The efficacy of electrical stimulation in lower extremity cutaneous wound healing: A systematic review

Abstract

Current gold standard lower extremity cutaneous wound management is not always effective. Cutaneous wounds generate a "current of injury" which is directly involved in wound healing processes. Application of exogenous electrical stimulation has been hypothesised to imitate the natural electric current that occurs in cutaneous wounds.The aim of this extensive review was to provide a detailed update on the variety of electrical stimulation modalities used in the management of lower extremity wounds.Several different waveforms and delivery methods of electrical stimulation have been used. Pulsed current appears superior to other electrical modalities available. The majority of studies support the beneficial effects of pulsed current over conservative management of lower extremity cutaneous wounds. Although it appears to have no benefit over causal surgical intervention, it is a treatment option which could be utilised in those patients unsuitable for surgery. Other waveforms and modalities appear promising; however, they still lack large trial data to recommend a firm conclusion with regards to their use. Current studies also vary in quantity, quality and protocol across the different modalities. The ideal electrical stimulation device needs to be noninvasive, portable and cost-effective and provides minimal interference with patients' daily life. Further studies are necessary to establish the ideal electrical stimulation modality, parameters, method of delivery and duration of treatment. The development and implementation of newer devices in the management of acute and chronic wounds provides an exciting direction in the field of electrotherapy. K E Y W O R D Selectrotherapy, humans, skin wounds

Electrical stimulation disrupts biofilms in a human wound model and reveals the potential for monitoring treatment response with volatile biomarkers

“…We identified that ES reduced biomass; this corroborates previous findings which found ES reduced biofilm attachment and adherence, key factors in biofilm formation and development . While the use of ES in wound care management is well established, we did not identify any previous studies assessing the impact of ES on wound biofilms in a human ex vivo model. Investigations of ES against biofilms in vivo are also sparse, with only six studies to date having assessed the effect of ES on biofilms, with the majority showing positive outcomes; however, none of these studies investigated the direct effect of ES on cutaneous wound bacterial biofilms.…”

“…The identification of the compounds using the mass spectral library must be interpreted with caution as they have not been confirmed using analytical standards. And finally, only DC ES was used; several different waveforms and delivery methods of ES are available in wound management …”

Hierarchical evaluation of electrical stimulation protocols for chronic wound healing: An effect size meta‐analysis

“…Electrical stimulation has been tested for decades to improve chronic wound healing and available evidence now suggests possible efficacy. Recently, there has been renewed interest to determine the amplitude of the effect and the best modality and several systematic reviews and meta‐analyses were published . However, while all of them concluded that this method improved chronic wound healing, results were conflicting and uncertainty remains regarding the best electrical stimulation protocol, and whether efficacy was similar across wound characteristics (underlying clinical condition, size, and age of the chronic wound).…”

New insights into the roles of myofibroblasts and innervation during skin healing and innovative therapies to improve scar innervation

“…It has also been shown to stimulate dermal angiogenesis and keratinocyte proliferation . The principle of ES is to mimic the endogenous electric current that occurs during wound healing and for that purpose, it is essential to establish ideal and standardized protocol parameters such as: modality, method of delivery and duration of treatment . ES has also been used to manage chronic neuropathic pain and improve nerve function in diabetic patients …”