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Electrotherapy reverses inframalleolar ischemia: a retrospective, observational study
Robert Goldman1, Barbara Brewley, Linqiu Zhou
1Department of Rehabilitation Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Objective:
To determine if high-voltage pulsed current (HVPC) augments ischemic wound healing and increases periwound perfusion.
Design:
A 5-year, retrospective, observational study was conducted on successive patients with ischemic wounds who were poor candidates for revascularization.
Intervention:
HVPC was applied directly to wounds at greater than 100 volts, 100 pulses per second, 1 hour per day. In addition to HVPC, patients received standard care for ischemic wounds at the study facility. Ischemic wounds for which HVPC was not clinically indicated or not available received standard care alone.
Main Outcome Measures:
Wound area measured by planimetry, wound appearance observed by digital imaging techniques, and microcirculation monitored by transcutaneous oxygen (TcPo(2)) levels.
Results:
The group that received HVPC plus standard care showed smaller wound areas from weeks 20 though 52 after the start of treatment compared with the group that received standard care alone (P <.05; Mann-Whitney test). One year after the start of treatment, 90% of HVPC-treated wounds were healed, compared with 29% of the wounds that received only standard care (P <.05; Fisher exact test). For the HVPC group, maximum periwound TcPo(2) improved during electrotherapy (6 +/- 8 mm Hg [standard deviation; SD] at baseline improved to 26 +/- 20 SD, during HVPC, P <.05; Wilcoxon signed rank test).
Conclusion:
The results of this retrospective trial demonstrate that HVPC plus standard care improved the healing rate of high-risk ischemic wounds. A direct relationship was shown between improved healing rates and increased periwound perfusion. A prospective randomized controlled trial is needed to further support these observational, preliminary findings.