Abstract
Electrical stimulation (ES) has been shown to have beneficial effects in wound healing. It is important to assess the effects of ES on cutaneous wound healing in order to ensure optimization for clinical practice. Several different applications as well as modalities of ES have been described, including direct current (DC), alternating current (AC), high-voltage pulsed current (HVPC), low-intensity direct current (LIDC) and electrobiofeedback ES. However, no one method has been advocated as the most optimal for the treatment of cutaneous wound healing. Therefore, this review aims to examine the level of evidence (LOE) for the application of different types of ES to enhance cutaneous wound healing in the skin. An extensive search was conducted to identify relevant clinical studies utilising ES for cutaneous wound healing since 1980 using PubMed, Medline and EMBASE. A total of 48 studies were evaluated and assigned LOE. All types of ES demonstrated positive effects on cutaneous wound healing in the majority of studies. However, the reported studies demonstrate contrasting differences in the parameters and types of ES application, leading to an inability to generate sufficient evidence to support any one standard therapeutic approach. Despite variations in the type of current, duration, and dosing of ES, the majority of studies showed a significant improvement in wound area reduction or accelerated wound healing compared to the standard of care or sham therapy as well as improved local perfusion. The limited number of LOE-1 trials for investigating the effects of ES in wound healing make critical evaluation and assessment somewhat difficult. Further, better-designed clinical trials are needed to improve our understanding of the optimal dosing, timing and type of ES to be used.
Highlights
Acute wounds normally undergo a complex healing process, which leads to a completely healed wound [1]
The results will be presented under the following headings: pulsed current, direct current, transcutaneous electrical nerve stimulation, frequency rhythmic electrical modulation system, biofeedback electrical stimulation and bioelectric dressings (Table 1)
The majority of level of evidence (LOE)-1 were for high-voltage pulsed current (HVPC), transcutaneous electrical nerve stimulation (TENS), frequency rhythmic electrical modulation systems (FREMS) and direct current (DC)
Summary
Acute wounds normally undergo a complex healing process, which leads to a completely healed wound [1]. There are a number of responses which can occur following a cutaneous injury; normal repair in the adult human skin should typically produce a fine line permanent scar, abnormal healing can result in excessive healing where there is an increased deposition of connective tissue leading to the formation of hypertrophic and keloid scars or either can deficient healing where there is insufficient deposition of connective tissue and new tissue formation is incomplete and can result in the formation of chronic wounds [2]. The actual number of patients suffering from these wounds, are on the increase, as the ageing population and the increasing incidence of risk factors such as diabetes mellitus and smoking, result in the rising incidence of chronic wound formation
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