How to use electrical stimulation (ES) for wound care?

How to Use Electrical Stimulation for Wound Care

Use electrical stimulation as adjunctive therapy to accelerate healing of stage 2-4 pressure ulcers and chronic wounds that have failed standard wound care, applying it in conjunction with—not as a replacement for—proper wound preparation, offloading, and appropriate dressings. 1

When to Initiate Electrical Stimulation

• Consider electrical stimulation when wounds fail to show 50% or more reduction in size after 4 weeks of appropriate standard wound management 1, 2
• Apply as adjunctive therapy alongside standard wound care principles including debridement, appropriate dressings, pressure relief, and nutritional support 1
• Most effective for pressure ulcers (stage 2-4), with moderate-quality evidence supporting accelerated healing rates 1
• Less robust evidence exists for diabetic and venous ulcers, though some benefit may occur 3

Optimal Electrical Stimulation Protocol

Use high-voltage pulsed current (HVPC) with the active electrode placed directly over the wound, as this represents the best evidence-based protocol with a large effect size (0.8 SMD). 3

Technical Parameters:

• Current type: Unidirectional high-voltage pulsed current (HVPC) is superior to other modalities including direct current, biphasic current, and electromagnetic therapy 3
• Electrode placement: Position the active electrode directly over the wound bed 3
• Treatment setting: Can be delivered effectively in both hospital and rehabilitation center settings 1

Patient Selection Considerations

• Electrical stimulation works equally well in patients with spinal cord injuries compared to other patient populations 1
• Caution in frail elderly patients: This population experiences higher rates of adverse events, particularly skin irritation 1
• Efficacy is inversely related to wound size and duration—smaller, more recent wounds respond better 3
• Pressure ulcers respond better than venous or diabetic ulcers 3

Essential Concurrent Wound Care

Electrical stimulation must be combined with standard wound management:

• Sharp debridement: Remove all necrotic tissue and surrounding callus frequently with a scalpel 4, 5
• Appropriate dressings: Use hydrocolloid or foam dressings to maintain moist wound environment and control exudate 1, 5
• Complete pressure offloading: Implement total contact casting for plantar ulcers or appropriate support surfaces for pressure ulcers 4, 5
• Nutritional support: Provide protein or amino acid supplementation, especially in nutritionally deficient patients 1, 5
• Infection control: Assess for and treat infection with appropriate antibiotics when indicated 2, 5

Important Limitations and Caveats

• No evidence for complete wound healing: While electrical stimulation accelerates healing rate and reduces wound size, data are insufficient to demonstrate superiority for achieving complete wound closure 1
• The relationship between accelerated healing rate and eventual complete healing remains undefined 1
• Most common adverse effect: Skin irritation, particularly in elderly or frail patients 1
• Not recommended for diabetic foot ulcers as primary therapy: The International Working Group on the Diabetic Foot found no convincing evidence of benefit for electrical stimulation in diabetic foot ulcers specifically 1

Common Pitfalls to Avoid

• Do not use electrical stimulation as monotherapy: It must be adjunctive to proper wound care, not a replacement 1
• Do not continue standard care alone beyond 4 weeks if the wound shows inadequate improvement without considering advanced therapies 1, 2
• Avoid in ischemic wounds without vascular assessment: Ensure adequate perfusion before initiating any advanced wound therapy 4
• Do not neglect basic wound care principles: Electrical stimulation cannot compensate for inadequate debridement, persistent pressure, or untreated infection 4, 2, 5

Mechanism of Action

Electrical fields activate multiple signaling pathways critical for wound healing, including polarized signaling of epidermal growth factor receptors, integrins, and phosphoinositide 3-kinase, resulting in enhanced directional cell migration (electrotaxis) toward the wound 6