FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
Pressure Ulcer Healing with Electrical Stimulation: Achievements Translated to Clinical
Guidelines
Luther C. Kloth
Department of Physical Therapy, Marquette University, United States, (luther.kloth@marquette.edu)
Introduction
Humans and other mammals have natural
endogenous electric field signals that guide cells to
migrate directionally to heal epithelial wounds.
Physiological electric fields have been shown to
override other guideance cues that direct epithelial cell
migration at the wound edge [1, 2]. Pharmacologic in
vivo manipulation of ion transport has been shown to
regulate the endogenous wound electric fields and
effects wound healing [3]. During the past 30 years 20
RCTs (9 on pressure ulcers) have provided strong
evidence that supports exogenous electric field
stimulation (EEFS) as a wound healing intervention. A
meta-analysis has validated the research findings of
the 9 RCTs with the strongest evidence [4,5,6]
supporting pressure ulcer (PU) healing [Table 1]. Best
practice clinical guidelines including that of EPUAP /
NPUAP have strongly recommended EEFS as a PU
treatment. Using EEFS to enhance healing of PUs and
other chronic wounds requires that one understand the
types of electrical currents, waveforms and devices
that have been reported to enhance wound healing.
Methods
Proof of the existence of endogenous electric fields
and their influence on wound healing based on
evidence will be presented. In addition, evidence from
clinical trials and best practice guidelines showing that
EEFS enhances PU healing will be presented (Fig. 1).
Identification and description of appropriate electrical
currents, waveforms, devices and treatment protocol
will also be explained [7].
Fig. 1: Exogenous electric field stimulation setup.
90
Results
Table 1
Discussion
Human skin has an inherent bioelectrical system that
significantly contributes to wound healing. Augmenting
this system with exogenous electric field stimulation
may explain why several RCTs have confirmed that
this intervention plus standard wound care (SWC)
hastens the rate of healing faster than SWC alone.
Although different combinations of electric field
parameters (pulse frequency, duration and amplitude)
have been used nevertheless, since the electrical
charge quantity in these studies fell between 250 and
500 µC, this dosage delivered to the wound tissues
produced positive wound healing outcomes.
Clinical relevance
EEFS for healing pressure ulcers is supported by
strong evidence from RCTs
Acknowledgements
Thank you to Dr. Min Zhao for permission to use
several of his illustrations in my presentation.
Conflict of Interest - None
References
[1] McCaig CD, et al. Physiol Rev. 85, 943-78, 2005.
[2] Zhao M, et al. Nature. 442, 457-60, 2006.
[3] Song B, et al. Proc Natl Acad Sci USA 99:13577-
582, 2002.
[4] Feedar J, et al. Phys Ther 7: 639-49, 1991.
[5] Gentzkow G, et al. WOUNDS 3: 158-70, 1991.
[6] Wood J, et al. Arch Dermatol 129: 999-09, 1993.
[7] Kloth LC, Zhao M. Endogenous and exogenous
electric fields for wound healing. In: McCulloch JM,
Kloth LC Wound Healing: Evidence Based
Management , 4 th ed. F.A. Davis Co., Philadelphia,
2010.
Copyright © 2011 by EPUAP