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Abstract-In spite of the extensive clinical work reported in the area of electrical wound healing, electrical stimulation to augment chronic wound repair is still far from being widely accepted in clinical practice. Problems in designing clinical studies (size of the sample observed, control group, ethics of the procedure), evaluating treatment efficacy, rationales for use of the treatment, and unknown underlying mechanisms contribute to the aforementioned fact. In the present study, we evaluated low frequency electrical current for its beneficial effects in pressure ulcer management. Seventy-three spinal cord injured patients with 109 pressure ulcers participated in the study. Patients were randomly assigned to a control group receiving conventional treatment of their ulcers, or to a stimulation group, in which the ulcers were additionally treated with low frequency pulsed current. A comparison of the two groups showed significantly higher average healing rate for the stimulated group. Patients from the control group had the opportunity of crossing over to the stimulation group after the required control period of four weeks. This group (the crossover group) was analyzed separately. In all but one ulcer out of 20, an improvement in the healing process was observed after electrical stimulation was initiated.

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Subjects with spinal cord injury are often distressed by pressure sores, which usually appear after prolonged pressure (wheelchair, bed) across the soft tissue which has already lost sensibility and has diminished microcirculation. The healing ability and its dynamics depend on the state of the subject's overall health. Consequently, evaluation of a particular treatment requires careful consideration of as many as possible of the parameters relevant to healing and an adequate criterion for assessing the state of the pressure sore. Bearing in mind these two circumstances, the results of a multicentre clinical study are analysed. The aim of the study was to test two hypotheses: first that healing is faster when sores are also treated by electric currents (ECs) (in addition to conventional treatment); and secondly that there exist differences in the efficiency of the treatment if direct or low-frequency pulsed currents (FES parameters) are applied. The data analysed show that pressure sores are likely to heal twice as fast when treated with low-frequency pulsed currents. EC seems to improve the healing rate in cases where the natural healing mechanisms of the body are not sufficient (chronic wounds, older subjects).

The healing of a cutaneous wound is accompanied by endogeneous electrical phenomena. Not knowing whether they represent merely a side-effect of the physiological processes which take course during healing or whether they play a much more important role as mediators of healing, externally applied electricity was examined as a therapeutic tool for the enhancement of natural regenerative processes. In the present review a historical literature survey dealing with human applications of electric current for wound healing acceleration is given. It presents a complete palette of heterogeneous studies, differing in the parameters of applied electric current, in delivery modes as well as in the types of wounds being stimulated. Because of all these differences, comparing the efficacy of the described methods is difficult and could hardly be objective. Therefore greater stress was laid upon the discussion concerning the problems in designing clinical studies (size of the sample observed, control group, ethics of the procedures), rationales for the employment and possible underlying mechanisms of particular methods, and problems of evaluating their efficacy. In spite of the extensive work performed in the field of electrical wound healing we remain only part way towards explaining the mechanisms by which electricity reinforces the regenerative capabilities of injured tissue as well as only part way towards the selection of the optimal stimulation method from among the published reports.