Efficacy of Biophysical Energies on Healing of Diabetic Skin Wounds in Cell Studies and Animal Experimental Models: A Systematic Review.

Rachel Kwan,Harry Choi,Song Lu,Luther Kloth,Gladys Cheing

doi:10.3390/ijms20020368

Abstract

We have systematically assessed published cell studies and animal experimental reports on the efficacy of selected biophysical energies (BPEs) in the treatment of diabetic foot ulcers. These BPEs include electrical stimulation (ES), pulsed electromagnetic field (PEMF), extracorporeal shockwave (ECSW), photo energies and ultrasound (US). Databases searched included CINAHL, MEDLINE and PubMed from 1966 to 2018. Studies reviewed include animal and cell studies on treatment with BPEs compared with sham, control or other BPEs. Information regarding the objective measures of tissue healing and data was extracted. Eighty-two studies were eventually selected for the critical appraisal: five on PEMF, four each on ES and ECSW, sixty-six for photo energies, and three about US. Based on the percentage of original wound size affected by the BPEs, both PEMF and low-level laser therapy (LLL) demonstrated a significant clinical benefit compared to the control or sham treatment, whereas the effect of US did not reveal a significance. Our results indicate potential benefits of selected BPEs in diabetic wound management. However, due to the heterogeneity of the current clinical trials, comprehensive studies using well-designed trials are warranted to confirm the results.

Highlights

Thirty million children and adults in the United States have diabetes [1]
Using the pre-defined keywords and Medical Subject Headings (MeSH), we identified 1731 publications pertaining to the use of Biophysical energies (BPEs) for diabetic wound treatment in animal and cellular models
Laser significantly increased the numbers of macrophages, fibroblasts, and blood vessel sections. 2. bFGF expression at 48 h revealed a significant increase in gene expression

Summary

Introduction

Thirty million children and adults in the United States have diabetes [1]. The incidence rate of diabetic foot ulcer is 6% [2], and 45% of diabetic patients die during the first year after the initial amputation [3]. Neuropathy, peripheral vascular disease and infection are the major risk factors for non-healing foot ulceration in patients with diabetes [4]. Treatments that manage neuropathy, ameliorate microcirculation and promote growth factor release may be helpful in treating chronic wounds or reducing their recurrence. BPE options for treating diabetic foot ulcers have included electrical stimulation (ES), MHz or kHz ultrasound (US), extracorporeal shockwave (ECSW), photo energies and pulsed electromagnetic field (PEMF). A systematic review reports positive findings on the use of the BPEs (ES, photo energies, and US) in managing foot ulcers [7] and peripheral neuropathy [8] in patients with diabetes. BPEs may restore diabetes-associated microvascular [9] and neurological changes [11] that are important risk factors for delayed wound healing in patients with diabetes

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