle) 2021; 10:461-476. [PMID: 32870772 DOI: 10.1089/wound.2019.1114] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Significance: Electric factors such as electric charges, electrodynamic field, skin battery, and interstitial exclusion permeate wound healing physiology and physiopathology from injury to re-epithelialization. The understanding of how electric factors contribute to wound healing and how treatments may interfere with them is fundamental for the development of better strategies for the management of pathological scarring and chronic wounds. Recent Advances: Angiogenesis, cell migration, macrophage activation hemorheology, and microcirculation can interfere and be interfered with electric factors. New treatments with various types of electric currents, laser, light emitting diode, acupuncture, and weak electric fields applied directly on the wound have been developed to improve wound healing. Critical Issues: Despite the basic and clinical development, pathological scars such as keloids and chronic wounds are still a challenge. Future Directions: New treatments can be developed to improve skin wound healing taking into account the influence of electrical charges. Monitoring electrical activity during skin healing and the influence of treatments on hemorheology and microcirculation are examples of how to use knowledge of electrical factors to increase their effectiveness.
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Affiliation(s)
| | - Felipe Contoli Isoldi
- Surgery Department, Plastic Surgery Division, Postgraduated Program in Translational Surgery, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Lydia Masako Ferreira
- Surgery Department, Plastic Surgery Division, Postgraduated Program in Translational Surgery, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
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Milne J, Swift A, Smith J, Martin R. Electrical stimulation for pain reduction in hard-to-heal wound healing. J Wound Care 2021; 30:568-580. [PMID: 34256596 DOI: 10.12968/jowc.2021.30.7.568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Despite treatment advances over the past 30 years, the societal impact of hard-to-heal wounds is increasingly burdensome. An unresolved issue is wound pain, which can make many treatments, such as compression in venous leg ulcers, intolerable. The aim of this review is to present the evidence and stimulate thinking on the use of electrical stimulation devices as a treatment technology with the potential to reduce pain, improve adherence and thus hard-to-heal wound outcomes. METHOD A literature search was conducted for clinical studies up to August 2020 reporting the effects of electrical stimulation devices on wound pain. Devices evoking neuromuscular contraction or direct spinal cord stimulation were excluded. RESULTS A total of seven publications (three non-comparative and four randomised trials) were identified with four studies reporting a rapid (within 14 days) reduction in hard-to-heal wound pain. Electrical stimulation is more widely known for accelerated healing and is one of the most evidence-based technologies in wound management, supported by numerous in vitro molecular studies, five meta-analyses, six systematic reviews and 30 randomised controlled trials (RCTs). Despite this wealth of supportive evidence, electrical stimulation has not yet been adopted into everyday practice. Some features of electrical stimulation devices may have hampered adoption in the past. CONCLUSION As new, pocket-sized, portable devices allowing convenient patient treatment and better patient adherence become more widely available and studied in larger RCTs, the evidence to date suggests that electrical stimulation should be considered part of the treatment options to address the challenges of managing and treating painful hard-to-heal wounds.
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Souza AK, Souza TR, Siqueira das Neves LM, de Paula Marcondes Ferreira Leite G, Garcia SB, Roberto de Jesus Guirro R, Barbosa RI, Caldeira de Oliveira Guirro E. Effect of High Voltage Pulsed Current on the integration of total skin grafts in rats submitted to nicotine action. J Tissue Viability 2019; 28:161-166. [DOI: 10.1016/j.jtv.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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