Morphological aspects of bedsore healing against high-frequency electrical stimulation in patients with severe brain damage

Abstract

BACKGROUND: Bedsores or decubital ulcers are significant medical and social problems in patients with serious brain damage. The majority of local treatments are ineffective and do not ensure their healing. Therefore, the search for nondrug methods as part of the complex treatment of decubital ulcers is extremely relevant.
 AIM: To assess the morphological picture of bedsores against the background of an improved method of treatment using high-frequency electrical stimulation with pulsed currents in chronically immobilised patients who survived a cerebral catastrophe.
 MATERIALS AND METHODS: Biopsies of bedsores were examined in 12 patients with severe neurological disorders that developed after a cerebral catastrophe. The initial status of all patients was a ‘chronic critical condition’ (CCS). In all patients, the bedsore defect was located in the sacral region, with a length of 7–25 cm2. The depth of the bedsore corresponded to grade III according to the classification of the Agency for Health Care Policy and Research. Two groups of patients were formed: the main group of five patients (three men + two women), with an average age of 49.0 years, who were subjected to electrical stimulation with pulsed currents of the radiofrequency range. A control group of seven patients (three men + four women), with an average age of 60.1 years, who underwent traditional treatment. The duration of the chronic wound process ranged from 2 months to 1.5 years. The immediate cause of CCS was more often a massive ischaemic stroke (8), less often a severe traumatic brain injury (3) and radical operations to remove brain tumours (1) of various prescriptions from 3 months to 1.5 years. Morphological studies were conducted in both groups to assess the complicated wound process.
 RESULTS: The complex morphological study revealed that in the presence of high-frequency electrical stimulation, an earlier appearance of foci of fibroblastic proliferation, an increase in the regenerative potential of tissues due to increased production of type I and III collagens, and myofibroblastic and endothelial growth factors were noted.
 CONCLUSION: In the case of CCS of cerebral genesis, the wound process in bedsores inevitably becomes complicated and, according to morphological research, is characterised by severe endothelial dysfunction, deep microcirculation disorders, depletion of the potential of myofibroblastic cells and deficiency of their growth factors. Local high-frequency electrical stimulation in patients with severe brain damage and decubital ulcers as a component of complex ulcer therapy significantly optimises cellular and tissue reactions in the area of bedsores.