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August 1993, Vol 129, No. 8 >
Article | August 1993

A Multicenter Study on the Use of Pulsed Low-Intensity Direct Current for Healing Chronic Stage II and Stage III Decubitus Ulcers

John M. Wood, PhD; Paul E. Evans, III, MD; Karin U. Schallreuter, MD; Wyman E. Jacobson, MD; Robert Sufit, MD; Jeffrey Newman, RPT; Clarence White, CPT; Maralyn Jacobson
[+] Author Affiliations

From the Department of Dermatology, University of Hamburg (Germany) (Drs Wood and Schallreuter); Department of Family Practice, Medical College of Virginia, Newport News (Dr Evans); Department of Medicine, University of Minnesota, Minneapolis (Dr W. E. Jacobson); Rehabilitation Medicine Service, Veterans Administration Hospital, Madison, Wis (Dr Sufit and Ms M. Jacobson); and Veterans Administration Medical Center, Minneapolis (Mr Newman); Veterans Administration Hospital, St Cloud, Minn (Mr White). Dr Wood is currently with Clinical Biochemistry, University of Bradford, Biomedical Sciences, United Kingdom.


Arch Dermatol. 1993;129(8):999-1009. doi:10.1001/archderm.1993.01680290071011
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Background and Design:  Pulsed low-intensity direct current (300 to 600 μA) has been used in a double-blind placebo multicenter study in the treatment of stage II and stage III chronic decubitus ulcers.

Results:  Seventy-four ulcers were treated in four centers. Forty-three patients were selected for the experimental group, and 31 control subjects used the sham instrument (placebo group). In the treated group, 25 ulcers (58%) healed in 8 weeks, whereas in the placebo group, only one ulcer (3%) healed and most ulcers increased in size. Statistical analysis, based on surface area and ulcer depth before and after treatment, showed that lowintensity direct current had a significant influence on the healing rates for these ulcers (P<.0001). Experiments with guinea pigs (n=10) showed that pulsed low-intensity direct current caused a rapid calcium flux in the epidermis.

Conclusions:  Pulsed low-intensity direct current represents a useful approach for the treatment of stage II and stage III chronic decubitus ulcers by increasing the healing rate. The growth of fibroblasts and keratinocytes may be enhanced by pulsed low-intensity direct current due to changes in calcium homeostasis.(Arch Dermatol. 1993;129:999-1009)

REFERENCES

1 +
Michocki RJ, Lamy PP.  The problem of pressure sores in a nursing home population: statistical data . J Am Geriatr Soc. 1976;;24:323-328.
2 +
Sternberg J, Spector WD, Kapp MC, Tucker RJ.  Decubitus ulcers on admission to nursing homes: prevalence and residents' characteristics . Decubitus. 1988;;1:14-20.
3 +
Hu KT, Go N, Dennis C, et al.  Effects of electric currents and interfascial potentials on wound healing . J Surg Res. 1962;;3:122-128.
4 +
Carey LC, Lepley D.  Effect of continuous direct electrical current on healing wounds . Surg Forum. 1962;;13:33-35.
5 +
Assimacopoulus D.  Low intensity negative electric current in the treatment of ulcers of the leg due to chronic venous insufficiency . Am J Surg. 1968;; 115:683-687.
6 +
Assimacopoulus D.  Wound healing promotion by the use of negative electric current . Am Surg. 1968;;34:423-431.
7 +
Alvarez OM, Mertz PM, Smerbeck RV, et al.  The healing of superficial skin wounds is stimulated by external electric current . J Invest Dermatol. 1983;; 81:144-148.
8 +
Carley PJ, Wainapel SF.  Electrotherapy for acceleration of wound healing: low intensity direct current . Arch Phys Med Rehabil. 1985;;66:443-446.
9 +
Kloth LC, Feeder JA.  Acceleration of wound healing with high voltage monophasic pulsed current . Phys Ther. 1988;;68:503-508.
10 +
Mulder GD.  Treatment of open skin wounds with electric stimulation . Arch Phys Med Rehabil. 1991;;72:375-377.
11 +
Weiss DS, Kirsner R, Eaglstein WH.  Electrical stimulation and wound healing . Arch Dermatol. 1990;;126:222-225.
12 +
Burr HS, Taffel M, Harvey SC.  An electrometric study of the healing wound in man . Yale J Biol Med. 1940;;12:483-485.
13 +
Barker AT, Jaffe LF, Venable JW.  The glabrous epidermis of caries contains a powerful battery . Am J Physiol. 1982;;242:358-365.
14 +
Illingurth CM, Barker AT.  Measurement of electrical currents emerging during the regeneration of amputated fingertips in children . Clin Phys Physiol Meas. 1980;;1:87-89.
15 +
Meyer W, Poehling HM, Neurard K.  Intra-epidermal distribution of free amino acids in porcine skin . J Dermatol Sci. 1991;;2: (5) , 383-392.
16 +
Becker RO.  The bioselectric factors in amphibian limb regeneration . J Bone Joint Surg Am. 1961;;43:643-656.
17 +
US Patent No. 4728250.
18 +
Cheng N, VanHoof H, Bock E.  The effects of electric currents on ATP generation, protein synthesis, and membrane transport in rat skin . Clin Orthop. 1982;;171:264-272.
19 +
Rodeheaver G.  Controversies in topical wound management . Ostomy/Wound Manag. 1988;;21:64-83.
20 +
Alvarez O.  Moist environment for healing: matching the dressing to the wound . Ostomy/Wound Manag. 1988;;21:64-83.
21 +
Schallreuter KU, Wood JM.  The role of thioredoxin reductase in the reduction of free radicals at the surface of the epidermis . Biochem Biophys Res Commun. 1986;;136: (2) , 630-637.
22 +
Schallreuter KU, Wood JM.  Thioredoxin reductase in control of the pigmentary system . In: Mackie R, ed. Clinics in Dermatology: Disorders of Pigmentation . Philadelphia, Pa: JB Lippincott; 1989;;7:92-105.
23 +
Sundaram C, Köster W, Schallreuter KU.  The effect of UV-radiation and sun blockers on free radical defense in human and guinea pig epidermis . Arch Dermatol Res. 1990;;282:526-531.
24 +
Schallreuter KU, Pittelkow MR, Wood JM.  EF-hands calcium binding regulates the thioredoxin reductase/thioredoxin electron transfer in human keratinocytes . Biochem Biophys Res Commun. 1989;;162:1311-1316.
25 +
Schallreuter KU, Wood JM.  Calcium regulates thioredoxin reductase in human metastatic melanoma . Biochim Biophys Acta . 1989;;997:242-247.
26 +
Schallreuter KU, Wood JM.  EF-hands calcium binding regulates the thioredoxin reductase/thioredoxin electron-transfer in human keratinocytes and melanoma . In: Heizmann K, ed. Recent Advances in the Role of Calcium in Medicine . New York, NY: Springer-Verlag NY Inc; 1991;:339-360.
27 +
Schallreuter KU, Jänner M, Mensing H, et al.  Thioredoxin reductase activity at the surface of human primary cutaneous melanomas and their surrounding skin . Int Cancer J. 1991;;48:15-19.
28 +
Fitton-Jackson SF, Bassett CAL. Tissue Culture in Medical Research II . Elmsford, NY: Pergamon Press Inc; 1980;;21-28.
29 +
Falanga V, Bourguigon GJ, Bourguigon LY.  Electrical stimulation increases the expression of fibroblast receptors for transforming growth factor β . J Invest Dermatol. 1987;;88:488.
30 +
Ratafia M.  Growth factors for wound healing . Ostomy/Wound Manag. 1988;; 21:20-24.
31 +
Mitchell P.  Vectorial chemistry and molecular mechanism of chemiosmosis coupling: power transmission by proticity . Biochem Soc Trans. 1976;;4: 400-430.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Michocki RJ, Lamy PP.  The problem of pressure sores in a nursing home population: statistical data . J Am Geriatr Soc. 1976;;24:323-328.
2 +
Sternberg J, Spector WD, Kapp MC, Tucker RJ.  Decubitus ulcers on admission to nursing homes: prevalence and residents' characteristics . Decubitus. 1988;;1:14-20.
3 +
Hu KT, Go N, Dennis C, et al.  Effects of electric currents and interfascial potentials on wound healing . J Surg Res. 1962;;3:122-128.
4 +
Carey LC, Lepley D.  Effect of continuous direct electrical current on healing wounds . Surg Forum. 1962;;13:33-35.
5 +
Assimacopoulus D.  Low intensity negative electric current in the treatment of ulcers of the leg due to chronic venous insufficiency . Am J Surg. 1968;; 115:683-687.
6 +
Assimacopoulus D.  Wound healing promotion by the use of negative electric current . Am Surg. 1968;;34:423-431.
7 +
Alvarez OM, Mertz PM, Smerbeck RV, et al.  The healing of superficial skin wounds is stimulated by external electric current . J Invest Dermatol. 1983;; 81:144-148.
8 +
Carley PJ, Wainapel SF.  Electrotherapy for acceleration of wound healing: low intensity direct current . Arch Phys Med Rehabil. 1985;;66:443-446.
9 +
Kloth LC, Feeder JA.  Acceleration of wound healing with high voltage monophasic pulsed current . Phys Ther. 1988;;68:503-508.
10 +
Mulder GD.  Treatment of open skin wounds with electric stimulation . Arch Phys Med Rehabil. 1991;;72:375-377.
11 +
Weiss DS, Kirsner R, Eaglstein WH.  Electrical stimulation and wound healing . Arch Dermatol. 1990;;126:222-225.
12 +
Burr HS, Taffel M, Harvey SC.  An electrometric study of the healing wound in man . Yale J Biol Med. 1940;;12:483-485.
13 +
Barker AT, Jaffe LF, Venable JW.  The glabrous epidermis of caries contains a powerful battery . Am J Physiol. 1982;;242:358-365.
14 +
Illingurth CM, Barker AT.  Measurement of electrical currents emerging during the regeneration of amputated fingertips in children . Clin Phys Physiol Meas. 1980;;1:87-89.
15 +
Meyer W, Poehling HM, Neurard K.  Intra-epidermal distribution of free amino acids in porcine skin . J Dermatol Sci. 1991;;2: (5) , 383-392.
16 +
Becker RO.  The bioselectric factors in amphibian limb regeneration . J Bone Joint Surg Am. 1961;;43:643-656.
17 +
US Patent No. 4728250.
18 +
Cheng N, VanHoof H, Bock E.  The effects of electric currents on ATP generation, protein synthesis, and membrane transport in rat skin . Clin Orthop. 1982;;171:264-272.
19 +
Rodeheaver G.  Controversies in topical wound management . Ostomy/Wound Manag. 1988;;21:64-83.
20 +
Alvarez O.  Moist environment for healing: matching the dressing to the wound . Ostomy/Wound Manag. 1988;;21:64-83.
21 +
Schallreuter KU, Wood JM.  The role of thioredoxin reductase in the reduction of free radicals at the surface of the epidermis . Biochem Biophys Res Commun. 1986;;136: (2) , 630-637.
22 +
Schallreuter KU, Wood JM.  Thioredoxin reductase in control of the pigmentary system . In: Mackie R, ed. Clinics in Dermatology: Disorders of Pigmentation . Philadelphia, Pa: JB Lippincott; 1989;;7:92-105.
23 +
Sundaram C, Köster W, Schallreuter KU.  The effect of UV-radiation and sun blockers on free radical defense in human and guinea pig epidermis . Arch Dermatol Res. 1990;;282:526-531.
24 +
Schallreuter KU, Pittelkow MR, Wood JM.  EF-hands calcium binding regulates the thioredoxin reductase/thioredoxin electron transfer in human keratinocytes . Biochem Biophys Res Commun. 1989;;162:1311-1316.
25 +
Schallreuter KU, Wood JM.  Calcium regulates thioredoxin reductase in human metastatic melanoma . Biochim Biophys Acta . 1989;;997:242-247.
26 +
Schallreuter KU, Wood JM.  EF-hands calcium binding regulates the thioredoxin reductase/thioredoxin electron-transfer in human keratinocytes and melanoma . In: Heizmann K, ed. Recent Advances in the Role of Calcium in Medicine . New York, NY: Springer-Verlag NY Inc; 1991;:339-360.
27 +
Schallreuter KU, Jänner M, Mensing H, et al.  Thioredoxin reductase activity at the surface of human primary cutaneous melanomas and their surrounding skin . Int Cancer J. 1991;;48:15-19.
28 +
Fitton-Jackson SF, Bassett CAL. Tissue Culture in Medical Research II . Elmsford, NY: Pergamon Press Inc; 1980;;21-28.
29 +
Falanga V, Bourguigon GJ, Bourguigon LY.  Electrical stimulation increases the expression of fibroblast receptors for transforming growth factor β . J Invest Dermatol. 1987;;88:488.
30 +
Ratafia M.  Growth factors for wound healing . Ostomy/Wound Manag. 1988;; 21:20-24.
31 +
Mitchell P.  Vectorial chemistry and molecular mechanism of chemiosmosis coupling: power transmission by proticity . Biochem Soc Trans. 1976;;4: 400-430.

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