Prognostic factors in the prediction of chronic wound healing by electrical stimulation

Abstract

-The aim of the study was to determine the effects of wound, patient and treatment attributes on wound healing rate and to propose a system for wound healing rate prediction. Predicting the wound healing rate from initial wound, patient and treatment data collected in our database of 300 chronic wounds was not possible. After considering weekly follow-ups, we determined that the best prognostic factors were weekly follow-ups of wound healing process, which alone were found to accurately predict the wound healing rate after minimal follow-up period of four weeks (at least five measurements of wound area). After combining them with wound, patient and treatment attributes, minimal follow-up period was reduced to two weeks (at least three measurements of wound area). After follow-up period of two weeks, we were able to predict the wound healing rate of an independent test set of chronic wounds with relative squared error 0.347, and after three weeks with relative squared error 0.181 (using regression trees with linear equations in its leaves). Results show that the type of treatment is just one of many prognostic factors. Arranged in the order of decreasing prediction capability, prognostic factors are: wound size, patient's age, elapsed time from wound appearance to the beginning of the treatment, width-to-length ratio, location and type of treatment.The data collected up to now strongly support our former findings that the biphasic and direct current stimulation contributes to faster healing of chronic wounds.Presented regression trees in combination with the mathematical model of the wound healing process dynamics represent a core of a prognostic system for the chronic wound healing rate prediction. If the wound healing rate is known, then the provided information can help to formulate appropriate treatment decisions.

Anodal and cathodal pulsed electrical stimulation on skin wound healing in guinea pigs

“…Regarding galvanotaxic effects of negative polarity in attraction and proliferation of fibroblast cells [27][28], electrical stimulation application in E1 appeared to cause more attraction and proliferation of fibroblast cells in the wound site. Normally, by the second or third day after wounding, fibroblast cells begin to proliferate and synthesize collagen fibers, raising collagen levels continually for approximately 3 weeks [36]. So, the use of negative polarity in the anodal groups (E1 and E3) after day 3 appears to have caused greater collagen synthesis.…”

Electrical stimulation therapy to promote healing of chronic wounds: a review of reviews

“…[54][55][56][57][58] Eleven clinical reports including several uncontrolled prospective cohort studies 59,60,65,66,72,74,77,78,80,[86][87][88]91 and retrospective analyses 78 showed that the application of EST to a variety of wound types consistently improved healing outcomes. Altogether, this body of literature provides strong support that EST stimulates generic processes of tissue repair and so is effective on many different types of chronic or recalcitrant wounds.…”

“…Several reports document the benefits and safe application of EST on specific cases with very challenging wounds 6,[64][65][66][67][68][69][70][71][72][73][74][75][76][77] and other noncontrolled retrospective 78,79 and prospective research designs. [80][81][82][83][84][85] Two of the original clinical reports are often identified as controlled studies since they included a relatively large number of subjects; however, they compared healing outcomes produced after EST to only six patients with bilateral wounds.…”

“…There are also two larger studies with historical controls which describe improved healing outcomes that can be achieved when EST is applied as part of standard clinical practice. 78,90 Collectively, the effects of EST on healing have been evaluated in over 2000 subjects and published in a total of 62 articles in peer-reviewed journals since 1968 (Table 3). In 33 of these clinical reports involving 1370 subjects, healing outcomes of an EST-treated group were compared to an appropriate control group.…”

Designing of Artificial Intelligence Model-Free Controller Based on Output Error to Control Wound Healing Process

“…Cyclic strain increased the production of collagen in engineered smooth muscle tissue [39] and the rate of collagen synthesis was increased in mechanically stimulated in-vitro pulmonary arteries [40]. Collagen content also increased in long-term tissueengineered vascular structures [41] and in axially stretched in-vivo carotid arteries [42]. Pulmonary fibroblasts also showed an increased collagen expression when stimulated mechanically.…”