Neuromuscular Electrostimulation and Microvascular Perfusion in Chronic Lower-Limb Ulcers: A Systematic Review

Area of Science:

• Vascular Medicine
• Regenerative Medicine
• Biomedical Engineering

Background:

• Impaired microcirculation is a key factor in delayed healing of various chronic lower-limb ulcers.
• The leg muscle pump mechanism, activated by neuromuscular electrostimulation, is a potential method to enhance microvascular perfusion.

Purpose of the Study:

• To review existing evidence on the impact of neuromuscular electrostimulation on microvascular flux in chronic lower-limb ulcers.
• To assess the efficacy of stimulating the common peroneal nerve in improving blood flow in ulcerated leg and foot tissues.

Main Methods:

• Systematic review of human studies evaluating neuromuscular electrostimulation for chronic lower-limb ulcers.
• Analysis of Laser Speckle Contrast Imaging data to measure microvascular flux and pulsatility changes.
• Inclusion of studies across all ulcer aetiologies: venous, arterial, diabetic, and mixed.

Main Results:

• Neuromuscular electrostimulation significantly increased wound bed flux (28.5%-60.9%) and pulsatility (126%-406%) across all ulcer types.
• Combined analysis showed a 37.6% increase in flux (p<0.001) and a 198% increase in pulsatility (p<0.001).
• Consistent improvements were observed in venous, arterial, mixed-aetiology, and diabetic foot ulcers.

Conclusions:

• Intermittent neuromuscular stimulation of the common peroneal nerve effectively enhances microcirculatory perfusion in chronic leg and foot ulcers.
• The observed physiological improvements suggest potential benefits as an adjunctive therapy for wound healing.
• Evidence supports neuromuscular electrostimulation as a viable option to improve blood flow in challenging ulcer cases.