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Eplasty. 2008; 8: e28.
Published online 2008 May 16.
PMCID: PMC2396465
PMID: 18552975


LOW-INTENSITY ELECTRICAL STIMULATION IN WOUND HEALING: REVIEW OF THE EFFICACY OF
EXTERNALLY APPLIED CURRENTS RESEMBLING THE CURRENT OF INJURY

Konstantine C. Balakatounis and Antonios G. Angoules


KONSTANTINE C. BALAKATOUNIS

School of Health and Social Care, Oxford Brookes University, England, United
Kingdom;

Find articles by Konstantine C. Balakatounis


ANTONIOS G. ANGOULES

School of Health and Social Care, Oxford Brookes University, England, United
Kingdom;

Find articles by Antonios G. Angoules
Author information Copyright and License information Disclaimer
School of Health and Social Care, Oxford Brookes University, England, United
Kingdom;
Filoktitis Medical Center (Center of Excellence in Physical Medicine and
Rehabilitation), Athens, Greece; and
Academic Unit of Orthopaedic Surgery and Trauma, Leeds Teaching Hospitals,
Leeds, England, United Kingdom
Correspondence: moc.liamg@sinuotakalab

Copyright © 2008 The Author(s)

This is an open-access article whereby the authors retain copyright of the work.
The article is distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.



Go to:


ABSTRACT

Objective: Low-intensity currents (LIC) have gained popularity during the last
years, and nowadays the majority of electrotherapy units may produce LIC. On
wounding, the body produces a current, the current of injury, which promotes
healing. Still, this current may gradually decrease resulting occasionally to
delayed or limited wound healing. Thus, by applying the same LIC externally,
healing may be accelerated by sustaining the LIC throughout the healing phases.
The first review of research studies on the effect of LIC on wound healing is
attempted, which can be considered useful for the practicing clinician, to
provide an overview of current evidence on the effectiveness of LIC and provide
protocols of treatment. Methods: Comprehensive review of randomized-controlled
trials investigating the effect of LIC on wound healing. Results: The review
revealed that LIC promote wound healing and appear to be effective in the range
of 200–800 μA. The direct current may be continuous or pulsed and polarity may
or may not be reversed. Conclusion: Research available indicates that LIC
accelerate wound healing. Further research is required to clarify the healing
effects of LIC on wounds.

In 2002, electrical stimulation was approved in the United States, for Medicare
coverage for the treatment of nonresponding to standard wound-healing
strategies, pressure, diabetic, stasis, and arterial ulcers. The approval of
electrical stimulation constitutes an indication of the growing acceptance and
evidence for its application for wound healing.1

Electrical stimulation may be highly variable in form and parameters. There is a
substantial number of research studies on wound healing,2 but there is rarely a
differentiation among types of electrical current. Still, various forms of
currents such as direct currents, pulsed direct currents, high- or low-voltage
pulsed currents, alternative currents, and low-intensity currents (LIC) are
available. Therefore, the identification of effective forms/parameters of
currents, which are supported by randomized-controlled trials, may be considered
as clinically relevant.

A review of the effectiveness of LIC on wound healing was considered important
by the authors, because LIC resemble the currents produced by the human body on
wounding; therefore, there is a reasonable question whether this particular form
of currents may be a beneficial range of amplitude for wound healing despite the
very low amplitude.

The purpose of the study was to concentrate available research on LIC
stimulation for wound healing and conduct the first review on the specific
topic, to investigate its effectiveness, guide clinicians by providing treatment
protocols, and stimulate further research on LIC and wound healing.

Go to:


DEFINITION AND TECHNICAL SPECIFICATIONS

Low-intensity electric currents or microcurrents (MCs) are currents of an
intensity less than or equal to 1 mA (1000 μA, μA = microampere). The current
may be direct or alternating of varying—mainly rectangular—waveforms, frequency,
and pulse duration. Low-intensity currents were formerly known as MC electrical
neuromuscular stimulators, but were later named microcurrent electrical
stimulator (MES) (MC electrical stimulator).2

Microcurrents are produced by low-voltage generators or combined electrotherapy
units. Such generators or units can produce a range of waveforms, from
monophasic to square or rectangular biphasic, with a range of frequencies from
0.3 to 50 Hz. Electrotherapeutic units of low voltage may produce currents of
intensities up to a few milliamperes in which case sensory stimulation or
muscular stimulation results. Pulse duration may also be modified from 1 to 500
milliseconds at low frequencies or may be preselected when pulsed current is
utilized.2

Go to:


CURRENT OF INJURY

In 1843, Dubois-Reymond reported a current of an intensity of 1-mA exiting human
skin wounds. It was later confirmed that wounds create a surrounding electric
field, the “current of injury,” which was found to be of an intensity less than
1 mA.3,4 The current of injury extends up to a radius of 2–3 mm around the
wound, and the gradient gradually decreases from 140 mV/mm to 0 mV/mm.5,6 It
also appears that the transportation of Na+ into the cell, through the cell
membrane, maintains skin “battery” of a potential difference of 20 to 40 mV, the
negative pole being outside the cell.

It has been supported that the current of injury can be maintained if a moist
occlusive dressing is applied, but will gradually decrease if the wound is left
open and unprotected.6,7 As the wound heals, the current of injury is also
reduced.6

By considering that healing appears to be promoted through the use of occlusive
dressings,8,9 which retain the current of injury within the wound environment,
it can be and has been postulated10 that the current of injury plays a
significant role in wound healing.11 Therefore, it can be claimed that LIC may
resemble the natural electric field/current created following injury, thus
enhancing a complex biological mechanism of wound healing.12 One of those
mechanisms is galvanotaxis. Galvanotaxis can be defined as the directional
migration of various types of cells,13,14 such as endothelial cells,15 and
keratinocytes, thus enhancing reepitheliazation.16,17 The biological processes
underlying galvanotaxis are under investigation, 1 proposed mechanism being
lateral electrophoresis resulting in changes in the plasma membrane and possibly
affecting protein redistribution.11

Go to:


METHODOLOGY

Initially, 4 electronic databases (MEDLINE, CINAHL, EMBASE, and PeDRO) were
searched for clinical studies from 1966, or earliest year available on the
database to March 2008.

An attempt to identify studies using LIC wound healing was made through the
implementation of a search strategy. A combination of the following key words
was employed: “low-intensity current,” “low-intensity stimulation,” and
“microcurrents” in combination with the key words “wound healing,” “ulcer,” and
“ulceration.” References in articles were scanned for additional clinical
studies. By scanning references in the retrieved articles, it became clear that
in numerous studies, MCs (LIC) were used in treatment but were not defined as
such. Instead, they were referred to as “electrical stimulation,” a term that
includes LIC as well. This fact led to a new broader search strategy using
electrical stimulation as a key word instead of the terms MCs or low-intensity
stimulation. Therefore, the key word electric stimulation was also used.

All results from the searches were carefully scanned for studies related to LIC
and wound healing.

The final search strategy was conducted by 2 reviewers independently, and final
studies retrieved and included in the study (n = 4) were reproduced successfully
by a medical doctor and physical therapist not involved in the study.

The inclusion criteria consisted of clinical trials investigating healing of
noninfected wounds in human subjects. No restriction on age and date of
publication was applied.

Exclusion criteria were as follows:

 * studies investigating healing of infected wounds;
 * studies in languages other than English, German, French, Spanish, and Greek;
   and
 * high-voltage currents and all other currents other than LIC.



Go to:


EFFECTIVENESS OF DIFFERENT TYPES OF LIC

The efficacy of LIC on wound healing has been investigated by several clinical
studies on human subjects.


LOW-INTENSITY DIRECT CURRENT

Low-intensity direct current (LIDC) is the most common type of LIC studied in
research. Wolcott et al18 studied wound healing resulting from application of
LIDC in 83 patients with ischemic wounds. Three sessions per day took place,
each lasting 2 hours. Intensity ranged from 200 to 800 μA, the negative
electrode was placed on the wound and the positive electrode proximally. After 3
days, polarity was reversed provided that no infection had appeared. In the
event of presence of infection, reversal was postponed until infection had
subsided and was then delayed for an additional 3 days. Afterward, polarity was
reversed each time healing reached a plateau. The rationale of the delay of
polarity reversal may be attributed to the study of Rowley et al,19 where by
placing the negative electrode on the wound in similar parameters, the current
presented with antimicrobial effects. Forty-five percent of wounds healed
completely around a mean of 9.6 weeks, and the rest reached partial healing up
to 64.7% over 7.2 weeks. Direct comparison of 2 treatments, standard treatment
versus LIC, on the same subjects also took place, a fact that eliminated
confounding factors stemming from differences among individuals such as age,
sex, general health, and underlying pathology (eg, diabetes). Eight of the
patients presented with bilateral wounds. One side was treated with LIDC (n = 8)
and the other received standard care (n = 8). Six of 8 LIDC-treated ulcers,
completely healed, while the rest 2 of 8 healed up to 70%. In the other side, 3
of 8 ulcers did not heal, 3 of 8 healed less than 50%, and 2 out of 8 healed no
more than 75%. In another clinical study,20 LIDC stimulation was applied to 6
patients with bilateral ischemic skin ulcers. The parameters of LIDC were same
as in the study by Wolcott et al,18 only polarity was reversed once. One side
received standard treatment, whereas the other side ulcer received the same
treatment plus LIDC stimulation. The healing rate of the non-LIDC side was 14.7%
compared with 30% in the LIDC-treated side. A significant enhancement of healing
was observed. A total of 100 patients also received LIDC treatment on ischemic
wounds including the six patients previously mentioned. Mean healing rate
amounted to 28.4% per week.

The positive effect of LIDC on chronic leg ulcers nonresponsive to other
treatment has also been supported in a case study by Assimacopoulos et al,21 in
which, LIDC was applied on 3 patients with venous leg ulcers. Healing occurred
in all 3 patients in 6 weeks, by applying a current of 100 μA. No control group
was available, and being a case study, the strength of the results is somewhat
limited.

Carley and Wainapel22 applied LIDC (200–800 μA) on 30 patients with ulcers of
various pathologies located over the sacrum or the lower limb below the knee.
Patients were assigned in an electrical stimulation treatment group (n = 15) or
conventional treatment group (n = 15) matched according to age, diagnosis,
etiology, and wound size, thus ensuring that confounding factors were controlled
to a considerable extent. Both groups received standard conservative treatment.
The treatment group received additional electrical stimulation of 200 to 800 μA
for 2 hours, twice daily, with an interval of at least 2 to 4 hours, 5 days per
week, for 5 weeks. The negative electrode was placed on the wound and the
positive electrode proximally. Reversal of polarity took place, as in the study
by Wolcott et al,18 and treatment was continued until full wound healing was
reached.

Results demonstrated statistically significant acceleration of wound healing of
1.5 to 2.5 times greater in the LIC group with respect to the conventional
treatment group, and furthermore, less debridement was required, as well as less
discomfort and resilient scars were observed. Healing was therefore enhanced by
LIC stimulation (Table (Table11).


TABLE 1

Low-intensity direct current randomized-controlled trials studies597*

Low-intensity direct current RCT studiesWolcot et al18Carley & Wainapel22Samplen
= 83n = 30Type of woundIschemic woundsUlcers over sacrum or lower limb (below
knee)GroupsTreatment group (1 group). Eight patients presented with bilateral
wounds. One side was treated with LIDC (n = 8) and the other received standard
care (n = 8)Electrical stimulation treatment along with conventional treatment
group (n = 15) or conventional treatment group (n = 15)TreatmentIntensity:
200–800 μA. Three sessions/d, 2 h per session. Polarity was reversed provided
that no infection was present on day 3. Treatment was continued to full wound
healingIntensity: 200–800 μA for 2 h, twice daily, 2- to 4-h interval, 5 d/wk,
for 5 weeks. Day 3: polarity was reversed unless infection appeared. Polarity
was reversed on plateausElectrode placementNegative electrode was placed on the
wound and the positive electrode proximallyNegative electrode placed on wound
and positive electrode proximallyResults45% of wounds healed completely (mean
9.6 weeks). The rest reached partial healing up to 64.7% over 7.2 weeksWound
healing was accelerated 1.5–2.5 times in the LIC group compared with the
conventional treatment group, and less debridement, less discomfort, and
resilient healed scars were observed Bilateral ulcer group: 6 of 8 LIDC-treated
ulcers completely healed, 2 of 8 healed up to 70%. Other side: 3 of 8 ulcers did
not heal, 3 of 8 healed less than 50%, and 2 of 8 healed up to 75%. 

Open in a separate window
*RCT indicates randomized-controlled trials; LIDC, low-intensity direct current.


LOW-INTENSITY PULSED DIRECT CURRENT

Low-intensity current provides minor stimulation to the healing site, being an
LIC. One might expect that by using a pulsed form of this current, effectiveness
would probably decrease because stimulation might be even less.

In a double-blind study by Wood et al,23 74 patients with stages II and III
chronic decubitus ulcers in 4 centers, were randomly allocated in a treatment
group (n = 43) and a placebo (sham treatment) group (n = 31), which received
standard treatment. Treatment composed of electrical stimulation using
low-intensity pulsed direct current (LIPDC) of 300 to 600 μA. After 8 weeks of
treatment, 58% of ulcers in the treatment group had healed, whereas in the
placebo group only 1 healed, and in the rest of the ulcers, ulcer area
increased. A statistically significant accelerated rate of healing (P < .0001)
was observed.

Reversal of polarity of pulsed direct current during the healing period has been
studied. Junger et al23 investigated the effect of LIPDC on venous leg ulcers of
15 patients who had not responded to standard compression treatment over 79
months. An intensity of 630 μA was selected initially (frequency: 128 pulses per
second; pulse duration: 140 μs) with the cathode placed on the wound for 7 to 14
days. The following 3 to 10 days, the positive electrode was positioned on the
wound, and after that specific time frame polarity was reversed again. As soon
as significant healing had occurred, intensity was reduced to 315μA (64 pulses
per second). Treatment was performed on a daily basis, each session lasting 30
minutes. Mean ulcer area was reduced to 63% (P < .01). Furthermore, capillary
density was increased to 43.5% (P < .039), and improvement of skin perfusion was
observed (PtCo2 = 13.5 increased to 24.7 to 40 mm Hg being normal) (Table
(Table22).


TABLE 2

Low-intensity pulsed direct current randomized-controlled trials studies

Low-intensity pulsed direct current RCT* studiesWood et al23Junger et
al23Samplen = 74 patients in 4 centersn = 15 nonresponsive to standard
compression treatment over 79 moType of woundStages II and III, chronic
decubitus ulcersVenous leg ulcersGroupsTreatment group (n = 43) and placebo
(sham treatment) group (n = 31) standard treatmentTreatment
groupTreatmentLow-intensity pulsed direct current of 300–600 μA, daily, for 8
wkTreatment: 38 days daily, session duration, 30 min. Intensity 630 μA (128 pps,
pulse duration—140 μs). On significant healing, intensity was diminished to 315
μA (64 pps).Electrode placementNot specifiedCathode electrode on wound for 7–14
d. Following 3–10 days, positive electrode positioned on wound, then polarity
was reversed again.Results8 wk—accelerated rate of healing (P < .0001). Ulcers
healed in treatment group—58%, 1 healed in placebo group, in remaining ulcers,
ulcer area increased.In 13/15 mean ulcer area, 63% (P < .01) (reduced)  2 ulcers
healed completely, capillary density 43.5% (P < .039) (increase).

Open in a separate window
*RCT indicates randomized-controlled trials.
Go to:


DISCUSSION

Current research indicates that LIDC within the range of 200 to 800 μA is
effective in promoting and accelerating wound healing. It is emphasized that in
no study was blood or serous exudate observed, an indication that the intensity
range of 200 to 800 μA is appropriate for low-intensity electrical stimulation.
In Table 3, a protocol of application of LIC is presented on the basis of
protocols used in studies.

Regarding LIPDCs, studies showed that an intensity of 630 μA is capable of
stimulating healing of ulcers that were unsuccessfully treated with standard
compression treatment and a current intensity of 300 to 600 μA, for stages II
and III pressure ulcers. Thus, an intensity range of 300 to 630 μA appears to be
an intensity of choice for treating these specific wounds.

The intensity proposed ranges from 300 to 630 μA on a daily basis for at least
30 minutes for 4 to 8 weeks. Reversal of polarity may be applied, and
frequencies of 130 Hz may also be applied. Reversal of polarity in LIPDC has
been proposed on the 3rd to 10th day of treatment, provided that no infection
has taken place. Reversal may be repeated whenever wound healing has reached a
plateau.

Another recommendation can be regarding wounds that have failed to heal using
other forms of electric stimulation. The selection of the reverse polarity to
the 1 used previously is proposed as employed in the studies by Wolcott et al,18
Carley and Wainapel,22 and Junger et al.23 The protocols presented in Tables 3
and 4 are then suggested.

A comparison of the results of studies on LIDC and LIPDC reveals that their
results, despite the numerous differences in protocols, populations studied, and
outcome measures, are largely comparable, a fact that weakens the initial
hypothesis in the “Results” section, that pulsed LIC might be less effective in
wound healing than LIDC.

Intensities of 0.001 to 200 μA and 800 to 1000 μA have not been studied, in
either continuous-direct or pulsed-direct LIC. It can only be postulated that
intensities of 800 to 1000 μA are effective, because amplitudes of 800 μA and 1
mA were both proven to be effective, although in different waveforms (800 μA in
direct current and 1000 μA in alternating current).

A general lack of clinical studies demonstrating no effect of MCs on wound
healing was observed. Only 1 study by Katelaris et al25 found MCs not to be
statistically significantly beneficial for wound healing but this study was not
included because this result was probably due to the cytotoxic effect of
povidone iodine, as reported by Kloth,10 which was used in conjunction with
stimulation. Therefore, it can be supported that LIC in wound healing appears to
be effective.

Regarding methodological issues, retrieving studies using LIC for wound healing
was challenging and required rigorous search strategies. This can be attributed
to the lack of differentiation of LIC from other currents of an intensity over 1
mA in the literature, commonly referred to as electrical stimulation in general.

It has to be underlined that in all studies the control or sham-treatment group
received standard wound care; therefore, treatment was not withheld, which would
be contrary to basic medical ethics. Thus, the control group was a
standard-treatment group, and acceleration of rate of healing was in relation to
standard treatment and not to no treatment at all. This fact supports that LIC
could not be used alone but could be used in conjunction with standard wound
care as current research suggests.

A definite conclusion and generalization could not be reached regarding the
effectiveness of LIC on wound healing. Only regarding intensity, is there an
agreement among studies. All other parameters vary across trials. The
effectiveness on a specific type of ulcer could not be established because of
the small number of studies for each type of wound. The LIC generators used in
the studies have been discontinued, a fact that is of limited significance
because parameters and technical characteristics are adequately presented in all
studies. Furthermore, another point to be taken is the presence of, to a certain
extent, varying outcome measures and criteria, which have been used in studies,
a fact that impedes comparison of results and reaching conclusions. Still, the
positive results indicate that LICs appear to have a beneficial effect on
stimulation and rate of wound healing. The factors mentioned above prevent
conclusions on the efficacy and extent of efficacy of LICs in stimulating and
accelerating wound healing.

The clinical implications of this study may also be considered. Wound healing is
a challenge and a delicate healthcare issue for the clinician. Physicians,
nurses, physiotherapists, and other members of the rehabilitation team
occasionally have to dedicate treatment time on wound care.26 Healing is
sometimes delayed, and the wound may not respond to standard treatment. These
constitute implications, which require a part of patient services to be focused
on wound healing. As a result, other healthcare issues might be overlooked or
receive less attention, or the presence of the wound itself might slow down
rehabilitation progress, impede patient recuperation, and discharge from
hospital. Overcoming or restricting the effects of lengthy or
treatment-resistant wound healing may enable the healthcare professional to
address other health issues such as training transfers to a tetraplegic patient
with a pressure sore in the sacral area. Furthermore, hospitalization may be
reduced reflecting faster rehabilitation of the patient, improvement of patient
services, and reduction of cost of care.

The review may also underline the need for a multidisciplinary approach to wound
care, through exploring and gathering evidence on the effectiveness of LIC
stimulation, a treatment applied by physiotherapists and physicians, who are a
part of the rehabilitation team, as well as the nurse and other rehabilitation
professionals.

Research studies unanimously support the efficacy of LIC, still the number of
studies on the topic is limited and further research is needed to establish the
effectiveness of LIC on promoting and accelerating wound healing. Future
research may focus on specific wound types such as diabetic ulcers, or
alternative methods of application, for instance, implanted electrodes. The type
of electrical current used could be specified to direct research toward
establishing the most effective treatment parameters and forms of current.

Go to:


CONCLUSION

The evidence available indicates that LIC appear to accelerate wound healing.
Regarding the selection of intensity, LIDC (continuous or pulsed) appears to be
effective in the range of 200 to 800 μA, and polarity may or may not be
reversed. Further research is required to elucidate the effect of LIC on wound
healing.


TABLE 3

Low-intensity direct current proposed parameters on the basis of protocols used
in studies (presented in Table

Intensity200–800 μA (negative electrode on wound)Treatment time2 hTimes/d2 to 3
sessions with a 2- to 4-h intervalTimes/wk5 d/wkDuration of treatment5 to 9 wk

Open in a separate window


TABLE 4

Low-intensity pulsed direct current proposed parameters on the basis of
protocols used in studies (presented in Table

Intensity300 to 630 μA (negative electrode on wound, stable polarity or reversal
of polarity on 3 to 10 days or when on plateau)Treatment time or times/wk30
minutes minimum per dayFrequency130 HzDuration of treatment4 to 8 wk

Open in a separate window
Go to:


REFERENCES

1. Electrostimulation for Wounds: Decision Memorandum (no. CAG-00068N)
Baltimore, Md: Centers for Medicare & Medicaid Services; 2002. Centers for
Medicare & Medicaid Services. [Google Scholar]
2. Prentice WE. Therapeutic Modalities in Rehabilitation. 3rd ed. New York:
McGraw Hill; 2005. [Google Scholar]
3. Barker A, Jaffee L, Vanable J., Jr The glabrous epidermis of cavies contains
a powerful battery. Am J Physiol. 1982;242:R258–66. [PubMed] [Google Scholar]
4. Illingworth C, Barker A. Measurement of electrical currents emerging during
the regeneration of amputated finger tips in children. Clin Phys Physiol Meas.
1980;1:87–9. [Google Scholar]
5. McGinnis M, Vanable J., Jr Voltage gradients in newt limb stumps. Prog Clin
Biol Res. 1986;210:231–8. [PubMed] [Google Scholar]
6. Jaffe L, Vanable J. Electrical fields and wound healing. Clin Dermatol.
1984;2(3):34–44. [PubMed] [Google Scholar]
7. Griffin J, Tooms R, Mendlus R, et al. Efficacy of high voltage pulsed current
for healing of pressure ulcers in patients with spinal cord injury. Phys Ther.
1991;71(6):433–42. [PubMed] [Google Scholar]
8. Alvarez O, Mertz P, Eaglstein W. The effect of occlusive dressings on
collagen synthesis and re-epithelialization in superficial wounds. J Surg Res.
1983;35:142–8. [PubMed] [Google Scholar]
9. Winter G. Epidermal regeneration studies in the domestic pig. In: Maibach H,
Rovee D, editors. Epidermal Wound Healing. Chicago, IL: Year Book Medical
Publishers; 1972. pp. 71–112. [Google Scholar]
10. Kloth LC. Electrical stimulation for wound healing: a review of evidence
from in vitro studies, animal experiments, and clinical trials. Int J Low Extrem
Wounds. 2005;4(1):23–44. [PubMed] [Google Scholar]
11. Ojingwa JC, Isseroff RR. Electrical stimulation of wound healing. J Invest
Dermatol. 2003;121(1):1–12. [PubMed] [Google Scholar]
12. Kloth LC, McCulloch JM. Promotion of wound healing with electrical
stimulation. Adv Wound Care. 1996;9(5):42–5. [PubMed] [Google Scholar]
13. Nuccitelli R. Physiologic electric fields can influence cell mobility growth
and polarity. Adv Cell Biol. 1988;2:213–33. [Google Scholar]
14. Robinson KR. The responses of cells to electrical fields: a review. J Cell
Biol. 1985;101:2023–27. [PMC free article] [PubMed] [Google Scholar]
15. Li X, Kolega J. Effects of direct current electric fields on cell migration
and actin filament distribution in bovine vascular endothelial cells. J Vasc
Res. 2002;39:391–404. [PubMed] [Google Scholar]
16. Nishimura KY, Isseroff RR, Nuccitelli R. Human keratinocytes migrate to the
negative pole in direct current electric fields comparable to those measured in
mammalian wounds. J Cell Sci. 1996;106:642–6. [PubMed] [Google Scholar]
17. Sheridan DM, Isseroff RR, Nuccitelli R. Imposition of a physiologic DC
electric field alters the migratory response of human keratinocytes on
extracellular matrix molecules. J Invest Dermatol. 1996;106:642–6. [PubMed]
[Google Scholar]
18. Wolcott LE, Wheeler PC, Hardwicke HM, Rowley BA. Accelerated healing of skin
ulcer by electrotherapy: preliminary clinical results. South Med J.
1969;62(7):795–801. [PubMed] [Google Scholar]
19. Rowley BA, McKenna JM, Chase GR, Wolcott LE. The influence of electrical
current on an infecting microorganism in wounds. Ann N Y Acad Sci.
1974;238:543–51. [PubMed] [Google Scholar]
20. Gault WR, Gatens PF., Jr Use of low intensity direct current in management
of ischemic skin ulcers. Phys Ther. 1976;56(3):265–9. [PubMed] [Google Scholar]
21. Assimacopoulos D. Low intensity negative electric current in the treatment
of ulcers of the leg due to chronic venous insufficiency. Preliminary report of
three cases. Am J Surg. 1968;115(5):683–7. [PubMed] [Google Scholar]
22. Carley PJ, Wainapel SF. Electrotherapy for acceleration of wound healing:
low intensity direct current. Arch Phys Med Rehabil. 1985;66(7):443–6. [PubMed]
[Google Scholar]
23. Junger M, Zuder D, Steins A, Hahn M, Klyscz T. Treatment of venous ulcers
with low frequency pulsed current (Dermapulse): effects on cutaneous
microcirculation. Hautarzt. 1997;48(12):897–903. [PubMed] [Google Scholar]
24. Wood JM, Evans PE, III, Schallreuter KU, et al. Multicenter study on the use
of pulsed low-intensity direct current for healing chronic stage II and stage
III decubitus ulcers. Arch Dermatol. 1993;129(8):999–1009. [PubMed] [Google
Scholar]
25. Katelaris PM, Fletcher JP, Little JM, McEntyre RJ, Jeffcoate KW. Electrical
stimulation in the treatment of chronic venous ulceration. Aust N Z J Surg.
1987;57(9):605–7. [PubMed] [Google Scholar]
26. McCulloch JM. The role of physiotherapy in managing patients with wounds. J
Wound Care. 1998;7(5):241–4. [PubMed] [Google Scholar]
 * Abstract
 * DEFINITION AND TECHNICAL SPECIFICATIONS
 * CURRENT OF INJURY
 * METHODOLOGY
 * EFFECTIVENESS OF DIFFERENT TYPES OF LIC
 * DISCUSSION
 * CONCLUSION
 * REFERENCES

--------------------------------------------------------------------------------

Articles from Eplasty are provided here courtesy of HMP Global

--------------------------------------------------------------------------------

1. Electrostimulation for Wounds: Decision Memorandum (no. CAG-00068N)
Baltimore, Md: Centers for Medicare & Medicaid Services; 2002. Centers for
Medicare & Medicaid Services. [Google Scholar] [Ref list]
2. Prentice WE. Therapeutic Modalities in Rehabilitation. 3rd ed. New York:
McGraw Hill; 2005. [Google Scholar] [Ref list]
3. Barker A, Jaffee L, Vanable J., Jr The glabrous epidermis of cavies contains
a powerful battery. Am J Physiol. 1982;242:R258–66. [PubMed] [Google Scholar]
[Ref list]
4. Illingworth C, Barker A. Measurement of electrical currents emerging during
the regeneration of amputated finger tips in children. Clin Phys Physiol Meas.
1980;1:87–9. [Google Scholar] [Ref list]
5. McGinnis M, Vanable J., Jr Voltage gradients in newt limb stumps. Prog Clin
Biol Res. 1986;210:231–8. [PubMed] [Google Scholar] [Ref list]
6. Jaffe L, Vanable J. Electrical fields and wound healing. Clin Dermatol.
1984;2(3):34–44. [PubMed] [Google Scholar] [Ref list]
7. Griffin J, Tooms R, Mendlus R, et al. Efficacy of high voltage pulsed current
for healing of pressure ulcers in patients with spinal cord injury. Phys Ther.
1991;71(6):433–42. [PubMed] [Google Scholar] [Ref list]
8. Alvarez O, Mertz P, Eaglstein W. The effect of occlusive dressings on
collagen synthesis and re-epithelialization in superficial wounds. J Surg Res.
1983;35:142–8. [PubMed] [Google Scholar] [Ref list]
9. Winter G. Epidermal regeneration studies in the domestic pig. In: Maibach H,
Rovee D, editors. Epidermal Wound Healing. Chicago, IL: Year Book Medical
Publishers; 1972. pp. 71–112. [Google Scholar] [Ref list]
10. Kloth LC. Electrical stimulation for wound healing: a review of evidence
from in vitro studies, animal experiments, and clinical trials. Int J Low Extrem
Wounds. 2005;4(1):23–44. [PubMed] [Google Scholar] [Ref list]
11. Ojingwa JC, Isseroff RR. Electrical stimulation of wound healing. J Invest
Dermatol. 2003;121(1):1–12. [PubMed] [Google Scholar] [Ref list]
12. Kloth LC, McCulloch JM. Promotion of wound healing with electrical
stimulation. Adv Wound Care. 1996;9(5):42–5. [PubMed] [Google Scholar] [Ref
list]
13. Nuccitelli R. Physiologic electric fields can influence cell mobility growth
and polarity. Adv Cell Biol. 1988;2:213–33. [Google Scholar] [Ref list]
14. Robinson KR. The responses of cells to electrical fields: a review. J Cell
Biol. 1985;101:2023–27. [PMC free article] [PubMed] [Google Scholar] [Ref list]
15. Li X, Kolega J. Effects of direct current electric fields on cell migration
and actin filament distribution in bovine vascular endothelial cells. J Vasc
Res. 2002;39:391–404. [PubMed] [Google Scholar] [Ref list]
16. Nishimura KY, Isseroff RR, Nuccitelli R. Human keratinocytes migrate to the
negative pole in direct current electric fields comparable to those measured in
mammalian wounds. J Cell Sci. 1996;106:642–6. [PubMed] [Google Scholar] [Ref
list]
17. Sheridan DM, Isseroff RR, Nuccitelli R. Imposition of a physiologic DC
electric field alters the migratory response of human keratinocytes on
extracellular matrix molecules. J Invest Dermatol. 1996;106:642–6. [PubMed]
[Google Scholar] [Ref list]
18. Wolcott LE, Wheeler PC, Hardwicke HM, Rowley BA. Accelerated healing of skin
ulcer by electrotherapy: preliminary clinical results. South Med J.
1969;62(7):795–801. [PubMed] [Google Scholar] [Ref list]
19. Rowley BA, McKenna JM, Chase GR, Wolcott LE. The influence of electrical
current on an infecting microorganism in wounds. Ann N Y Acad Sci.
1974;238:543–51. [PubMed] [Google Scholar] [Ref list]
20. Gault WR, Gatens PF., Jr Use of low intensity direct current in management
of ischemic skin ulcers. Phys Ther. 1976;56(3):265–9. [PubMed] [Google Scholar]
[Ref list]
21. Assimacopoulos D. Low intensity negative electric current in the treatment
of ulcers of the leg due to chronic venous insufficiency. Preliminary report of
three cases. Am J Surg. 1968;115(5):683–7. [PubMed] [Google Scholar] [Ref list]
22. Carley PJ, Wainapel SF. Electrotherapy for acceleration of wound healing:
low intensity direct current. Arch Phys Med Rehabil. 1985;66(7):443–6. [PubMed]
[Google Scholar] [Ref list]
23. Junger M, Zuder D, Steins A, Hahn M, Klyscz T. Treatment of venous ulcers
with low frequency pulsed current (Dermapulse): effects on cutaneous
microcirculation. Hautarzt. 1997;48(12):897–903. [PubMed] [Google Scholar] [Ref
list]
25. Katelaris PM, Fletcher JP, Little JM, McEntyre RJ, Jeffcoate KW. Electrical
stimulation in the treatment of chronic venous ulceration. Aust N Z J Surg.
1987;57(9):605–7. [PubMed] [Google Scholar] [Ref list]
26. McCulloch JM. The role of physiotherapy in managing patients with wounds. J
Wound Care. 1998;7(5):241–4. [PubMed] [Google Scholar] [Ref list]

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