Electrical Stimulation in Wound Healing

If wound healing is not successfully achieved using a conservative approach, through sterile dressings or topical antibiotics, for example, a surgical strategy is often the next course of action. However, a less invasive approach to wound healing, and one which is gathering support from both clinicians and researchers, is electrical stimulation.^1–3 In this technique, one electrode is typically applied to the skin near the wound while another is applied to saline-moistened gauze placed over the wound, allowing an electric current to pass directly through the wound.¹ In most cases, a pulsed current is delivered at a low voltage in a technique known as low-voltage biphasic-pulsed current (LVBPC). LVBPC is used in transcutaneous electrical nerve stimulation (TENS) devices, and is also the form of electrical stimulation with the best supporting evidence in terms of a benefit in wound healing. ²

Electrical stimulation when used in wound healing may involve electrical potentials of up to 200 volts. However, the pulse length and frequency of the current are adjusted such that muscular contractions are not induced, since such muscular contractions could result in pain or an impairment of the healing process.¹

Benefits of Electrical Stimulation

Research has shown that a great many types of wound benefit from electrical stimulation, making this a modality with a wide therapeutic potential. In particular, electrical stimulation has been shown to have a potential benefit in:²

• Pressure ulcers
• Venous insufficiency leg ulcers
• Arterial insufficiency ulcers
• Diabetic neuropathic foot ulcers
• Dehisced surgical wounds
• Failing flaps and grafts

Contradictions for electrical stimulation include malignancy or osteomyelitis. Furthermore, electrical stimulation should not be applied to the pericardial area, carotid sinus, phrenic nerve, parasympathetic nerves, or ganglia. ²

Despite the growing body of evidence to support a benefit of electrical stimulation in wound healing, a comprehensive understanding of the underlying mechanisms is still some way off.  It is known that electric fields activate multiple signaling pathways that are critical for wound healing. Importantly, the electric field provides a powerful directional signal for cell migration in wound healing. The resulting cell migration appears to result from polarized signaling of epidermal growth factor receptors, integrins, and phosphoinositide 3 kinase/Pten, and may be mediated by protein kinase C, intracellular Ca²⁺, and cyclic adenosine monophosphate (cAMP). Because directional cell migration is a key component in wound healing, galvanotaxis is thought to be essential in this process.³

Although the mechanism of action of electrical stimulation in wound healing remains inadequately understood, this modality appears to represent a promising and unique strategy to induce cell and tissue growth in a directional manner, thus enhancing wound healing.³

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References

1. WellCare. Electrical stimulation and electromagnetic therapy for wound healing. Policy number HS-125. 8 February 2012.
2. Scarborough P and Kloth LC. E-Stimulation: an effective modality to facilitate wound healing. Today’s Wound Clinic. May 2012. 28–32
3. Zhao M, Penninger J, Isseroff RR. Electrical activation of wound-healing pathways. Adv Skin Wound Care 2010; 1: 567–573.