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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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Rampazo ÉP, Liebano RE, Pinfildi CE, Folha RAC, Ferreira LM. High voltage pulsed current in collagen realignment, synthesis, and angiogenesis after Achilles tendon partial rupture. Braz J Phys Ther 2016; 20:312-9. [PMID: 27556387 PMCID: PMC5015677 DOI: 10.1590/bjpt-rbf.2014.0167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 02/10/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To verify the efficacy of high voltage pulsed current in collagen realignment and synthesis and in angiogenesis after the partial rupturing of the Achilles tendon in rats. Method Forty male Wistar rats were randomized into four groups of 10 animals each: sham, cathodic stimulation, anodic stimulation, and alternating stimulation. Their Achilles tendons were submitted to direct trauma by a free-falling metal bar. Then, the treatment was administered for six consecutive days after the injury. In the simulation group, the electrodes were positioned on the animal, but the device remained off for 30 minutes. The other groups used a frequency of 120 pps, sensory threshold, and the corresponding polarity. On the seventh day, the tendons were removed and sent for histological slide preparation for birefringence and Picrosirius Red analysis and for blood vessel quantification. Results No significant difference was observed among the groups regarding collagen realignment (types I or III collagen) or quantity of blood vessels. Conclusion High voltage pulsed current for six consecutive days was not effective in collagen realignment, synthesis, or angiogenesis after the partial rupturing of the Achilles tendon in rats.
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Affiliation(s)
- Érika P Rampazo
- Departamento de Cirurgia Plástica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Richard E Liebano
- Departamento de Fisioterapia, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Roberta A C Folha
- Departamento de Cirurgia Plástica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lydia M Ferreira
- Departamento de Cirurgia Plástica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Jeon JK, Park SK, Lee JH. Effects of high voltage pulsed current stimulation with a visible contraction intensity on expression of TGF-β1 and synthesis of type I collagen in wound-induced white rats. J Phys Ther Sci 2015; 27:1485-90. [PMID: 26157246 PMCID: PMC4483424 DOI: 10.1589/jpts.27.1485] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/20/2015] [Indexed: 12/26/2022] Open
Abstract
[Purpose] This study aimed to examine the expression of transforming growth factor β1 (TGF-β1) and type I collagen by applying high voltage pulsed current stimulation (HVPCS) with a visible contraction intensity to white rats with induced wounds. [Subjects] Thirty-six white rats were used for this study. HVPCS with a non-visible contraction intensity was applied to experimental group I, and HVPCS with a visible contraction intensity was applied to experimental group II. Placebo stimulation was applied to the control group. [Methods] After wounds were triggered, the intervention appropriate for each group was applied. Changes in the size of their wounds and expression of TGF- β1 and type I collagen were measured on the third, fifth, and seventh days. [Results] Comparison of the sizes of the wounds among the groups showed that the most significant decreases were found in experimental group II on the fifth and seventh days. TGF-β1 expression comparison revealed that experimental group II had the most expression on the fifth day. [Conclusion] HVPCS with a visible contraction intensity was effective in promoting wound healing by increasing expression of TGF-β1 and synthesis of type I collagen.
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Affiliation(s)
- Jae-Keun Jeon
- Department of Physical Therapy, Hanlyo University, Republic
of Korea
| | - Seung-Kyu Park
- Department of Physical Therapy, Sehan University, Republic
of Korea
| | - Joon-Hee Lee
- Department of Physical Therapy, Cheongju University, Republic of Korea
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Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, DiPietro L, Falanga V, Fife C, Gardner S, Grice E, Harmon J, Hazzard WR, High KP, Houghton P, Jacobson N, Kirsner RS, Kovacs EJ, Margolis D, McFarland Horne F, Reed MJ, Sullivan DH, Thom S, Tomic-Canic M, Walston J, Whitney JA, Williams J, Zieman S, Schmader K. Chronic wound repair and healing in older adults: current status and future research. J Am Geriatr Soc 2015; 63:427-38. [PMID: 25753048 DOI: 10.1111/jgs.13332] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Older adults are more likely to have chronic wounds than younger people, and the effect of chronic wounds on quality of life is particularly profound in this population. Wound healing slows with age, but the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The effect of age and accompanying multimorbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables; lack of standardization in data collection; and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this article, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify research questions to guide future study of age-associated changes in chronic wound healing.
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Affiliation(s)
- Lisa Gould
- Wound Recovery and Hyperbaric Medicine Center, Kent Hospital, Warwick, Rhode Island
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Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, DiPietro L, Falanga V, Fife C, Gardner S, Grice E, Harmon J, Hazzard WR, High KP, Houghton P, Jacobson N, Kirsner RS, Kovacs EJ, Margolis D, McFarland Horne F, Reed MJ, Sullivan DH, Thom S, Tomic-Canic M, Walston J, Whitney J, Williams J, Zieman S, Schmader K. Chronic wound repair and healing in older adults: current status and future research. Wound Repair Regen 2015; 23:1-13. [PMID: 25486905 DOI: 10.1111/wrr.12245] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/19/2014] [Indexed: 12/21/2022]
Abstract
The incidence of chronic wounds is increased among older adults, and the impact of chronic wounds on quality of life is particularly profound in this population. It is well established that wound healing slows with age. However, the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The impact of age and accompanying multi-morbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables, lack of standardization in data collection, and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this paper, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify key research questions to guide future study of age-associated changes in chronic wound healing.
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Affiliation(s)
- Lisa Gould
- Wound Recovery and Hyperbaric Medicine Center, Kent Hospital, Warwick, Rhode Island
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Barnes R, Shahin Y, Gohil R, Chetter I. Electrical stimulation vs. standard care for chronic ulcer healing: a systematic review and meta-analysis of randomised controlled trials. Eur J Clin Invest 2014; 44:429-40. [PMID: 24456185 DOI: 10.1111/eci.12244] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 01/14/2014] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Rachel Barnes
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull, UK
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ELECTROPHYSICAL AGENTS - Contraindications And Precautions: An Evidence-Based Approach To Clinical Decision Making In Physical Therapy. Physiother Can 2011; 62:1-80. [PMID: 21886384 PMCID: PMC3031347 DOI: 10.3138/ptc.62.5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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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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Weber SA, Vonhoff PA, Owens FJ, Byrne J, McAdams ET. Development of a multi--electrode electrical stimulation device to improve chronic wound healing. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:2145-2148. [PMID: 19964585 DOI: 10.1109/iembs.2009.5333963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A new device has been developed for the application of Electrical Stimulation to improve healing of chronic wounds. The device enables the creation of a composite electrode hence matching the electrode(s) to the size and shape of the wound. Up to 49 electrodes in an array can be combined, delivering High Voltage Pulsed Current (HVPC) in the range 60-120 Hz with a pulse duration range from 90-110 mus and the possibility of treating the patient with direct current instead of HVPC. In addition, the software can import the measurements from the ImpediMap device, analysing the electrical impedance of the tissues involved. A test on healthy volunteers did not prove a statistically significant rise in skin temperature, TcPO2 or impedance due to the stimulation, even though a slight reddening of the stimulated site was observed.
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Affiliation(s)
- Sonja A Weber
- Nanotechnology and Integrated BioEngineering Centre, University of Ulster, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland.
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Abstract
BACKGROUND The management of diabetic foot ulcers remains a problem. A treatment modality that uses compressed air massage has been developed as a supplement to standard surgical and medical treatment. Compressed air massage is thought to improve local tissue oxygenation around ulcers. The aim of this study was to determine whether the addition of compressed air massage influences the rate of healing of diabetic ulcers. METHODS Sixty consecutive patients with diabetes, admitted to one hospital for urgent surgical management of diabetic foot ulcers, were randomized into two groups. Both groups received standard medical and surgical management of their diabetes and ulcer. In addition, one group received 15-20 min of compressed air massage, at 1 bar pressure, daily, for 5 days a week, to the foot and the tissue around the ulcer. Healing time was calculated as the time from admission to the time of re-epithelialization. RESULTS Fifty-seven patients completed the trial; 28 received compressed air massage. There was no difference in the mean age, Wagner score, ulcer size, pulse status, or peripheral sensation in the two groups. The time to healing in the compressed air massage group was significantly reduced: 58.1 +/- 22.3 days (95% confidence interval: 49.5-66.6) versus 82.7 +/- 30.7 days (95% confidence interval: 70.0-94.3) (P = 0.001). No adverse effects in response to compressed air massage were noted. CONCLUSIONS The addition of compressed air massage to standard medical and surgical management of diabetic ulcers appears to enhance ulcer healing. Further studies with this new treatment modality are warranted.
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Affiliation(s)
- M Mars
- Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag 7, Congella 4013, South Africa.
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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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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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