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

Impaired microcirculation contributes to delayed healing in venous, arterial, diabetic and mixed-aetiology ulcers. Activation of the leg muscle pump by intermittent neuromuscular electrostimulation of the common peroneal nerve has been proposed to improve microvascular perfusion. This review examines current evidence for neuromuscular electrostimulation effecting changes in microvascular flux in chronic lower-limb ulcers of all aetiologies, as measured by Laser Speckle Contrast Imaging. Eligible studies were limited to human research evaluating the effects on chronic lower-limb ulcers of any aetiology. Four eligible studies (total n = 44) were identified. In venous ulcers, neuromuscular electrostimulation increased wound bed flux by 28.5% (p < 0.05), and pulsatility by 126% (p < 0.05). In arterial leg ulcers, flux increased by 60.9% (p < 0.02) and pulsatility by 161% (p < 0.02). In mixed aetiology ulcers, wound bed flux increased by 38.2% (p < 0.05) and pulsatility by 214% (p < 0.05). In diabetic foot ulcers, flux increased by 40.2% (p < 0.01) and pulsatility by 406% (p < 0.01). Across all ulcer types combined, wound-bed flux increased by 37.6% (p < 0.001) and pulsatility by 198% (p < 0.001). There is compelling evidence that intermittent neuromuscular stimulation of the common peroneal nerve enhances microcirculatory perfusion in the wound bed of chronic leg and foot ulcers. These consistent physiological improvements support its potential as an adjunctive therapy.