Electricity Can Renovate Even the Worst Type of Wounds

Electricity has been used in so many applications in the past, but its use to heal wounds is an emerging field that is gaining people's interest in research and the health arena. Recently, a study made some discoveries that could validate that electricity can heal wounds to a more impressive extent by threefold on even the worst cases. This groundbreaking discovery not only illuminates the complex mechanisms of electrical healing but will eventually become the innovation in the field for new approaches in medical treatment and wound care. We explore here the transformative power of electricity in wound healing through our look into the key findings of the study, its implications for healthcare practices and the future prospects of integrating electrical stimulation in clinical settings.

How electricity actually heal wounds

Our skin is our body’s largest external organ and it plays a crucial role in acting as the first line of defense against mechanical and pathogenic threats, and ideally, any injury to this barrier will be repaired rapidly [1]. A wound is any injury causing a break in the structure of living tissue, which may go beyond the skin’s epithelial layer to affect the underlying subcutaneous structures depending on the extent of damage [1]. Wound healing is a complex yet well-orchestrated physiological process involving a variety of cells and chemical mediators. The series of events involved in wound healing can be broadly classified into three main phases: (a) The inflammatory phase, (b) the proliferative phase, and (c) the remodeling phase [1]. The events occurring in these phases involve hemostasis to control bleeding, migration of inflammatory cells to the wound site (chemotaxis), granulation tissue formation, collagen repair, vascularization, and re-epithelialization [2]. These important events work through a signaling system coordinated by a myriad of mediators such as growth factors and cytokines [2]. Examples of these include transforming growth factor (TGF), insulin-like growth factor (IGF), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF), keratinocyte growth factor (KGF), and platelet derived growth factor (PDGF), that collectively help induce differentiation of immune cells to clear debris and fight infection, stimulate growth, promote formation of new blood vessels, and release inflammatory mediators [3]. Figure 1 depicts the stages of cutaneous wound healing (specifically Figure 1A depicts a wound during the inflammatory phase of healing and Figure 1B depicts a wound during the proliferative and remodeling phase of healing) and the respective growth factors released to stimulate immune cells and cutaneous structures.
       
           
       

Figure 1. (A) A cutaneous wound 3 days after injury. Growth factors thought to be necessary for cell movement into the wound are shown. TGF-?1, TGF-?2, and TGF-?3 denote transforming growth factor ?1, ?2, and ?3, respectively; TGF-? transforming growth factor ?; FGF fibroblast growth factor; VEGF vascular endothelial growth factor; PDGF, PDGF AB, and PDGF BB platelet-derived growth factor, platelet-derived growth factor AB, and platelet-derived growth factor BB, respectively; IGF insulin-like growth factor; and KGF keratinocyte growth factor. (B) A cutaneous wound 5 days after injury. Blood vessels are seen sprouting into the fibrin clot as epidermal cells resurface the wound. Proteinases thought to be necessary for cell movement are shown. The abbreviation u-PA denotes urokinase-type plasminogen activator; MMP-1, 2, 3, and 13 matrix metalloproteinases 1, 2, 3, and 13 (collagenase 1, gelatinase A, stromelysin 1, and collagenase 3, respectively); and t-PA tissue plasminogen activator. Images reproduced with permission from [4]. The wound healing process is also influenced by our skin’s endogenous electric potential [5], also dubbed the endogenous “skin battery” [6]. In undamaged skin, a natural electrical potential of 10–60 mV between the epidermal and sub-epidermal layer exists [6]. This is largely attributed to the transport of ions through ion channels and the frequent depolarization and repolarization of cells [7]. This trans-epithelial voltage (TEP) largely increases around a wound. The disruption to the epithelium by an injury creates a short-circuit to the TEP, driving positive electrical flow towards the wound, as depicted in Figure 2. [8,9].
       
           
       

Injuries produce an electric current [10], and clinical studies have shown that the voltage difference between the wound site and the undamaged skin ranges between 100 and 150 mV/mm [7,8,9].

Figure 2. The current of injury is thought to be significant in initiating repair. Undamaged human skin has an endogenous electrical potential and a transcutaneous current potential of 20–50 mV. This is generated by the movement of sodium ions through Na+/K+ ATPase pumps in the epidermis. The current of injury is generated through epithelial disruption. Following an injury to the skin, a flow of current through the wound pathway generates a lateral electrical field and this is termed the “current of injury” or “skin battery” effect. Image reproduced with permission from [11]. These endogenous electric fields play a critical role in wound healing [7,8], with resulting endogenous currents acting as a cue for cellular migration which concomitantly help heal wounds [8]. In addition, it is noteworthy that without this current, it is estimated that the average healing rate decreases by 25% [12]. This phenomenon motivates the exploration of the use of electrical stimulation (ES) to accelerate wound healing for various applications [13]. Most cutaneous lesions take a week or two to heal. However, this is prolonged in chronic wounds, which do not progress systematically through the healing stages [14]. This can be due to factors that hamper the wound healing process such as age, obesity, smoking, nutritional deficiencies or underlying diseases that predispose patients to develop chronic wounds (e.g., diabetes mellitus and/or peripheral venous disease) [14]. In conditions such as diabetes, wounds remain in a chronic inflammatory phase due to impaired cellular migration, growth factor release, and poor microcirculation [15]. In addition to this, chronic wounds host various microbes that colonize and multiply within the unhealed tissue, further contributing to impaired healing [15]. Chronic wounds broadly include diabetic ulcers, pressure sores, and ulcers caused by arterial and venous insufficiency (vascular ulcers) [16]. Figure 3 depicts these chronic wounds and their pathophysiology is briefly described in Table 1 [17]. The staging of pressure and diabetic foot ulcers is outlined in Appendix A. Some researchers postulate that the endogenous current observed upon injury is markedly reduced in chronic wounds, contributing to its impaired healing [18]. Although these wounds have different etiologies, they possess common characteristics including: Excessive inflammation, tendency to get recurrent infection, improper vascularization, and slower migration of epithelial cells to mediate repair [17,18,19].
       
           
       

Figure 3. Types of chronic wounds (from left to right): Venous leg ulcer, arterial leg ulcer, neuropathic diabetic foot ulcer, and pressure ulcer. Image adapted with permission from [20].

Types of electrical stimulation

Electrical stimulation is used for a variety of clinical applications, such as fracture repair, pain management, and wound healing. Several different applications of electricity have been described, including direct current (DC), alternating current (AC), high-voltage pulsed current (HVPC), and low-intensity direct current (LIDC). Physicians are probably most familiar with pulsed electromagnetic field (PEMF) for repair of fracture non-unions and transcutaneous electrical nerve stimulation (TENS) for pain control (29, 30). Frequency rhythmic electrical modulation systems (FREMS) is a form of transcutaneous electrotherapy using electrical stimulation that automatically varies in terms of pulse, frequency, duration, and voltage (31). Even through the electrical stimulation and wound healing literature uses several different types of electrical stimulation, they all seem to have positive results.

Treatment Side Effects

the concept of using electricity on the body may sound painful and horrifying, it is not so in actuality. Many people find the sensation relaxing. People experience a tingling, vibrating, or buzzing sensation which is not unpleasant. It includes a range of treatments using electricity to reduce pain, improve circulation, repair tissues, strengthen muscles and promote bone growth. However, the most common side effect with electrotherapy is skin irritation, which is even caused by the overuse of adhesives electrodes or the tape holding the electrodes in place.

Although there are no side effects of Electrotherapy devices, there are few recommendation applies to the following people:

Pregnant women. People with epilepsy. People with heart problems or any type of electrical or metal implant. Not to be applied over organs or infectious area of the skin.

Study limitations

There are several limitations to this review. There were several different applications of electrical stimulation (PEMF, TENS, high voltage galvanic stimulation), different doses, and durations of therapy that were studied and reported. In addition, many of the studies were small and may have been underpowered. And unlike industry-sponsored phase-three clinical trials, many studies looked at percent change in wound area at 4–6 weeks as the primary outcome rather than complete wound healing at 12 or 20 weeks. Despite variations in the type of current, duration, and dosing of electrical stimulation, the majority of trials showed a significant improvement in wound area reduction or wound healing compared to the standard of care or sham therapy (Table 2) as well as improved local perfusion (Table 1). In fact, these factors were different in all 16 RCTs