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Electrical Stimulation in Wound Treatment

Polak A, Franek A, Taradaj J. High-Voltage Pulsed Current Electrical Stimulation in Wound Treatment. Adv Wonud Care. Feb 1, 2014; 3(2): 104-117. Level of Evidence: Ib This article critically examined the results of clinical trials published by researchers using high-voltage pulsed current (HVPC) to treat chronic wounds. Target population: This article involved studies that looked at the effect of HVPC treatment for Stage II, II, and IV pressure ulcers, as well as chronic leg ulcers. Type of electrotherapy: All of the reviewed studies used HVPC with monophasic double-peaked pulses. Specific electrotherapy parameters used: The pulse duration was set at 100 μs, voltage ranged from 50 to 200 V, with intensity at the sensory level to prevent motor reactions. In most of the studies, HVPC frequency was between 100 and 105 pps. Protocol used in the article: One study found significant results with HVPC applied for only 45 min/day, 3 days/week (2.25 hours/week), but most studies had treatment times of 45-60 min/day, 5-7 days/week (total of 3.75-7 hours of treatment/week). In all of the studies the treatment electrode was placed on the wound with a return electrode on healthy skin at least 15-20 cm from the treatment electrode, with most researchers first using the negative electrode to stimulate the wound surface. Outcome found with the protocol mentioned: In all studies except one, wound healing progress was observed for at least 4 weeks, with 3 studies up to 10 weeks with HVPC treatment. However, only one study had wounds that were treated until complete closure. In all of the other studies that did not have full wound closure, the author’s provided percentage of healed wound area rates that correlated to fully healed wounds. Opinion: I would use the information provided in this critical review and apply it conservatively to certain patients with specific wounds (i.e. diabetic foot, venous leg, and pressure ulcers as were observed in this study). HVPC has been shown to improve blood flow and capillary density, promoting wound closure in a reasonably minimal daily/weekly duration, as was observed in all of the studies, which indicates that HVPC is an effective and minimal time consuming treatment to promote wound healing. The only reserve that I have regarding this study is that only one of the studies observed went until full wound closure, however the rest of the studies and wound percentage closure rates that were indicative of rapid progression to full wound closure within minimal duration of treatment.