Effect of electrical stimulation on foot skin perfusion in persons with or at risk for diabetic foot ulcers

Abstract

The failure of foot wounds to heal results in 54,000 people with diabetes having to undergo extremity amputations annually. Therefore, treatment is needed to speed healing in people with diabetes in order to reduce the need for amputation. This study tested the effect of high-voltage pulsed current on foot blood flow in human beings who are at risk for diabetic foot ulcers. Neuropathy, vascular disease, Wagner Class, glucose, gender, ethnicity, and age were measured. A sample of 132 subjects was tested using a repeated-measures design. A baseline transcutaneous oxygen level was obtained; stimulation was applied, and transcutaneous oxygen measurements were recorded at 30- and 60- minute time intervals. The grouped foot transcutaneous oxygen levels decreased (F = 5.66, p =. 0039) following electrical stimulation. Analysis of variance (Scheffe, p <.05) showed that initial transcutaneous oxygen was significantly higher than subsequent readings. However, oxygen response was distributed bimodally: 35 (27%) subjects showed increased transcutaneous oxygen (mean 14.8 mm Hg), and 97 (73%) experienced a decreased transcutaneous oxygen reading (mean 12.2 mm Hg). Logistic regression analysis did not explain these differences. Although this treatment appears to increase blood flow in a subset of patients, further study is needed to identify probable mechanisms for this response.

Effect of low-intensity direct current on expression of vascular endothelial growth factor and nitric oxide in diabetic foot ulcers

“…The use of low-intensity ES can be effective in promoting wound closure by mimicking the internal bioelectric system within the wound site. There are some reports that ES promotes blood perfusion and wound closure in diabetic patients [30][31][32]. The results of the present study coincide with previous studies.…”

“…Despite the strong evidence supporting the useful effects of ES for managing chronic wounds [29][30][31][32], the mechanisms of these effects are not yet fully understood. VEGF, as an important angiogenic factor, and NO, as a vasodilator, play a potent role in the formation of new vessels (angiogenesis) in the wound healing process [8][9][10][11]17].…”

Frequency-modulated electromagnetic neural stimulation (FREMS) as a treatment for symptomatic diabetic neuropathy: results from a double-blind, randomised, multicentre, long-term, placebo-controlled clinical trial

“…The rationale for using electrical or magnetic stimulation is the potential enhancement of the microcirculation and endoneural blood flow, possibly counteracting the ischaemic pathogenetic component [8–10], and possibly other poorly understood mechanisms such as masking pain by interfering with pain gate control [11, 12]. …”

The effect of induced biphasic pulsed currents on re‐epithelialization of a novel wound healing model

“…Application of AC and DC currents to in vivo skin wounds has been investigated. Directly applied AC voltages in diabetic and neuropathic foot ulcers showed a positive effect on healing rate and perfusion [Baker et al, 1997[Baker et al, ,1999Gilcreast et al, 1998]. Electromagnetically induced currents have also been used in studies on bone fracture healing [Chen and Saha, 1987;Cane et al, 1993;Otter et al, 1998] and investigated as a potential aid to corneal healing [Basu et al, 1989] and epithelial wound healing [Patino et al, 1996].…”