Discussion: Advanced Technologies to Improve Wound Healing: Electrical Stimulation, Vibration Therapy, and Ultrasound—What Is the Evidence?

Author:
Publisher website
Google Scholar
Abstract
This article is a must read literature review of 3 forms of physical energy; electrical stimulation energy (ESE), vibration energy (VE), and ultrasound energy (USE) that when delivered therapeutically into wound tissues elicit biophysical responses that enhance wound healing. The authors acknowledge that enhanced chronic wound healing with ESE is supported with more research evidence from in vitro, animal, and clinical trials. ESE as stated includes the biological skin battery voltage signals that exist in healthy and wound tissues and that exogenous ESE signals delivered into chronic wounds may amplify the biological signals, leading to enhanced cellular responses and healing. However, as indicated, the evidence supporting the alluded to phenomenon of galvanotaxis or electrotaxis comes primarily from in vitro research.1–3 In addition, numerous in vitro research publications are cited that have reported enhanced angiogenesis,4 protein and DNA synthesis,5,6 and augmented migration of fibroblasts7 and endothelial cells3 all of which the authors indicate a need of further verification of mechanisms involved from in vivo animal and human studies. On the use of ESE for additional clinical uses related to wound healing, the authors alert readers to several possible future applications that are presently supported by in vitro and human research. Included are wound bioburden studies showing that positively charged silver ions embedded in dressing materials have enhanced antimicrobial effects when anodal current is applied to the dressings.8 This has obvious implications for the treatment of infected wounds. The recent findings of ESE stimulated angiogenesis in ischemic patients and acute human skin wounds is very exciting and is supported by increased skin flap viability in animals, but more research is needed. The use of ESE to determine its effects on chronic wound healing in humans has resulted in publications that report wounds treated with ESE plus standard wound care heal more than wounds treated with standard wound care alone.9–12 Also, readers of ESE wound healing research may not understand that clinical trials that have used different pulse frequencies, durations, and amplitudes produce an electrical current charge delivered to the wound that falls within the range of 250 to 500 μC/s as mentioned by the authors. This range of charge is the dosage of the reproducible electrical energy delivered to the wound tissues that have resulted in positive wound healing outcomes.11,12 VE is relatively new as far as wound treatment is concerned. VE is a form of mechanical energy that is generated by a number of sources, including megahertz and kilohertz ultrasound. However, the vibrations described in the studies cited were low intensity and low frequency with 2 animal studies13,14 and 2 human subject studies.15,16 The interesting effects elicited by VE in the animal studies included angiogenesis and granulation tissue formation, as well as increases in wound levels of monocyte chemoattractant protein-1, vascular endothelial growth factor, and insulin-like growth factor-1. The VE treatment of pressure ulcers in humans also produced rather surprising results with 8 of 16 wounds closed with 15-minute treatments 3 times daily. Other studies cited enhanced blood flow in different tissue types. The future of VE for wound healing likely will depend on the outcomes of future human subject research and the instrumentation that becomes available for administering this form of physical energy to intractable wounds. USE can be high-frequency (MHz) mechanical energy that when produced at 1 and 3 MHz is used to introduce thermal energy into musculoskeletal tissues to enhance blood flow or to phonophoretically deliver analgesic and anti-inflammatory medications to tissues.

This publication has 12 references indexed in Scilit: