Electrical Stimulation to Enhance Wound Healing
Abstract
:1. Introduction
2. Literature Search Method
3. Results
3.1. Effects of ES on Bacteria Colonising Wounds
3.2. Effects of ES on Cellular Migration and Tissue Perfusion
3.3. Effects of ES on the Proliferative and Remodelling Phase of Healing
3.4. Effects of ES on Chronic Wounds
4. Discussion
4.1. General Considerations
4.2. Limitations on Chronic Wound Studies
4.3. Potential Implications for Clinical Practice
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Stage | Description of Wound |
---|---|
Stage I | Skin is intact with no open tears. Reddened area with possible blanching and pain. Area has a different texture compared to surrounding skin. |
Stage II | Skin tears, forming an open wound with blisters. Painful with exudate release. |
Stage III | Painful deep wound. Dermis is lost, fully exposing the fatty layer below. No muscle or bone visible. |
Stage IV | Deeper, painful wound which exposes the underlying muscle, tendon, or bone. |
Stage | Grade 0 | Grade I | Grade II | Grade III |
---|---|---|---|---|
A | Ulcerative lesion completely epithelialized | Superficial ulcer, not penetrating to tendon or muscle | Ulcer penetrating to tendon or capsule | Ulcer penetrating to bone or joint |
B | Infection | Infection | Infection | Infection |
C | Ischemia | Ischemia | Ischemia | Ischemia |
D | Infection and Ischemia | Infection and Ischemia | Infection and Ischemia | Infection and Ischemia |
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Chronic Wound | Pathophysiology |
---|---|
Pressure ulcer | Necrosis of skin and underlying soft tissue due to prolonged unrelieved pressure, compression or friction. |
Venous ulcer | Most commonly caused by venous hypertension due to faulty valves that lead to a sudden backflow of blood and increased pressure on vessel walls. |
Arterial ulcer | Ischemic ulcers caused by obstructions that narrow arterial lumen such as embolisms or atheroma. |
Diabetic ulcer | Commonly affects the lower extremities of the body. Loss of sensation (diabetic peripheral neuropathy), and existing vascular conditions contribute to foot ulcers. |
Type of Exogenous ES | Characteristics |
---|---|
Direct current (DC) | Continuous flow of electric charge in a monophasic waveform (in one direction). Currents of 20–200 µA can be supplied at a low voltage. |
Alternating current (AC) | Has a biphasic waveform, with two symmetrical electrical pulses alternating one after the other. Voltages typically 50–150 V dependent on tissue hydration. |
Pulsed current (PC) | Intermittent flow of charged particles with gaps in current flow. This can have a monophasic or biphasic waveform. Currents of 1.2–1.5 mA can be supplied to the tissue at high voltage. |
Degenerate wave (DW) | A type of waveform used in certain biofeedback devices. A constant current of 0.3 mA, which delivers an electric field of 10 mV/mm between the electrodes can be used. |
Study Design | Type of ES | Exposure Duration | Experimented on | Key Outcome(s) | Reference |
---|---|---|---|---|---|
RCT | TENS | 15 min | 30 healthy subjects High frequency (n = 10) Low frequency (n = 10) Control (n = 10) | Increase in skin perfusion | [38] |
RCT | Subcontractile ES | 60 min/day Total 6 weeks | 36 patients with ischemic limbs ES group (n = 24) Control (n = 12) | Increase in capillary density and skin perfusion | [39] |
RCT | HVPC | Four 60-min periods Total 1 day | 11 diabetic patients with and without PVD | Transient increase in TcPO2 in participants with PVD within 5 min | [40] |
Case series | HVPC | 1 h/day, 7 days/week for 1–9 months | 6 patients with ischemic leg ulcers | Increased TcPO2 and total healing of ulcers post exposure | [41] |
RCT | HVPC | 1 h/day, 7 days/week, 14 weeks | 8 Ischemic limb wounds ES group (n = 4) Sham treatment (n = 4) | Decreased wound size and increased peri-wound circulation | [42] |
Study Design | Type of ES | Exposure Duration | Experimented on | Key Outcome(s) | Reference |
---|---|---|---|---|---|
RCT | DW | 14 days | 20 healthy subjects, served as own control | Increase in VEGF, collagen, epidermal cells, and cell apoptotic markers | [43] |
RCT | DW | 14–20 days | 40 healthy subjects, served as own control | Reduced wound volume, increased perfusion and vascularity | [44] |
In vitro | Pulsed DC | At 4, 8, and 24 h | Human umbilical vein endothelial cell cultures | Increase in endothelial cell migration and VEGF production | [45] |
In vitro | DC | At 2, 4, and 6 h | Human fibroblast cells in a wound model | Increase in FGF and differentiation of fibroblasts | [46] |
In vitro | DC | 10 min | Fibronectin coated and non-fibronectin coated dermal fibroblast cells | Increased random migration of fibroblast cells, no increase in dermal fibroblast gene expression | [47] |
In vitro | AC | 12 h | Dermal cell matrix | Dermal fibroblasts entered into the growth phase of cell cycle with continuous ES exposure | [48] |
In vitro | DC and DW | 16 days | Punch biopsies on sample human skin tissues | Increase in epidermis thickness and keratinocyte proliferation | [49] |
Study Design | Type of ES/Electrode Placement | Exposure Duration | Type of Chronic Wound | No. of Participants | % Wound Area Reduction/% of Wounds Healed | Reference |
---|---|---|---|---|---|---|
RCT | HVPC †/Treatment electrode placed over wound | 50 min/day, 5 days/week for 6 weeks | Pressure ulcers | 63 patients Cathodal (n = 23) Anodal-cathodal (n = 20) Sham treatment(n = 20) | PAR 1 82.34% and 70.77% in ES group, respectively, 40.53% in control/Wound healing not specified | [52] |
RCT | HVPC/Treatment electrode placed over wound | 50 min/day, 5 days/week for 6 weeks | Pressure ulcers | 77 patients ES (n = 24) Sham (n = 28) US 1 (n = 25) | PAR 76.19% in ES group 48.97% in control group/52% of ulcers healed in ES group, 23% healed in control | [53] |
RCT | HVPC/Treatment electrode placed over wound | 60 min/day for 20 days | Pressure ulcers | 17 patients ES (n = 8) Sham (n = 9) | Wound PAR not specified, higher in ES than control group/38% of ES wound healed vs. 22% in sham group (p > 0.05) | [54] |
RCT | HVPC/Treatment electrode placed over wound | 45–120 min daily for 5 weeks (45 min for sham treatment) | Pressure ulcers | 60 patients ES (n = 45) Sham (n = 15) | After 60 and 120 min exposure PAR 91% in ES group vs. 25% in sham group/Wound healing not recorded | [55] |
RCT | HVPC/Treatment electrode placed over wound | 45 min/day, five days/week for average 7.4 weeks | Pressure ulcers | 16 patients ES (n = 9) Sham (n = 7) | 100% wound area reduction in treatment group, 28.9% increase in wound area in control group/Complete healing in ES group | [56] |
RCT | Biphasic current/Treatment electrode places across wound on intact skin | 30 min/day, 3 days/week, for 4 weeks | Mixed ulcers (diabetic and vascular) | 17 patients Diabetic (n = 8) Non-diabetic (n = 9) | PAR 70% in diabetic group, 38.4% in non- diabetic group/Wound healing not specified | [57] |
RCT | HVPC/Treatment electrode placed over wound | 45 min/day, 3 days/week for 4 weeks | Mixed ulcers (diabetic and venous) | 27 patients ES (n = 14) Sham (n = 13) | Wound PAR 44.3% in ES group and 16.6% in control group/Wound healing not specified | [58] |
RCT | PC (using bodyflow device)/Treatment electrodes placed above and below the wound site | 20 min/day, 4 days/week for 8 weeks | Venous ulcers | 23 patients ES (n = 14) Sham (n = 9) | PAR 32.67% in ES, Sham ES 23.15%/Wound healing not recorded | [59] |
RCT | Biphasic PC/Treatment electrodes placed over intact skin proximal to the wound site | 30 min of exposure | Diabetic footulcers | 80 patients Asymmetrical PC (n = 21), Symmetrical PC (n = 20), Low stimulation current (n = 19) Sham (n = 20) | Healing rate per week: 27% in asymmetrical PC, 16% in symmetrical PC, ~9.7% in control group/Wound healing not recorded | [60] |
RCT | AC ‡/Not specified | 20 min twice daily for 12 weeks | Diabetic footulcers | 51 patients ES (n = 24) Placebo (n = 27) | PAR 61% in ES group, 41% in placebo group/42% of ES exposed ulcers healed vs. 15% in placebo group | [61] |
RCT | HVPC/Treatment electrodes embedded in stockings placed around the wound | 8 h nightly for 12 weeks | Diabetic footulcers | 40 patients ES (n = 20) Sham (n = 20) | PAR 86% in ES group, 71% in sham group/65% of ES wounds healed vs. 35% of wounds in sham group | [62] |
RCT | HVPC/Treatment electrodes placed on opposite edges of the wound site | 50 min/day, 5 day/week for 8 weeks | Pressure ulcers | 61 patients Anodal HVPC (n = 20) Cathodal HVPC (n = 21) Sham (n = 20) | PAR 64.1% in anodal HVPC group, 74.06% in cathodal HVPC group, 41.42% in sham group/Complete wound healed not recorded | [63] |
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Rajendran, S.B.; Challen, K.; Wright, K.L.; Hardy, J.G. Electrical Stimulation to Enhance Wound Healing. J. Funct. Biomater. 2021, 12, 40. https://doi.org/10.3390/jfb12020040
Rajendran SB, Challen K, Wright KL, Hardy JG. Electrical Stimulation to Enhance Wound Healing. Journal of Functional Biomaterials. 2021; 12(2):40. https://doi.org/10.3390/jfb12020040
Chicago/Turabian StyleRajendran, Saranya B., Kirsty Challen, Karen L. Wright, and John G. Hardy. 2021. "Electrical Stimulation to Enhance Wound Healing" Journal of Functional Biomaterials 12, no. 2: 40. https://doi.org/10.3390/jfb12020040
APA StyleRajendran, S. B., Challen, K., Wright, K. L., & Hardy, J. G. (2021). Electrical Stimulation to Enhance Wound Healing. Journal of Functional Biomaterials, 12(2), 40. https://doi.org/10.3390/jfb12020040