Electrotherapy promotes healing and microcirculation of infrapopliteal ischemic wounds: a prospective pilot study.

OBJECTIVE: To determine if high-voltage pulsed current (HVPC) electrotherapy augments ischemic wound healing and increases periwound microcirculation. DESIGN: A prospective, randomized, single-blinded, sham-controlled clinical trial was conducted on a homogenous subset of quasi-stable ischemic wounds. INTERVENTION: Active HVPC or sham HVPC was applied to wounds for a 14-week period. MAIN OUTCOME MEASURE: Wounds were monitored every 4 weeks, except 2 weeks between weeks 12 and 14, for wound area, wound appearance, and microcirculation, which was measured by transcutaneous oxygen (TcPO2) levels and laser Doppler flow. RESULTS: Ischemic wounds treated with active HVPC decreased in size, contrary to the expected increase in ischemic wound size that was observed in wounds in the control group (P <.05, Student t test; week 4). A trend toward smaller wound area occurred in wounds in the HVPC group compared with wounds in the control group (week 14). Among the HVPC group, an improvement in periwound microcirculation occurred at weeks 8 (P <.05, TcPO2; P <.01, laser Doppler) and 12 (P <.05, laser Doppler). These increases suggest that HVPC promotes arteriolar vasodilation and dermal capillary formation. HVPC was well tolerated. CONCLUSION: The results of this study demonstrate that HVPC decreased the area of ischemic wounds, reversing the expected increase in wound size, and improved microcirculation. The promising results of this pilot study require a larger Phase II study to confirm and generalize these findings. CLINICAL RELEVANCE: Electrotherapy may prove to be a relatively safe and effective complement to surgical revascularization to improve the odds of healing ischemic wounds and promoting limb salvage.

Electrotherapy reverses inframalleolar ischemia: a retrospective, observational study.

OBJECTIVE: To determine if high-voltage pulsed current (HVPC) augments ischemic wound healing and increases periwound perfusion. DESIGN: A 5-year, retrospective, observational study was conducted on successive patients with ischemic wounds who were poor candidates for revascularization. INTERVENTION: HVPC was applied directly to wounds at greater than 100 volts, 100 pulses per second, 1 hour per day. In addition to HVPC, patients received standard care for ischemic wounds at the study facility. Ischemic wounds for which HVPC was not clinically indicated or not available received standard care alone. MAIN OUTCOME MEASURES: Wound area measured by planimetry, wound appearance observed by digital imaging techniques, and microcirculation monitored by transcutaneous oxygen (TcPo(2)) levels. RESULTS: The group that received HVPC plus standard care showed smaller wound areas from weeks 20 though 52 after the start of treatment compared with the group that received standard care alone (P <.05; Mann-Whitney test). One year after the start of treatment, 90% of HVPC-treated wounds were healed, compared with 29% of the wounds that received only standard care (P <.05; Fisher exact test). For the HVPC group, maximum periwound TcPo(2) improved during electrotherapy (6 +/- 8 mm Hg [standard deviation; SD] at baseline improved to 26 +/- 20 SD, during HVPC, P <.05; Wilcoxon signed rank test). CONCLUSION: The results of this retrospective trial demonstrate that HVPC plus standard care improved the healing rate of high-risk ischemic wounds. A direct relationship was shown between improved healing rates and increased periwound perfusion. A prospective randomized controlled trial is needed to further support these observational, preliminary findings.

Measured improvement in rate of healing of venous ulceration.

This case study describes a pivotal intervention associated with improved wound appearance and healing rate in a young, active woman with extensive venous stasis ulcers. These extensive ulcerations were heavily exudative and covered by a layer of yellow eschar. Yellow eschar and drainage were successfully managed with a capillary dressing (Vacutex), which promoted therapeutic compression as applied by standard dressings. This case provides data in favour of wound care protocols featuring Vacutex, specifically designed to address the consequences that wound drainage and eschar have in dramatically large venous stasis ulcers.

Electrotherapy reoxygenates inframalleolar ischemic wounds on diabetic patients: a case series.

OBJECTIVE: To retrospectively evaluate the ability of high voltage pulsed current (HVPC) to increase microcirculation in critically ischemic wounds (transcutaneous oxygen [TcPO(2)] less than 10 mm Hg) and, as a result, to improve wound healing. DESIGN AND METHODS: Clinical case series with successive adult diabetic subjects (3 men and 3 women) with nonsurgical ischemic malleolar or inframalleolar skin lesions, each subject serving as his or her own control. Wound area and TcPO(2) were measured periodically. Presence of distal arteriosclerosis was assessed on 5 patients by 2-dimensional, time-of-flight magnetic resonance angiography. End point was either complete wound closure or leg amputation. RESULTS: Maximum mean TcPO(2) was 2 +/- 2 mm Hg at the wound edge before the start of electrotherapy. After electrotherapy began, maximum TcPO(2) was 33 +/- 18 mm Hg (N=6; P<.05, Wilcoxon signed rank test). After treatment with HVPC, 4 patients' wounds healed and 2 patients underwent amputation. As expected, healed patients initially deteriorated after the start of treatment, but their wounds began healing when the perilesion TcPO(2) measurement exceeded 20 mm Hg. Thereafter, the wounds closed at a predictable rate. Complete closure occurred for patients who had a relatively low atherosclerotic burden. CONCLUSION: The results of this clinical case series suggest that electrotherapy can improve periwound microcirculation of ischemic inframalleolar skin lesions.