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Dai J, Shao J, Zhang Y, Hang R, Yao X, Bai L, Hang R. Piezoelectric dressings for advanced wound healing. J Mater Chem B 2024; 12:1973-1990. [PMID: 38305583 DOI: 10.1039/d3tb02492j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The treatment of chronic refractory wounds poses significant challenges and threats to both human society and the economy. Existing research studies demonstrate that electrical stimulation fosters cell proliferation and migration and promotes the production of cytokines that expedites the wound healing process. Presently, clinical settings utilize electrical stimulation devices for wound treatment, but these devices often present issues such as limited portability and the necessity for frequent recharging. A cutting-edge wound dressing employing the piezoelectric effect could transform mechanical energy into electrical energy, thereby providing continuous electrical stimulation and accelerating wound healing, effectively addressing these concerns. This review primarily reviews the selection of piezoelectric materials and their application in wound dressing design, offering a succinct overview of these materials and their underlying mechanisms. This study also provides a perspective on the current limitations of piezoelectric wound dressings and the future development of multifunctional dressings harnessing the piezoelectric effect.
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Affiliation(s)
- Jinjun Dai
- Shanxi Key Laboratory of Biomedical Metal Materials, College of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
| | - Jin Shao
- Taikang Bybo Dental, Zhuhai, 519100, China
| | - Yi Zhang
- Shanxi Key Laboratory of Biomedical Metal Materials, College of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
| | - Ruiyue Hang
- Shanxi Key Laboratory of Biomedical Metal Materials, College of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
| | - Xiaohong Yao
- Shanxi Key Laboratory of Biomedical Metal Materials, College of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
| | - Long Bai
- Institute of Translational Medicine, Shanghai University, Shanghai, 200444, China.
| | - Ruiqiang Hang
- Shanxi Key Laboratory of Biomedical Metal Materials, College of Materials Science and Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
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Borges D, Pires R, Ferreira J, Dias-Neto M. The effect of wound electrical stimulation in venous leg ulcer healing-a systematic review. J Vasc Surg Venous Lymphat Disord 2023; 11:1070-1079.e1. [PMID: 37196922 DOI: 10.1016/j.jvsv.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The benefit of using electric stimulation therapy (EST) to heal venous leg ulcers (VLUs) is not well established. The main aim of this systematic review was to evaluate the effects of ulcer EST in VLU healing. METHODS A systematic search of the literature was conducted using the databases PubMed, Scopus, and Web of Science and included original studies that reported VLU healing after EST. The inclusion criteria were at least two surface electrodes placed on or near the wound or a planar probe covering the ulcer area to be treated. The Cochrane risk of bias tool for randomized control trials (RCTs) and Joanna Briggs Institute critical appraisal checklist for case series were used to evaluate the risk of bias. RESULTS This review included eight RCTs and three case series involving a total of 724 limbs in 716 patients with VLUs. The mean patient age was 64.2 years (95% confidence interval, 62.3-66.2), and 46.2% (95% confidence interval, 41.2%-50.4%) were men. The active electrode was placed on the wound with the passive electrode placed on healthy skin (n = 6), the two electrodes were placed on either side of the wound edges (n = 4), or a planar probe was used (n = 1). The pulsed current was the most used waveform (n = 9). The change in the ulcer size was the main method used to determine ulcer healing (n = 8), followed by the ulcer healing rate (n = 6), exudate levels (n = 4), and the time to healing (n = 3). Five RCTs detected a statistically significant improvement in at least one VLU healing outcome, after EST compared with the control group. In two of these, EST was better than the control but only for patients who had not undergone surgical treatment of VLU. CONCLUSIONS The findings from the present systematic review support the use of EST to accelerate wound healing of VLUs, especially for patients who are not surgical candidates. However, the significant variation in electric stimulation protocols represents an important limitation to its use and should be addressed in future studies.
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Affiliation(s)
- Daniela Borges
- Faculdade de Medicina da Universidade do Porto, University of Porto, Porto, Portugal.
| | - Raquel Pires
- Escola Superior de Biotecnologia, Universidade Católica do Porto, Porto, Portugal
| | - Joana Ferreira
- Department of Angiology and Vascular Surgery, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Tsolakidis S, Rosenauer R, Schmidhammer R, Pallua N, Rennekampff HO. Wireless microcurrent stimulation improves blood flow in burn wounds. Burns 2022; 48:1230-1235. [PMID: 34607727 DOI: 10.1016/j.burns.2021.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022]
Abstract
RATIONALE Skin breakdown, as in wounds, leads to an electric potential, defined as current of injury with the intent of wound closure. Burn wounds are defined by different zones of perfusion having a direct influence on further therapy (e.g. conservative management or skin grafting). We studied immediate, quantifiable effects of electric stimulation on skin perfusion in burn wounds. METHOD Wireless Microcurrent Stimulation (WMCS) was utilised as an adjunct therapeutic modality in 10 patients with partial thickness burn wounds. Microcirculation in the skin was quantified with a Laser Doppler (LDI) before and after WMCS treatment. We included a control group of 10 healthy individuals. RESULTS A single application of WMCS significantly increased mean flow, velocity and subsequently, haemoglobin and oxygen saturation in partial thickness burn wounds. In healthy skin these parameters increased, but were far less pronounced than in thermally injured skin. CONCLUSION This study revealed, for the first time that non-contact WMCS improves blood flow in critically perfused partial thickness burn wounds without disturbing the wound or systemically affecting the patient and may represent a promising adjunct tool in burn treatment, with the potential of faster healing by enhanced perfusion of burn wounds and reduction of the zone of stasis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- S Tsolakidis
- Austrian Cluster of Tissue Regeneration and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology at the Research Centre for Traumatology of the Austrian Workers Compensation Board (AUVA), Donaueschingenstraße 13, 1200 Vienna, Austria; Millesi Center for Surgery of Peripheral Nerves, Vienna Private Clinic, Pelikangasse 15, 1090 Vienna, Austria.
| | - R Rosenauer
- Austrian Cluster of Tissue Regeneration and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology at the Research Centre for Traumatology of the Austrian Workers Compensation Board (AUVA), Donaueschingenstraße 13, 1200 Vienna, Austria; Trauma Hospital Lorenz Boehler of the Austrian Workers Compensation Board (AUVA), Donaueschingenstrasse 13, 1200 Vienna, Austria; Millesi Center for Surgery of Peripheral Nerves, Vienna Private Clinic, Pelikangasse 15, 1090 Vienna, Austria.
| | - R Schmidhammer
- Austrian Cluster of Tissue Regeneration and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology at the Research Centre for Traumatology of the Austrian Workers Compensation Board (AUVA), Donaueschingenstraße 13, 1200 Vienna, Austria; Millesi Center for Surgery of Peripheral Nerves, Vienna Private Clinic, Pelikangasse 15, 1090 Vienna, Austria.
| | - N Pallua
- Faculty of Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - H O Rennekampff
- Klinik für Plastische Chirurgie, Hand-und Verbrennungschirurgie, Rhein-Maas Klinikum, Mauerfeldchen 25, 52146 Wuerselen, Germany.
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Konstantinou E, Zagoriti Z, Pyriochou A, Poulas K. Microcurrent Stimulation Triggers MAPK Signaling and TGF-β1 Release in Fibroblast and Osteoblast-Like Cell Lines. Cells 2020; 9:E1924. [PMID: 32825091 PMCID: PMC7564311 DOI: 10.3390/cells9091924] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022] Open
Abstract
Wound healing constitutes an essential process for all organisms and involves a sequence of three phases. The disruption or elongation of any of these phases can lead to a chronic or non-healing wound. Electrical stimulation accelerates wound healing by mimicking the current that is generated in the skin after any injury. Here, we sought to identify the molecular mechanisms involved in the healing process following in vitro microcurrent stimulation-a type of electrotherapy. Our results concluded that microcurrents promote cell proliferation and migration in an ERK 1/2- or p38-dependent way. Furthermore, microcurrents induce the secretion of transforming growth factor-beta-1 (TGF-β1) in fibroblasts and osteoblast-like cells. Interestingly, transcriptomic analysis uncovered that microcurrents enhance the transcriptional activation of genes implicated in Hedgehog, TGF-β1 and MAPK signaling pathways. Overall, our results demonstrate that microcurrents may enhance wound closure through a combination of signal transductions, via MAPK's phosphorylation, and the transcriptional activation of specific genes involved in the healing process. These mechanisms should be further examined in vivo, in order to verify the beneficial effects of microcurrents in wound or fracture healing.
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Affiliation(s)
| | | | | | - Konstantinos Poulas
- Laboratory of Molecular Biology and Immunology, Department of Pharmacy, University of Patras, 26504 Rio, Greece; (E.K.); (Z.Z.); (A.P.)
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Wireless Direct Microampere Current in Wound Healing: Clinical and Immunohistological Data from Two Single Case Reports. BIOSENSORS-BASEL 2019; 9:bios9030107. [PMID: 31492004 PMCID: PMC6784371 DOI: 10.3390/bios9030107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/01/2019] [Accepted: 09/02/2019] [Indexed: 01/22/2023]
Abstract
Chronic pressure ulcers are hard-to-heal wounds that decrease the patient’s quality of life. Wireless Micro Current Stimulation (WMCS) is an innovative, non-invasive, similar to electrode-based electrostimulation (ES) technology, that generates and transfers ions that are negatively-charged to the injured tissue, using accessible air gases as a transfer medium. WMCS is capable of generating similar tissue potentials, as electrode-based ES, for injured tissue. Here, through immunohistochemistry, we intended to characterize the induced tissue healing biological mechanisms that occur during WMCS therapy. Two single cases of bedridden due to serious stroke white men with chronic non-healing pressure ulcers have been treated with WMCS technology. WMCS suppresses inflammatory responses by decreasing the aggregation of granulocytes, followed by stimulating myofibroblastic activity and a new formation of collagen fibers, as depicted by immunohistochemistry. As a result, WMCS provides a special adjunct or stand-alone therapy choice for chronic and non-healing injuries, similar to electrode-based ES, but with added (i.e., contactless) benefits towards its establishment as a routine clinical wound healing regime.
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Abstract
Martorell's ulcers are hard-to-heal leg ulcers typically accompanied by a significant elevation of blood pressure and severe pain. This case study examines the use of an innovative technology, wireless microcurrent stimulation, for the healing of a Martorell's ulcer. Using wireless microcurrent stimulation, study authors managed to reduce the size of a large Martorell's ulcer by 90% within 8 weeks. In this article, the case of a 65-year-old woman is discussed in detail, and this new, contactless method is compared with traditional ulcer healing methods.
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Kambouris ME, Markogiannakis A, Arabatzis M, Manoussopoulos Y, Kantzanou M, Velegraki A. Wireless electrostimulation: a new approach in combating infection? Future Microbiol 2017; 12:255-265. [DOI: 10.2217/fmb-2017-0157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Electrostimulation (ES), hitherto successfully employed in wound treatment, has shown potential in antimicrobial applications, suggesting its use as synergistic to or replacement of antibiotics. The differential susceptibility of pathogens and host tissue and organs to various ES modalities might allow selective use against specific infections. The use of ES is cheaper in terms of development/testing, routine application and environmental footprint. If extensive substitution of chemical compounds is achieved, the development of resistance might be reversed through negative selection. A promising setup of ES seems to be the noncontact current transfer, due to low amperage similar to innate bioelectricity, painlessness, simple logistics and low risk for treatment-caused infection.
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Affiliation(s)
| | | | - Michael Arabatzis
- Mycology Research Laboratory, Department of Microbiology, Medical School, National and Kapodistrian University of Athens 11527, Greece
| | | | - Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics, National Retrovirus Reference Center, Medical School, National and Kapodistrian University of Athens 11527, Greece
| | - Aristea Velegraki
- Mycology Research Laboratory, Department of Microbiology, Medical School, National and Kapodistrian University of Athens 11527, Greece
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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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“Toothbrush” the Feet. INT J LOW EXTR WOUND 2015; 14:291-4. [DOI: 10.1177/1534734615578058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic wounds develop when the sequence of healing events are disrupted, usually in patients with underlying diseases such as diabetes mellitus, venous insufficiency, peripheral artery disease, and neuropathies and they affect most often the lower extremities. We present a 68-year-old woman with plantar ulceration, lasting for approximately 18 months, resistant to healing with conventional therapy and various modalities we used. The patient had a long history of seronegative enteropathic arthritis, Crohn’s disease, secondary fibrillar amyloidosis, multiplex neuropathy, and small vessel vasculitis, the latter being the trigger event for the ulceration of her right foot. Before the decision for a final surgical intervention, we implemented a mechanical periodic stimulus using a soft toothbrush, which resulted in the gradual and complete healing of the ulcer within a period of 6 weeks. Patient’s history and previous treatments are presented along with the procedures that led to the healing of the chronic wound. This report supports the idea that periodic mechanical stimulus is of great importance for the healing process and this could be the mechanism of action of some other methods that have been described in the medical literature.
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Park S, Kim H, Makin I, Skiba J, Izadjoo M. Measurement of microelectric potentials in a bioelectrically-active wound care device in the presence of bacteria. J Wound Care 2015; 24:23-33. [DOI: 10.12968/jowc.2015.24.1.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- S.S. Park
- Diagnostics and Translational Research Center, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Gaithersburg, MD, USA
| | - H. Kim
- Diagnostics and Translational Research Center, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Gaithersburg, MD, USA
| | | | | | - M.J. Izadjoo
- Diagnostics and Translational Research Center, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Gaithersburg, MD, USA
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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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Reid B, Zhao M. The Electrical Response to Injury: Molecular Mechanisms and Wound Healing. Adv Wound Care (New Rochelle) 2014; 3:184-201. [PMID: 24761358 DOI: 10.1089/wound.2013.0442] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 06/21/2013] [Indexed: 01/06/2023] Open
Abstract
Significance: Natural, endogenous electric fields (EFs) and currents arise spontaneously after wounding of many tissues, especially epithelia, and are necessary for normal healing. This wound electrical activity is a long-lasting and regulated response. Enhancing or inhibiting this electrical activity increases or decreases wound healing, respectively. Cells that are responsible for wound closure such as corneal epithelial cells or skin keratinocytes migrate directionally in EFs of physiological magnitude. However, the mechanisms of how the wound electrical response is initiated and regulated remain unclear. Recent Advances: Wound EFs and currents appear to arise by ion channel up-regulation and redistribution, which are perhaps triggered by an intracellular calcium wave or cell depolarization. We discuss the possibility of stimulation of wound healing via pharmacological enhancement of the wound electric signal by stimulation of ion pumping. Critical Issues: Chronic wounds are a major problem in the elderly and diabetic patient. Any strategy to stimulate wound healing in these patients is desirable. Applying electrical stimulation directly is problematic, but pharmacological enhancement of the wound signal may be a promising strategy. Future Directions: Understanding the molecular regulation of wound electric signals may reveal some fundamental mechanisms in wound healing. Manipulating fluxes of ions and electric currents at wounds might offer new approaches to achieve better wound healing and to heal chronic wounds.
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Affiliation(s)
- Brian Reid
- Departments of Dermatology and Ophthalmology, School of Medicine, University of California, Davis, California
| | - Min Zhao
- Departments of Dermatology and Ophthalmology, School of Medicine, University of California, Davis, California
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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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