Electrical Stimulation

The concept of “Current of Injury”

The human body has its own bioelectrical system controlling virtually all bodily functions.

Already in 1843 was a German physiologist, named Emil du Bois-Reymond, able to measure the presence of electrical current in wounded tissue. This discovery led several medical scientists to unravel the mystery behind the natural wound healing process in the human body, which became known as the Current of Injury . [1]

 

 

This Current of Injury promotes wound healing by attracting the cells of repair, changing cell membrane permeability, enhancing cellular secretion through cell membranes and orienting cell structures. Studies have shown the presence of electrical potential in all these cells, which provoke them to migrate towards the wounded areas. This interaction is referred to as the concept of galvanotaxis. [2]

Acute wounds in otherwise healthy patients have normal bioelectrical activity. Thus, healthy tissue is formed in a relatively short period of time.  If the Current of Injury is not optimal, or has ceased completely, a delayed wound healing will occur.  This situation is referred to as a Chronic Wound (typically a wound that has not healed with normal care for 3 months).

1. Kloth LC. Electrical Stimulation for Wound Healing: A Review of Evidence from In Vitro Studies, Animal Experiments and Clinical Trials.  International Journal of Lower Extremity Wounds 2005; 4:23-44

2. Zhao M, Song B, Pu J, et al. Electrical Signals Controls Wound Healing through phosspatidylinositol-3 OH kinase-gamma and PTEN. Nature, 2006; 42:457-460.

Electrical Stimulation – “Old School”

The discovery of the Current of Injury eventually led to the development of new wound treatment techniques, by which Electrical Stimulation (“ES”) was artificially applied to the wound in order to mimic the body’s natural healing process. The purpose being to accelerate the healing process, or in the case of Chronic Wounds, to “kick-start” the healing of an otherwise “hard-to-heal” wound.

Common for all these have until now been that the electrical stimulation is applied by the use of a pair of electrodes, one of which is applied in (or sometimes in close proximity to) the wound bed while the other is placed on intact healthy skin nearby.

The clinical results have been outstanding. ES is recognized as an efficient method for wound care in more than 500 published articles describing in vitro studies, animal experiments and clinical trials. The efficiency of ES for wound healing has achieved “Oxford  CEBM Class 1A evidence”, the highest possible. As a result, the American College of Physicians, in their latest Clinical Guidelines recommends ES as the only efficient form of adjunctive therapy for the treatment of pressure ulcers.

In spite of the indisputable scientific results, ES is not commonly used. The reason for this is that the traditional modalities have a number of practical problems . [3] The use of electrodes in, or in close proximity to, the wound bed is very painful for the patient and leads to high risk of infections. Skin irritation and allergies are also common side effects and due to the limited size of the treatment area for each session, treatment of a complete wound bed is often very time consuming.

3.Guangping Tai, Michael Taiand Min Zhao. Electrically stimulated cell migration and its contribution to wound healing. Burns & Trauma, 2018; 6:20.

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