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Rajendran SB, Challen K, Wright KL, Hardy JG. Electrical Stimulation to Enhance Wound Healing. J Funct Biomater 2021; 12:40. [PMID: 34205317 PMCID: PMC8293212 DOI: 10.3390/jfb12020040] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
Electrical stimulation (ES) can serve as a therapeutic modality accelerating the healing of wounds, particularly chronic wounds which have impaired healing due to complications from underlying pathology. This review explores how ES affects the cellular mechanisms of wound healing, and its effectiveness in treating acute and chronic wounds. Literature searches with no publication date restrictions were conducted using the Cochrane Library, Medline, Web of Science, Google Scholar and PubMed databases, and 30 full-text articles met the inclusion criteria. In vitro and in vivo experiments investigating the effect of ES on the general mechanisms of healing demonstrated increased epithelialization, fibroblast migration, and vascularity around wounds. Six in vitro studies demonstrated bactericidal effects upon exposure to alternating and pulsed current. Twelve randomized controlled trials (RCTs) investigated the effect of pulsed current on chronic wound healing. All reviewed RCTs demonstrated a larger reduction in wound size and increased healing rate when compared to control groups. In conclusion, ES therapy can contribute to improved chronic wound healing and potentially reduce the financial burden associated with wound management. However, the variations in the wound characteristics, patient demographics, and ES parameters used across studies present opportunities for systematic RCT studies in the future.
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Affiliation(s)
- Saranya B. Rajendran
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire LA1 4AT, UK;
| | - Kirsty Challen
- Emergency Department, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, Lancashire PR2 9HT, UK;
| | - Karen L. Wright
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire LA1 4YG, UK
| | - John G. Hardy
- Department of Chemistry, Faculty of Science and Technology, Lancaster University, Lancaster, Lancashire LA1 4YB, UK
- Materials Science Institute, Lancaster University, Lancaster, Lancashire LA1 4YB, UK
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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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Effects of High-Voltage Electrical Stimulation in Improving the Viability of Musculocutaneous Flaps in Rats. Ann Plast Surg 2017; 77:e50-4. [PMID: 26418786 DOI: 10.1097/sap.0000000000000621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The musculocutaneous flap of the transverse rectus abdominis muscle is a technique used for breast reconstruction, and one of the complications of this procedure is tissue necrosis. The objective of the study is to determine the effect of high-voltage electrical stimulation (HVES) in the transverse rectus abdominis muscle flap in rats. METHODS Fourteen rats underwent surgery for obtaining the flap. The rats were distributed into 2 homogeneous groups: group 1 underwent both surgery and the use of HVES, whereas group 2 underwent just the surgery (control). Electrical stimulation was applied immediately after surgery and for 2 consecutive days. The percentage of necrotic area was analyzed using the Image J software, and blood flow was assessed by infrared thermography in different regions of the flap, divided into 4 zones according to the proximity of the pedicle of the inferior epigastric artery. RESULTS The results were analyzed using a Student t test, where group 1 experienced a necrotic area of 26.2%, and group 2 had an area of 54.5%. Regarding the temperature, the 2 groups showed increase in the minimum and maximum temperature on the fourth postoperative day. CONCLUSION The HVES appeared to have a positive influence on the viability of the flap.
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Ashrafi M, Alonso-Rasgado T, Baguneid M, Bayat A. The efficacy of electrical stimulation in lower extremity cutaneous wound healing: A systematic review. Exp Dermatol 2017; 26:171-178. [DOI: 10.1111/exd.13179] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Mohammed Ashrafi
- Plastic and Reconstructive Surgery Research; Centre for Dermatological Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
| | | | - Mohamed Baguneid
- University Hospital South Manchester NHS Foundation Trust; Wythenshawe Hospital; Manchester UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research; Centre for Dermatological Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
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Annabestani Z, Mohseni S, Torkaman G, Nasirpoor F, Larijani B, Mohajeri-Tehrani MR. Electrical stimulation-induced bullous formation in a pemphigoid diabetic patient: a case report. Int J Diabetes Dev Ctries 2014. [DOI: 10.1007/s13410-014-0212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Wirsing PG, Habrom AD, Zehnder TM, Friedli S, Blatti M. Wireless micro current stimulation--an innovative electrical stimulation method for the treatment of patients with leg and diabetic foot ulcers. Int Wound J 2013; 12:693-8. [PMID: 24373098 DOI: 10.1111/iwj.12204] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/26/2013] [Accepted: 11/20/2013] [Indexed: 11/29/2022] Open
Abstract
Clinical experience with a new electrical stimulation (ES) technique, the wireless micro current stimulation (WMCS), for the treatment of chronic wounds is described. WMCS transfers the current to any surface wound from a distance, by using oxygen's and nitrogen's ability to exchange electrons. We studied 47 patients with hard-to-heal wounds. Patients with venous, arterial and mixed leg ulcers were predominant; other aetiologies such as diabetic foot lesions, pressure ulcers, vasculitis and pyoderma were also included. WMCS treatment protocol specified treatment twice or thrice per week, for 45-60 minutes per session, with 1·5 μA current intensity. Standard wound care was applied to all patients, including compression bandages, if necessary. Clear progress of wound healing, even after 2 weeks, was observed in all cases. The mean reduction of the wound surface after WMCS treatment was 95% in 8 weeks. Complete healing was achieved within 3 months for the majority of the cases. No clinical side effects were observed. WMCS technology significantly accelerated wound healing for patients with hard-to-heal wounds of different aetiologies. This new therapy offers multiple advantages compared with the previous methods of ES, as it is contactless, free of pain and very easy to use.
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Gui MS, Guirro RRDJ, Sakabe DI, Sakabe FF. Estimulação elétrica de alta voltagem incrementa a cicatrização de lesões cutâneas crônicas: análise de seis casos. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000300014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O tratamento de úlceras cutâneas por estimulação elétrica tem crescido na prática clínica, no entanto, faltam estudos que investiguem a efetividade desse recurso em acompanhamento prolongado ou até que ocorra a cicatrização completa das lesões. Assim, a estimulação elétrica de alta voltagem (EEAV) foi aplicada em úlceras cutâneas crônicas com o objetivo de reduzir a área da lesão. Para tanto, participaram do estudo quatro homens que apresentavam seis úlceras cutâneas que receberam a EEAV (fase=15ms; F=100 Hz; T: 100 a 150 V; fases gêmeas), 2 vezes por semana, durante 30 minutos. O eletrodo com polaridade negativa foi colocado sobre a lesão e o positivo no trajeto vascular. As úlceras foram avaliadas pré e pós-intervenção por meio da fotogrametria, sendo calculada a área da lesão. Como resultado, observamos o fechamento completo da lesão nos sujeitos I e II (área de 4,66 cm² para 0 após 21 sessões e de 1,74 cm² para 0 após 16 sessões, respectivamente). O sujeito III obteve redução de 93% na área da lesão direita (de 2,02 para 0,14 cm²) e na esquerda de 80,40% (de 2,50 para 0,49 cm²), após 100 sessões. No sujeito IV ocorreu o fechamento completo da lesão sacral (de 10,74 cm² para 0) e a redução da lesão isquiática de 11,01 para 2,43 cm², após 75 sessões. Desse modo, concluímos que a EEAV facilitou o processo de cicatrização das úlceras estimuladas, pois as áreas de todas as úlceras apresentaram diminuição superior a 78%, havendo cicatrização completa em três delas.
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Castana O, Dimitrouli A, Argyrakos T, Theodorakopoulou E, Stampolidis N, Papadopoulos E, Pallantzas A, Stasinopoulos I, Poulas K. Wireless electrical stimulation: an innovative powerful tool for the treatment of a complicated chronic ulcer. INT J LOW EXTR WOUND 2013; 12:18-21. [PMID: 23378515 DOI: 10.1177/1534734613476517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High-voltage electrical stimulation has been long proposed as a method of accelerating the wound healing process. Its beneficial effect has been successfully evaluated in the treatment of a number of chronic ulcers and burns. We present here the implementation of a new wireless electrical stimulation technique for the treatment of a complicated chronic ulcer of the lower limb. The device is transferring charges to the wound, without any contact with it, creating a microcurrent that is able to generate the current of injury. The results suggest that this easy-to-use method is an effective therapeutic option for chronic ulcers.
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The Roles of Physical Therapists in Wound Management: Part IV. THE JOURNAL OF THE AMERICAN COLLEGE OF CERTIFIED WOUND SPECIALISTS 2009; 1:106-8. [PMID: 24527128 DOI: 10.1016/j.jcws.2009.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Physical therapists are important members of the comprehensive wound management team. In addition to being able to provide standard wound care, they are well prepared to treat wounds with a variety of biophysical agents that introduce electromagnetic, acoustic, and mechanical energies that enhance healing. Physical therapists also address restoration of function that is frequently compromised in patients who suffer from chronically and acutely wounded tissues.
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Goldman RJ. Hyperbaric Oxygen Therapy for Wound Healing and Limb Salvage: A Systematic Review. PM R 2009; 1:471-89. [DOI: 10.1016/j.pmrj.2009.03.012] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 03/02/2009] [Accepted: 03/08/2009] [Indexed: 11/30/2022]
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Frequency rhythmic electrical modulation system in the treatment of chronic painful leg ulcers. Arch Dermatol Res 2008; 300:377-83. [DOI: 10.1007/s00403-008-0875-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 06/23/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
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Abstract
Mr Jones lived independently until he developed necrotic pressure ulcers over his heels and could no longer mobilize to care for himself. He was transferred to a nursing home where he lived for 18 months and where the nurses could care for his wounds. The wound had been on his right heel without changing over the 18 months and, although attempts to hydrate the eschar had been somewhat successful, the necrotic tissue proved stubborn creating large quantity of fibrous slough. Mr Jones was initially assessed by the tissue viability consultant on 14 March 2005 and agreed to the application of bio-electric stimulation therapy (POSiFEC). The wound change was immediate and was fully healed by 16 June 2005, 12 weeks after his initial assessment. This article outlines his care and the background to bio-electrical stimulation in wounds.
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Affiliation(s)
- Sylvie Hampton
- Dental Practice Board, Compton Place Road, Eastbourne, UK
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Kloth LC. Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments, and clinical trials. INT J LOW EXTR WOUND 2005; 4:23-44. [PMID: 15860450 DOI: 10.1177/1534734605275733] [Citation(s) in RCA: 205] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article reviews theories linked to endogenous bioelectric currents and the role they may play in wound repair with further appraisal of in vitro and in vivo research related to the effects of clinically applicable electrical currents on protein synthesis, cell migration, and antibacterial outcomes. In addition, studies on the effects of electrical stimulation (ES) on skin grafts, donor sites, and musculocutaneous flaps in animals are evaluated, as well as assessments of numerous clinical reports that examined the effects of ES on angiogenesis, perfusion, PtcO2, and epithelialization. Finally, a plethora of clinical trials related to the responses of chronic lower extremity wounds to ES therapy are reviewed, with emphasis on wounds caused by venous insufficiency, diabetic neuropathy, and ischemia in patients with and without diabetes mellitus. A glossary that addresses ES terminology is also included.
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Affiliation(s)
- Luther C Kloth
- Department of Physical Therapy, Marquette University, Milwaukee, WI 53201-1881, USA.
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Abstract
Growth substances (cytokines and growth factors) are soluble signaling proteins affecting the process of normal wound healing. Cytokines govern the inflammatory phase that clears cellular and extracellular matrix debris. Wound repair is controlled by growth factors (platelet-derived growth factor [PDGF], keratinocyte growth factor, and transforming growth factor beta). Endogenous growth factors communicate across the dermal-epidermal interface. PDGF is important for most phases of wound healing. Becaplermin (PDGF-BB), the only growth factor approved by the Food and Drug Administration, requires daily application for neuropathic wound healing. Gene therapy is under development for more efficient growth factor delivery; a single application will induce constitutive growth factor expression for weeks. Based on dramatic preclinical animal studies, a phase 1 clinical trial planned on a PDGF genetic construct appears promising.
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Affiliation(s)
- Robert Goldman
- Department of Rehabilitation Medicine, University of Pennsylvania, Philadelphia, USA
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Goldman R, Rosen M, Brewley B, Golden M. Electrotherapy Promotes Healing and Microcirculation of Infrapopliteal Ischemic Wounds: A Prospective Pilot Study. Adv Skin Wound Care 2004; 17:284-94. [PMID: 15289715 DOI: 10.1097/00129334-200407000-00010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if high-voltage pulsed current (HVPC) electrotherapy augments ischemic wound healing and increases periwound microcirculation. DESIGN A prospective, randomized, single-blinded, sham-controlled clinical trial was conducted on a homogenous subset of quasi-stable ischemic wounds. INTERVENTION Active HVPC or sham HVPC was applied to wounds for a 14-week period. MAIN OUTCOME MEASURE Wounds were monitored every 4 weeks, except 2 weeks between weeks 12 and 14, for wound area, wound appearance, and microcirculation, which was measured by transcutaneous oxygen (TcPO2) levels and laser Doppler flow. RESULTS Ischemic wounds treated with active HVPC decreased in size, contrary to the expected increase in ischemic wound size that was observed in wounds in the control group (P <.05, Student t test; week 4). A trend toward smaller wound area occurred in wounds in the HVPC group compared with wounds in the control group (week 14). Among the HVPC group, an improvement in periwound microcirculation occurred at weeks 8 (P <.05, TcPO2; P <.01, laser Doppler) and 12 (P <.05, laser Doppler). These increases suggest that HVPC promotes arteriolar vasodilation and dermal capillary formation. HVPC was well tolerated. CONCLUSION The results of this study demonstrate that HVPC decreased the area of ischemic wounds, reversing the expected increase in wound size, and improved microcirculation. The promising results of this pilot study require a larger Phase II study to confirm and generalize these findings. CLINICAL RELEVANCE Electrotherapy may prove to be a relatively safe and effective complement to surgical revascularization to improve the odds of healing ischemic wounds and promoting limb salvage.
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Affiliation(s)
- Robert Goldman
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA
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Goldman RJ, Brewley BI, Cohen R, Rudnick M. Use of Electrotherapy to Reverse Expanding Cutaneous Gangrene in End-Stage Renal Disease. Adv Skin Wound Care 2003; 16:363-6. [PMID: 14688644 DOI: 10.1097/00129334-200312000-00013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert J Goldman
- Department of Rehabilitation Medicine, University of Pennsylvania School of Medicine, USA
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Goldman R, Brewley B, Zhou L, Golden M. Electrotherapy reverses inframalleolar ischemia: a retrospective, observational study. Adv Skin Wound Care 2003; 16:79-89. [PMID: 12690231 DOI: 10.1097/00129334-200303000-00009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if high-voltage pulsed current (HVPC) augments ischemic wound healing and increases periwound perfusion. DESIGN A 5-year, retrospective, observational study was conducted on successive patients with ischemic wounds who were poor candidates for revascularization. INTERVENTION HVPC was applied directly to wounds at greater than 100 volts, 100 pulses per second, 1 hour per day. In addition to HVPC, patients received standard care for ischemic wounds at the study facility. Ischemic wounds for which HVPC was not clinically indicated or not available received standard care alone. MAIN OUTCOME MEASURES Wound area measured by planimetry, wound appearance observed by digital imaging techniques, and microcirculation monitored by transcutaneous oxygen (TcPo(2)) levels. RESULTS The group that received HVPC plus standard care showed smaller wound areas from weeks 20 though 52 after the start of treatment compared with the group that received standard care alone (P <.05; Mann-Whitney test). One year after the start of treatment, 90% of HVPC-treated wounds were healed, compared with 29% of the wounds that received only standard care (P <.05; Fisher exact test). For the HVPC group, maximum periwound TcPo(2) improved during electrotherapy (6 +/- 8 mm Hg [standard deviation; SD] at baseline improved to 26 +/- 20 SD, during HVPC, P <.05; Wilcoxon signed rank test). CONCLUSION The results of this retrospective trial demonstrate that HVPC plus standard care improved the healing rate of high-risk ischemic wounds. A direct relationship was shown between improved healing rates and increased periwound perfusion. A prospective randomized controlled trial is needed to further support these observational, preliminary findings.
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Affiliation(s)
- Robert Goldman
- Department of Rehabilitation Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Abstract
PURPOSE To improve clinical practice and the quality of patient care by providing a learning opportunity that enhances the participant's understanding of the tools and techniques available for wound measurement. TARGET AUDIENCE This CME/CE activity is intended for physicians and nurses with an interest in learning about tools and techniques available for wound measurement. OBJECTIVES After reading the article and taking the test, the participant will be able to: Identify advantages and disadvantages of various dimensional methods used to measure wounds. Identify advantages and disadvantages of visual and photographic assessment methods. Identify advantages and disadvantages of vascular and pressure assessment methods.
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