The effect of stochastic electrical noise on hard-to-heal wounds

Novel Technologies in Chronic Wound Care

In Israel, 20% of wounds do not progress to full healing under treatment with conservative technologies of which 1 to 2% are eventually defined as chronic wounds. Chronic wounds are a complex health burden for patients and pose considerable therapeutic and budgetary burden on health systems. The causes of chronic wounds include systemic and local factors. Initial treatment involves the usual therapeutic means, but as healing does not progress, more advanced therapeutic technologies are used. Undoubtedly, advanced means, such as negative pressure systems, and advanced technologies, such as oxygen systems and micrografts, have vastly improved the treatment of chronic wounds. Our service specializes in treating ulcers and difficult-to-heal wounds while providing a multiprofessional medical response. Herein, we present our experience and protocols in treating chronic wounds using a variety of advanced dressings and technologies.

Electrical stimulation for difficult wounds: only an alternative procedure?

In the wound healing research, the exact mechanism of action of different modalities of electrical stimulation (ES) remains controversial and unresolved. In this study we discuss a particular ES, with a different type of waveform, corresponding to the principle of stochastic resonance. Between July 2008 and May 2010, 32 patients were enrolled and ES was applied to wounds using the bioelectrical signal therapy (BST) device (LifeWave, Petach Tiqwa, Israel). The outcome evaluated in group 1 (n = 21) was wound healing, while group 2 (n = 11) was evaluated for wound-related pain [Visual Number Scale (VNS) pain scale] during treatment. In group 1, 87% of the wounds closed in an average time of 97 days (range 10-150 days); three patients were lost to follow-up. In group 2, 45% of the patients experienced a complete pain disappearance after 7 days of treatment; 36% reported a reduction in VNS from 9·3 to 3·2 in 7 days; 19% stopped morphine-like painkillers after 2 weeks. The clinical application of the stochastic resonance enables the usage of easy-to-use, non-invasive, painless and pain-relief treatment. Our experience with ES has demonstrated the BST device to be a very good alternative in cases of small size defects, compared with other therapies such as surgery, dressing and negative pressure devices.

Electrical Stimulation Therapy and Wound Healing: Where Are We Now?

BACKGROUND

Healing chronic wounds is an ongoing challenge for clinicians and poses a serious public health burden. Electrical stimulation (ES), broadly defined as the application of electrical current via electrodes placed on the skin adjacent to or directly within the wound, has been proposed as a therapeutic modality over a century ago, and recent advances in understanding the biology of electrical phenomena in the skin have rekindled an interest in this modality.

THE PROBLEM

Despite evidence that has shown ES to be effective for wound healing, it has been slow to gain acceptance in the United States. Also, there has been no consensus in terms of standardization of parameters to devise a systematic protocol for implementation of this technology.

BASIC/CLINICAL SCIENCE ADVANCES

The epidermis maintains a "skin battery" that generates an endogenous electric field and current flow when wounded. Experimental models have demonstrated that most of the cell types within the wound can sense an electric field in the range of that endogenously generated in the wound, and respond with a variety of biological and functional responses that can contribute to healing. Multiple animal wound models have demonstrated enhancement of a number of parameters of healing when ES is exogenously supplied.

CLINICAL CARE RELEVANCE

Clinical trials have investigated the efficacy of multiple forms of ES for improving healing in a wide variety of human chronic wounds. In 2002 the Centers for Medicare and Medicaid Services approved reimbursement for use of ES in a clinical setting for certain chronic wounds.

CONCLUSION

THERE REMAIN MANY VOIDS IN OUR KNOWLEDGE BASE: clinical evidence is limited by deficiencies in the design of many of the trials, a multiplicity of ES application modes and waveforms used in trials prevent selection of an optimal modality, and lack of uniformity in reporting ES dosages leave us not much advanced from our clinical knowledge base a decade ago.