Electrochemical treatment of ex vivo human abdominal skin and potential use in scar management: A pilot study

Abstract

Introduction: Scar treatments aim to address pathologic collagen deposition; however, they can be expensive or difficult to control. Electrochemical therapy (ECT) offers a simple alternative treatment. The purpose of this study is to examine the acid-base and histological changes in ex vivo human abdominal skin following ECT. Methods: Forty-two ex vivo human panniculus tissue sections collected from six individuals were tumesced with normal saline. ECT was performed by inserting two platinum needle electrodes connected to a DC power supply into each specimen. Voltage was varied (3–6 V) and applied for 5 minutes. Each specimen was sectioned across both electrode insertion sites and immediately stained with pH sensitive dye. The width of dye color change for each dosimetry pair was calculated. Hematoxylin and eosin staining was used to evaluate samples. Results and Discussion: ECT caused a spatially localised and dose-dependent increased area of acidic and basic pH around the anode and cathode, respectively. A significantly greater mean width of pH change was generated at the cathode compared to the anode in all treatment groups. Histological evaluation displayed broad condensation and hyalinisation of dermal collagen. Conclusion: ECT triggered dermal pH alterations and changed the underlying structural framework of the specimen. This technology may serve as a low-cost, minimally invasive local soft-tissue remodeling technique with potential application in scar management. Level of Evidence: 5 Lay Summary Electrochemical therapy is a novel treatment that causes spatially selective dermal injury in areas of interest. This study measures the effects of electrochemical therapy when applied to abdominal skin. Electrochemical therapy appears to have beneficial effects by causing a highly localised reduction in collagen content or local softening of tissue, which is consistent with other studies on scar therapies, including chemexfoliation, radiofrequency technologies, and lasers. However, electrochemical therapy can be performed at a fraction of the costs of these aforementioned modalities.

In vivo electrochemical lipolysis of fat in a Yucatan pig model: A proof of concept study

“…This was the highest dosimetry parameter tested for P‐ECLL and may represent an upper limit dosimetry limit. Hyperpigmentation of the skin at the needle insertion and exit points was also observed here as in previous studies 31,34,35 . This is a common effect observed in many energy‐based skin therapies and is an unpredictable process associated with moderate tissue injury 40–43 .…”

“…Hyperpigmentation of the skin at the needle insertion and exit points was also observed here as in previous studies. 31,34,35 This is a common effect observed in many energy-based skin therapies and is an unpredictable process associated with moderate tissue injury. [40][41][42][43] This needs to be further explored if this technology is to be directed for treating skin.…”

“…With ECT, charge transfer determines the amount of acid or base formed, which in turn is proportional to the tissue effect. 10,12,31,33,35 The degree of charge transfer is controlled by changing electrochemical systems, voltage, and time parameters. Increasing voltage or time parameters results in increasing charge transfer.…”

“…This is achieved through water electrolysis via the reactions: $$$2{{\rm{H}}}_{2}{\rm{O}}\to {{\rm{O}}}_{2}+4{{\rm{H}}}^{+}+4{{\rm{e}}}^{-}$$$ $$$4{{\rm{H}}}_{2}{\rm{O}}+4{{\rm{e}}}^{-}\to 2{{\rm{H}}}_{2}+4{\text{OH}}^{-}$$$which occur at the anode and cathode, respectively. Electrochemical therapy (ECT) has been studied in a number of tissues and has been shown to create a localized tissue injury resulting in lengthening of tendons, cartilage reshaping, and collagen remodeling in skin 10,13–35 . A previous ECT study on fat demonstrated that ECLL results in pH gradients that lead to adipocyte cell deaths via membrane lysis, saponification of triglycerides, and nucleic acid and protein degradation 10 …”

“Electrochemical Lipolysis Induces Adipocyte Death and Fat Necrosis: In Vivo Pilot Study in Pigs”

“…Volume 153, Number 2 • In Vivo Electrochemical Lipolysis 335e new, low-cost, nonsurgical fat reduction modality involving the use of in situ water hydrolysis to modify the biochemical and physical tissue properties. We have demonstrated that in situ water electrolysis to generate acid (at the anode) and base (at the cathode) can modify cartilage pliability, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] cause localized collagen injury to skin, [33][34][35][36][37] and induce adipocyte necrosis and lipolysis when applied to fat. 38,39 In this latter application, referred to as electrochemical lipolysis (ECLL), saline is first injected into fat for tumescence and to increase tissue electrical conductivity.…”