Electrical stimulation (ES) is one of several biophysical technologies recognized by clinicians to be one of the most cost effective, therapeutically efficacious tissue repair and wound healing accelerators. By restoring the natural electrical potentials necessary for cellular activities that have become stalled, ES re-establishes and intensifies healing processes.
There are three types of electrical current that assist in wound closure and healing: direct current (DC), alternating current (AC), and pulsed current (PC). The majority of clinical trials using ES currents for wound healing have used PC delivered in either monophasic- or biphasic-pulsed waveforms, whereby current is delivered to the wound via a number of pulses per second (pps). There are three variations of PC that have been reported to augment chronic wound closure and healing. They are: high-voltage monophasic-pulsed current, frequently referred to as hi-volt pulsed current (HVPC), low-voltage monophasic-pulsed current and low-voltage biphasic-pulsed current (LVBPC). LVBPC is employed in transcutaneous electrical nerve stimulation (TENS) devices, primarily for pain control.
At present, HVPC is the current most supported by evidence for wound healing and is most frequently used for this purpose. HVPC devices provide choices for polarity and pulsed frequency, which are known to affect cell behavior in and near the wound bed.
A positive or negative polarity is introduced into the wound bed and is chosen by the clinician depending on wound healing phase and desired effects. In general, starting with negative polarity is recommended when the goal is to enhance granulation tissue formation in the wound bed and when re-epithelialization is desired. Positive polarity is chosen to enhance antimicrobial effects.
Many ES device manufacturers preset some of these parameters to simplify treatment application. The following suggestions relate to parameter selection:
Settings:
- Pulse frequency: 100 pps.
- Pulse duration: 20-100 µsec (usually fixed by the manufacturer).
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