Effectiveness, Tolerability and Safety of Electrical Stimulation in Wound Care

Nous Sarom MD

Department of Plastic Reconstructive Surgery

Preah Ketmealea Hospital, Phnom Penh

Background

• The.purpose.of.this.study.was.to.determine.

effectiveness,.tolerability,.and.safety.of.electrical.

stimulation.therapy.(EST).using.Wireless.Micro.

Current.Stimulation.(WMCS)..device.to.treat.

wounds.under.hospitalized.at.wound.care.unit.in.

our.plastic.surgery.department..Preah Ketmealea

Hospital,.Phnom.Penh.

• Most.of.the.cases.are.acute.wound.from.burn,.

traumatic,..and.surgical.condition..

Introduction

Electrical.Stimulation.Therapy.(EST).of.refractory.

wounds.has.become.an.important.treatment.option.in.

recent.years..Several.national.and.international.

guidelines.recommend.the.use.of.EST.for.hard.to.heal.

wound.such.as.:..acute.and.chronic.wounds,.including.

burn,.lower.leg.ulcers.and.pressure.ulcers...Intact.skin.

forms.a.barrier.between.the.negative.charges.on.the.

surface.and.the.positive.charges.in.the.dermis..This.

barrier.is.lost.when.skin.continuity.is.disrupted,.resulting.

in.a.“shortJcircuit.current”..

This.“wound.current”.is.accompanied.by.an.

electrical.field.(EF),.which..has.been.shown.to.be.

essential.for.wound.healing..Furthermore,.there.is.

evidence.that.electrical.fields.promote.the.

migration.of.neutrophils.and.macrophages,.

stimulate.fibroblasts,.and.improve.blood.flow.

Modern.medicine.used.to.focus.for.intervention.on.

three.main.(although.not.exclusive).approaches:.

•A..Biochemistry,.

•B..Irradiation.and,.

•C..Surgery.

This.trinity.does.not.capitalize on.one.modality.long.

known.for.its.key.role.in.many.functions.in.cell.and,.

most.important,.in.whole.organism.level: electric.

currents

It.is.well.known.that.the.current:

•Can.influence.cell.functions.

•Can.influence.structure.and.function.of.molecules.

•Can.influence..signal.transmission.and.information.carriage.

Electricity.=.Drug?

Electrical.Stimulation.(ES).and..

Wound.Healing.Management

Chronology Accomplishments1events

1st millennium5BC Amber.and.magnetite.(static.electrism).used.by.Egyptians.for.headache.and.arthritis.

4205BC Hippocrates.prescribes.shocks.from.torpedo.fish

5th c5BC Asklepeia.near.ionized.water.environment.(falls).

17th c5AD Golden.artifacts,.charged,.to.treat.smallpox.lesions.

1752 Franklinism by.Ben.Franklin;.static.electricity.to.relieve.pain.

1800s Galvanism;.DC.to.relieve.pain.

1825 Sarlandiere and.Berlioz.combine.Galvanism.ES.and.acupuncture.

1832 Faradism;.use.of.AC.for.ES;.Duchenne employs.it.for.muscle.stimulation.

1850 Publication.of.the.use.of.ES.for.bone.fractures.in.US.

1888 D’Arsonvalisation:.use.of.high.frequency.currents..

1900 Carnage.foundation.establishes.Fleiner committee..

19105 Fleiner results.discontinue.ES.in.the.US.

1930s ES.modalities.actively.marketed.in.Europe..

1944 Galvanic.Exercise.for.wounded.personnel.of.US.Armed.Forces.

1957 Electric.properties.of.the.bone.first.published.by.Fukada &.Yasuda.

1960s ES.effect.on.cell.wallJprinciple.of.electroporation.

1967 Wall.&Sweat:.100Hz.ES.in.skin.proved.analgesic.

1970s5 Bruce.Lee.perfects.galvanic.exercise.for.accelerated.training.

1980s Regular.ES.use.in.sports.injuries.and.muscle.atrophy;.discovery.of.skin.battery.potentials;.antimicrobial.effect.of.ES.in.vivo,.usual.

treatment.of.bone.fractures.

1982 Cheng.et.al.publish.the.impact.of.ES.to.ATP.generation.

1990s Wound.healing.by.ES.becomes.prominent..

2000s Development.of.NCCT.combining.different.ES.schemes’.advantages..

2010s Massive.development.of.different.ES.schemes.and.approaches.

2013 Concept.of.electroceuticals.

The.current.of.injury.is.thought.to.be.significant.in.initiating.repair..Undamaged

human.skin.has.an.endogenous.electrical.potential.and.a.transcutaneous.current.potential

of.20–50.mV..This.is.generated.by.the.movement.of.sodium.ions.through.Na+/K+.ATPase

pumps.in.the.epidermis..The.current.of.injury.is.generated.through.epithelial.disruption.

Following.an.injury.to.the.skin,.a.flow.of.current.through.the.wound.pathway.generates.a

lateral.electrical.field.and.this.is.termed.the.“current.of.injury”.or.“skin.battery”.effect.

“Current of Injury”

Potential5difference

Cells.of.repair

Electric.fields.in.the.

edge.of.the.wound

Healing of wounds by the use of Electrical Stimulation

(a).Application.of.ES.by.electrodes.placed.near.or.on.the.wound.site.and.connected.to.a.device

(b).Application.of.a.bioelectric.dressing.to.the.wound.site(c).Wireless.application.of.ES.to.a.

wound...(d).Application.of.ES.in.the.form.electro.biofeedback.by.the.use.of.a.device.with.an.

electrode.placed.in.different.areas.around.the.wound.site

O2 O2J

e J

Return.connection

Current.of.injury

(c).Electrical.Stimulation.WMCS.device.for.wound.healing.

Clinical.Case.Studies

Results.of.2.months’.“trials”...10.clinical.cases,.using.WMCS.are.

presented.(November.J December.2013)

DiagnosisBurns.

Traumatic.wounds,

Skin.graft.patients

Complications.after.surgical.procedures

Pressure.ulcers.

Wound Assessment & Follow-upi) Inflammatory and infection wound Wound Cleansing, Irrigation, use hydroactive / moist wound dressing. Wound culture, antibiotic and pain control, compression therapy in case of venous leg ulcer.

ii) Proliferative ES (WMCS), Examine and treat the cause of wound.

iii) Examine the peri-wound skin. Take a swab (for obtaining a wound culture).

iv) Examine wound exudative. Culture.

CLINICALCASE 1: FULLTHICKNESS SKIN NECROSIS JTRAUMATICWOUND

A 40JyearJold female, severe facial trauma 2 weeks ago.

Full thickness skin necrosis at forehead, ~ 3x3cm (A).

Treatment (according to protocol):

✦No antibiotics, no pain killers

✦Wound debridement

✦WMCS treatment applied: 1.5uA 1h daily for 1 week.

Result:

(B) dayJ7 afterWMCS initiation, wound remodeling,

epithelialization and contraction from the wound edge.

Patient discharged.

Follow1up:

(C) 4 weeks:Wound completely healed.

B

A

C

CLINICALCASE 2: INFECTEDTRAUMATICWOUND

A 23JyearJold male, presented with a right temporal

infected wound after 2 weeks of facial trauma (A).

Treatment (according to protocol)

✦Antibiotics, orally administered during the treatment.

✦WMCSwas applied: 1.5uA 1h daily for 5 days.

Results

(B) day 5 afterWMCS treatment initiation.

The wound is clean, epithelialization and contraction from

the wound edge can be seen. Patient was discharged.

Follow1up

(C) wound completely healed 2 weeks afterWMCS,

without any other additional treatment.

C

A

B

CLINICALCASE 3: SURGICALWOUNDCOMPLICATION

A 57JyearJold female, presented with a wound at

pelvis region along the previous surgical line 3months

after a laparotomy procedure.Wound: 3x4cm (A).

Treatment (according to protocol)

✦WMCS treatment applied:1.5uA 1h daily for 5 days.

Result:

(A) day of admission

(B) day 5 afterWMCS . Contraction from the wound edge

was remarkable.Patient gave up the treatment after day5

Follow1up

The wound healing period was not clear afterWMCS ,

BUT not any additional treatment had been reported.

(C) 7 months followJup.Wound completely healed.

Patient returned for eventration repair.

B

C

A

CLINCALCASE 4: SKINGRAFT PATIENT

A 23JyearJold female with a history of scalp peeling by a rice machine, presented with a

highly sloughy skin graft wound after 2 weeks of skingraft procedure.

More than 50% of the skin graft were slough,

(A) Frontal skull bone was extensively exposed.

Treatment (according to protocol)

✦Gentle debridement only at the first day

✦Wound cleansing with normal saline and

vaseline gauze dressing were applied

every other day.

✦WMCS: 1.5uA 1h for each area daily for 3 weeks.

✦Moist dressing after anyWMCS treatment.

✦Antibiotics administered orally.

A

Result

(A): Day of admission

(B): 3 weeks after WMCS initiation. The granulation tissue completely covers the exposed

skull bone. Epithelialization and new skin were appearing at the wound edge. Patient was

asked for discharged .

Follow1up

(C): 3 months fellowJup of the

wound. New skin is covering

Entirely the exposed skull bone.

No hair are appearing through the new skin at this time.

It is a hard1to heal1wound.WMCS isVERY helpful and

first choice.

A B

C

CLINICALCASE 5: SECONDJDEGREE BURN

A 21JyearJ old male, presented with a 60% secondJdegree burn (A).

He was referred to the Plastic Surgery Department

after overnight stay at Emergency Unit.

Treatment (according to protocol)

✦Fluid and electrolyte restoration management.

✦Antibiotics and pain control.

✦WMCS treatment applied: 1.5uA daily for 10 days.

Result:

(A): Day of admission, blisters, very painful wound.

Note: Day 5 afterWMCS treatment, painful was still

But much less was reported.

(B): Day10 ofWMCS.Wound completely healed.

Follow1up

(C): 2 months followJup: Excellent wound healing quality.

WMCS is an excellent technology for burn patient Treatment.

A

This image cannot currently be displayed.

B

C

CLINICALCASE 6: PRESSURE SORE

A 53JyearJold male , paralyzed patient , presented with

a pressure sore on the back and hip (A). Lower limb sensation

was lost.

Treatment (according to protocol)

✦Antibiotics orally

✦WMCS treatment applied: 1.5uA daily for 4 weeks.

Results:

(A): Day of admission

(B): 4 weeks afterWMCS initiation. Contraction and

epithelialization observed. Improvement of lower limb

sensation was reported.

FollowJup:

(C): 3 months afterWMCS initiation. New skin is developing from

the wound edge. More than 70% of healing process is seen.

B

C

A

Discussions

• Electrical.Stimulation.Therapy.(EST).has.been.used.for.

wound.healing.for.many.years.

• Through.our.clinical.study.EST.is.safety,.tolerability.and.

effectiveness.in.wound.care.management.

• ES.increases.fibroblast.production,.promotes.cell.

migration,.increases.wound.angiogenesis.and.tissue.

oxygenation,.and.decreases.bacterial.burden..EST.is.

ideal..technology.for.hardJtoJheal.wound.

• More.experiments.are.ongoing.to.prove.such.as

• histological,..cellular.and.the.genetic.parameters..even.

associated.with.the.EST.that.are.responsible.for.the.

wound.to.heal.

Thank you for your attention