September 2, 2008

WOUND HEALING WITH ELECTRICAL STIMULATION^©

Lyn Paul Taylor, A.A., B.A., M.A., R.P.T.

(Editing Assistant and Computer Consultant: Joanna Soon, B.S.)

Clinical research and experience have confirmed that low intensity, low frequency electrical stimulation may facilitate the healing processes of damaged soft tissues, increasing the quality and rate of repair.  Electrical stimulation has been shown to be remarkably effective for precipitating the closure of healing-resistant incisions and pressure sores (decubiti).

Many types of electrical instrumentation provide current forms with the requisite amplitudes (0 to 100 milliamperes or up to 90 volts), frequencies (1 to 10 hertz), and pulse width duration (100 to 200 milliseconds) necessary to facilitate soft tissue healing.  Of all the current forms, the pulsed square wave has been shown to be the most effective and safest.

To promote wound healing (without the presence of infection) with electrical stimulation, go through the following steps:

• Surface electrodes should be placed in opposition on either side of the open wound.  If four electrodes are available, the electrodes should be arranged in a crisscross pattern (negative-positive, positive-negative) to allow the current flow to intersect over the surface of the wound.

• The electrical stimulation unit should be preset at zero amplitude, at a minimum frequency of 28 hertz, and at the longest possible pulse width (from 100 to 200 milliseconds).

• The electrical stimulation unit should be turned on and the intensity slowly increased until the patient reports “feeling” the stimulation, usually at 20 milliamperes or slightly less. Higher currents are not thought to be advisable, and no involuntary muscle contraction or increased muscle tonus should be allowed to occur.

• Stimulation should last for 30 to 60 minutes.

• Ideally, this treatment should be applied three or four times a day, at equally spaced intervals.  Successful treatment has been noted to occur if stimulation is provided once a day, or as little as three times a week.  However, the speed of healing seems directly related to the number and frequency of treatment sessions.

• Following treatment, the surface electrodes should be removed and the skin under the electrodes thoroughly cleansed.

References:

G. Alon, "High Voltage Stimulation," Physical Therapy, 65:6, June 1985. Pp. 890-895

M. Brown, M.K. McDonnell, D.N. Menton, "Electrical Stimulation Effects on Cutaneous Wound Healing in Rabbits," Physical Therapy, 68:6, June 1988. Pp. 955-960

J.A. Feeder, L.C. Kloth, G.D. Gentzkow, "Chronic Dermal Ulcer Healing Enhanced with Monophasic Pulsed Electrical Stimulation," Physical Therapy, 71:9, September 1991. Pp. 639-649

J.W. Griffin, R.E. Tooms, R.A. Mendius, J.K. Clifft, R.V. Zwaag, F. El-Zeky, "Efficacy of High Voltage Pulsed Current for Healing of Pressure Ulcers in Patients with Spinal Cord Injury," Physical Therapy, 71:6, June 1991. Pp. 433-444

D.B. Harrington and R. Meyer, "Effects of Small Amounts of Electric Current at the Cellular Level," Annals of the N.Y. Academy of Science, vol. 238, October 11, 1974. Pp. 300-305

M.J. Im, W.P.A. Lee, J.E. Hoopes, "Effect of Electrical Stimulation on Survival of Skin Flaps in Pigs," Physical Therapy, 70:1, January 1990. Pp. 37-40

L.C. Kloth, J.A. Feedar, "Acceleration of Wound Healing with High Voltage, Monophasic, Pulsed Current," Physical Therapy, 68:4, April 1988. Pp. 503-508

B.A. Rowley, J.M. McKenna and G.R. Chase, "The Influence of Electrical Current on an Infecting Microorganism in Wounds," Annals of the N.Y. Academy of Sciences, vol. 238, October 11, 1974. Pp. 543-551

L.P. Taylor, T. Hui, The Taylor Technique of Soft Tissue Management, Inflammation: Evaluation & Treatment, 2002.  Pp. 76-77

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