High-voltage galvanic stimulation on wound healing in guinea pigs: longer-term effects

Effect of Magnetohydrodynamic on Cutaneous Wound Healing in Rat Model

Background: Exogenous electrical stimulation of the skin may mimic its endogenous bioelectric currents. In this study, a combination of direct current (DC) and magnetic field (MF) was investigated in the excision of the rat wound model. Methods: A circular wound was created on the posterior of the neck, and an electrode was fixed in the wound center. Rats were divided into sham, DC (600 µA), MF (~0.8 T), and magnet-direct current (MDC) groups. The study was conducted in 14 days with 20-min treatment daily. Results: The DC and MDC groups had higher healing percentages (P < 0.01) with mean differences of -13.42 and -15.63, respectively. Direct current on days 2, 5, and 6, and MDC on days 8, 9, 10, 11, 12, and 13 showed higher wound closing. In the DC-treated group, angiogenesis was improved on day 7. In MDC-treated rats, angiogenesis and fibroplasia were improved on day 13. The MF and MDC groups had lower granulation thicknesses on day 7. Granulation thickness increased on day 13 in the MF and MDC groups, while it decreased in the DC group. Direct current treatment improved healing in the first half of the study period, whereas MDC enhanced it in the second half, overtaking DC. From day 7, the magnet group started to overtake the control group slightly in the last four days. Conclusions: To accelerate wound healing, we suggest applying DC in the first days of wounding and MDC in the following days.

The Efficacy of Pressure Ulcer Treatment With Cathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial

BACKGROUND

Studies show that anode and cathode electrical stimulation (ES) promotes the healing of wounds, but specific protocols for both electrodes are not available.

OBJECTIVE

To compare the effectiveness of cathodal versus cathodal+anodal ES in the treatment of Category II-IV pressure ulcers (PrUs).

DESIGN

Prospective, randomized, controlled, clinical study.

SETTING

Three nursing and care centers.

PATIENTS

Sixty-three participants with PrUs were randomly formed into a cathodal ES group (CG: N = 23; mean age of 79.35; SD 8.48), a cathodal+anodal ES group (CAG: N = 20; mean age of 79.65; SD 11.44) and a placebo ES group (PG: N = 20; mean age of 76.75; SD 12.24).

INTERVENTION

All patients were treated with standard wound care and high-voltage monophasic pulsed current (HVMPC; twin-peak impulses; 154 μs; 100 pps; 0.25 A; 250 μC/s) for 50 minutes per day, 5 times a week, for 6 weeks. The CG, CAG, and PG received, respectively, cathodal, cathodal+anodal, and sham ES through electrodes placed on a moist gauze pad. The treatment electrode was placed on the wound, and the return electrode was positioned on healthy skin at least 20 cm from the PrU.

MEASUREMENTS

Measurements were made at baseline, and after each of the 6 weeks of treatment. Primary outcome was percentage wound surface area reduction at week 6.

RESULTS

Wound surface area decreased in the CG by 82.34% (95% confidence interval [CI] 70.06-94.63) and in the CAG by 70.77% (95% CI 53.51-88.04). These reductions were significantly greater than in the PG (40.53%; 95% CI 23.60-57.46). The CG and CAG were not statistically significantly different regarding treatment results.

LIMITATIONS

The time of treatment proved insufficient for PrUs to close.

CONCLUSIONS

Cathodal and cathodal+anodal HVMPC similarly reduced the area of Category II-IV PrUs.

The use of animals in medical research - a historical perspective

Even though not human, animals are not research equipment

Electrical Stimulation of Wound Healing: A Review of Animal Experimental Evidence

Significance: Electrical stimulation (ES) is a therapeutic intervention that may help specialists facilitate wound healing rates. The purpose of this section is to compile the available animal research regarding the effectiveness of ES on the injury potential, healing rate, cellular and molecular proliferation, mechanical properties, and survival rate of skin flaps. Recent Advances: Regardless of the type of ES current and polarity used, most of the animal experimental evidence suggests that application of ES can facilitate wound healing. However, treatment time should be sufficiently long to attain good mechanical strength of regenerated tissue, because tensile strength is not consistent with augmented collagen deposition. ES improves the survival rate and skin blood flow of animal flaps, but clinical studies are needed to substantiate the findings from these animal experiments. Critical Issues: Impaired or delayed healing is a major clinical problem that can lead to wound chronicity. ES with various strategies has been used to facilitate the healing process, but many aspects remain controversial. Despite much research, no consensus exists regarding the detailed effects of ES on wound healing. Nevertheless, ES has been approved by the Center for Medicare and Medicine Services for reimbursement of the treatment of some chronic ulcers. Future Directions: Exogenous ES may promote the directional migration of cells and signaling molecules via electrotaxis; however, its underlying mechanism is still poorly understood. Future studies that further elucidate the mechanisms regulating electrotaxis will be necessary to optimize the use of ES in different wound states.

Pulsed radiofrequency energy accelerates wound healing in diabetic mice

BACKGROUND

Impaired healing is a problematic and common complication of chronic wounds. Although pulsed radiofrequency energy has been used in the treatment of chronic wounds with promising efficacy, its mechanism is still poorly characterized. In this study, the authors used a diabetic mouse model to illustrate the action of pulsed radiofrequency energy on cutaneous wounds and set the stage to begin to understand its mechanism.

METHODS

Full-thickness cutaneous wounds were created in diabetic mice (n = 26). The experimental group (n = 13) was subject to pulsed radiofrequency energy treatment two times per day, whereas the sham group (n = 13) was subjected to sham devices. The rate of wound closure was evaluated by digital analysis of surface area of the wound bed, zone of reepithelialization, and rate of contraction. Mice were euthanized on days 7, 10, 22, and 42 and wounds were evaluated qualitatively and quantitatively by hematoxylin and eosin, Masson's trichrome, and Ki-67 assay for cell proliferation.

RESULTS

In the experimental group, the rate of wound closure was significantly accelerated, particularly beyond day 17. Contraction contributed to the wound healing process rather than reepithelialization. This was also associated with increased granulation tissue that was most prominent by day 22 and with enhanced dermal cell proliferation, with 25 percent and 45 percent Ki-67-positive nuclei on days 10 and 22, respectively, as compared with control animals.

CONCLUSION

These results indicate that pulsed radiofrequency energy accelerates impaired wound healing mainly through wound contraction by means of stimulating cell proliferation, granulation tissue formation, and collagen deposition.

Enhanced healing of diabetic foot ulcers using local heat and electrical stimulation for 30 min three times per week

BACKGROUND

Electrical stimulation (ES) with heating is effective in healing chronic wounds. However, it this effect due to ES alone or both heating and ES? The aim of the present study was to deduce the individual roles of heat and ES in the healing of chronic wounds.

METHODS

The study was performed on 20 patients (mean age 48.4 ± 14.6 years) with non-healing diabetic foot ulcers (mean duration 38.9 ± 23.7 months) who received local dry heat (37°C; n = 10) or local dry heat + ES (n = 10) three times a week for 4 weeks. Patients were given ES using biphasic sine wave stimulation (30 Hz, pulse width 250 μs, current approximately 20 mA).

RESULTS

  Skin blood flow in and around the wound was measured with a laser Doppler flow imager. In the ES + heat group, the average wound area and volume decreased significantly by 68.4 ± 28.6% and 69.3 ± 27.1%, respectively (both P < 0.05), over the 1-month period. During the average session, blood flow increased to 102.3 ± 25.3% with local heat and to 152.3 ± 23.4% with ES + heat. In the group receiving treatment with local heat only, wounds that had not healed for at least 2 months showed 30.1 ± 22.6% healing (i.e. a decrease in wound area) after 1 month. Although this level of healing was significant, it was less than that observed in the ES + heat group (P<0.05).

CONCLUSIONS

  Local dry heat and ES work well together to heal chronic diabetic foot wounds; however, local heat would appear to be a relevant part of this therapy because ES alone has produced little healing in previous studies.

The combined effect of a three-channel electrode delivery system with local heat on the healing of chronic wounds

BACKGROUND

Historically, electrical stimulation (ES) has been used as a treatment for wound care. However, some studies show wounds healing with ES, whereas others do not. Part of the difficulty can be resolved by using heat to help dilate blood vessels, but an inherent problem with ES is uneven currents across the wound due to the use of only two electrodes. Therefore, we designed and tested a multi-electrode ES device in combination with local warming of the wound in non-healing chronic ulcers.

STUDY DESIGN

Eighteen subjects (mean +/- SD age, 35.7 +/- 21.3 years) with chronic ulcers (no healing for 26.1 +/- 24.6 months) received ES treatment three times a week for 4 weeks. A heat lamp was used before and during ES to keep the wound and area surrounding the wound warm (37 degrees C). ES was applied for 30 min with biphasic sine wave stimulation at a frequency of 30 Hz, pulse width of 250 micros, and current of about 20 mA. Skin blood flow (BF) in and around the wound was measured with a laser Doppler imager. Wound size was measured prior to each treatment.

RESULTS

Over the 1-month period, the mean wound area significantly decreased by 43.4 +/- 44.5% (P < 0.05), and wound volume decreased by 57.0 +/- 27.9% (P < 0.05). Skin BF significantly increased after application of ES and local heat (P < 0.05). The skin BF response decreased as time progressed and the wound healed.

CONCLUSIONS

Thus, in this pilot study, application of a three-channel ES system in combination with local heat is effective in the healing of non-healing chronic wounds. Future studies should examine a larger population with variables such as treatment duration, number of days, or length of treatment to optimize the effect of ES on healing of non-healing chronic wounds.

Does preoperative electrical stimulation of the skin alter the healing process?

BACKGROUND

In vitro studies have demonstrated that electrical current may affect fibroblast proliferation and synthesis of collagen fibers. In humans, the application of electrical current by positioning the positive electrode on skin wounds resulted in thinner hypertrophic scars. The aim of this study was to evaluate the effects of preoperative electrical stimulation on cutaneous wound healing in rats.

MATERIALS AND METHODS

Forty rats were divided into two groups of 20 animals each. In the control group, an incision was made on the back of the animals. In the stimulation group, a preoperative electrical stimulation was applied using a rectangular pulse current at a frequency of 7.7 Hz, and intensity of 8 mA, for 30 min, with the positive electrode placed on the back of the animal, and the negative electrode placed on the abdominal wall. Following, an incision was made on their back. Biopsy was carried out on postoperative day 7 and 14, and histologic analysis was performed.

RESULTS

The number of newly formed vessels, fibroblasts, and type III collagen fibers in the stimulation group on postoperative day 7 were greater than those in the control group.

CONCLUSIONS

Preoperative positive-polarity electrical stimulation positively affects angiogenesis and fibroblast proliferation.

A review of mechanical adjuncts in wound healing: hydrotherapy, ultrasound, negative pressure therapy, hyperbaric oxygen, and electrostimulation

Chronic or non-healing wounds may develop in the setting of many diseases and are the source of considerable morbidity as well as health costs. These wounds demand an aggressive, multifactorial approach including surgical debridement, revascularization, antibiotics and dressings. In addition several adjuvant treatment methods have been developed to further stimulate healing. Whirlpool, although used frequently, has not been proven to be of benefit. However, pulsed lavage does show a promising future. Ultrasound has demonstrated beneficial effects but further controlled studies are needed. Subatmospheric pressure therapy is associated with few complications and is fast becoming a mainstay of adjuvant therapy. Hyperbaric oxygen therapy has been shown to be effective for many types of wounds. Unfortunately, cost and access to chambers may prohibit its use on a routine basis. Finally, electrostimulation may be one of the up and coming therapies for the future. Though, more studies are needed to determine the mode of delivery for various types of wounds.

EFFECTS OF ELECTRICAL STIMULATION ON THE HISTOLOGICAL PROPERTIES OF WOUNDS IN DIABETIC MICE

The purpose of this study was to identify mechanisms underlying electrically stimulated wound closure in diabetic mice. Adult male mice (n = 58) with full-thickness excisional wounds were treated five times using negative polarity over the wound site for 15 minutes each over a 16-day period with sham (0 Volts) or 5.0, 10.0, 12.5 Volts. In addition, animals (diabetic (n = 33) and nondiabetic (n = 22)) received treatments of electrical stimulation (12.5 V), or sham treatment (0 V) at wound sites which were then harvested and prepared for histological analysis at 2, 8, and 16 days postwounding. Using computerized image analysis of sections stained with a picro sirus red-fast green staining technique, we found that increasing doses of electrical stimulation reduced collagen/noncollagenous protein ratios measured in the superficial scar of nondiabetic animals, with no effect in diabetic animals. In the deep scar, lower doses of electrical stimulation (5.0 V) produced significantly (p < 0.01) increased collagen deposition in wounds of nondiabetic animals compared with sham controls. Higher doses of electrical stimulation (12.5 V) were required to produce changes in diabetic animals than were observed in nondiabetic animals. These results suggest that electrical stimulation altered collagen deposition in excisional wounds of diabetic and nondiabetic animals. Electrical stimulation had a differential effect on wound healing in diabetic compared with nondiabetic animals. These data speak to the need to study the effects of electrical stimulation on healing in disease-specific models.

Modern application of high voltage stimulation for enhanced healing of venous crural ulceration

The objective of this paper was to evaluate the effect of high voltage stimulation (HVS) on the process of healing of crural ulceration. Three comparative groups of patients, A, B and C, were drawn at random from patients with venous crural ulceration. Thirty-three patients in group A were subjected to treatment with HVS. In the course of treatment, doubled-peak monophasic impulses of a total duration of 0.1 ms and frequency of 100 Hz were applied. The voltage was 100 V. Group B, made up of 32 patients treated with topically applied medicine, and group C, made up of 14 patients treated with Unna's boot were used as control. In all patients in all groups (A, B and C) a significant reduction in wound size in relation to baseline was found. The rate of wound area change was highest in group A. The rate of pus cleansing was significantly highest in group A. The degree of granulation after 2 weeks was significantly greater in group A than in the other groups (P<0.003). High voltage stimulation was an efficient method of enhancement of the healing of crural ulceration.

Tissue repair of the epidermis and dermis

Wounds of the skin heal in a predictable fashion and at a fairly constant rate if impediments to healing can be avoided. For the skin wound of the hand, the therapist and surgeon face paradoxic demands to balance optimal immobilization for wound healing with optimal motion for function. As long as the wound remains stable, therapy can begin very early in the postoperative period without interruption of the wound-healing process.