Electric Stimulation Enhances Healing of Diabetic Foot Ulcers

WESTPORT, CT (Reuters Health) Jun 2001 - When used in conjunction with appropriate off-loading and local wound care, high-voltage, pulsed galvanic electric stimulation appears to increase the likelihood of healing of diabetic foot ulcers, according to data from a trial conducted in Texas.

In the Archives of Physical Medicine and Rehabilitation for June, Dr. Lawrence A. Lavery and colleagues describe "the Micro-Z, a small 5.5 x 6 cm electric stimulation device, that delivers current [at a subsensory level] via a microcomputer to a Dacron-mesh silver nylon stocking."

Dr. Lavery, of the University of Texas Health Sciences Center in San Antonio, told Reuters Health that the Micro-Z differs from traditional transcutaneous electrical nerve stimulation (TENS) units in "providing high-pulse galvanic voltage and penetrating more deeply into tissue."

He and his team treated 40 diabetic patients with noninfected foot ulcers with debridement, collagen wound gel, pressure reduction at the ulcer site, and twice-daily dressing changes. Subjects were randomly assigned to electric stimulation or sham treatment.

For 8 hours a night, the electric stimulation device was programmed to repeatedly deliver a 50 V dose "with 80 twin peak monophasic pulses per second" for 10 minutes, followed by 10 minutes of eight pulses per second and then 40 minutes on standby.

Ulcers healed in 13 patients treated with electric stimulation and seven patients given sham treatment during the 12-week study period. Dr. Lavery and his associates report that change in ulcer cross-sectional area was 86.2% in the treatment group and 71.4% in the control group.

Electric stimulation "didn't heal ulcers faster, but healed a higher proportion of them," Dr. Lavery pointed out.

"We've been using electric stimulation for about 4 years now," he continued. "For some people, it gives them the metabolic nudge, if you will, to turn the corner when their wounds have stalled."

He added that this therapy has been a good option for patients with vascular disease who "couldn't be bypassed because they were too systemically sick or there was no good place to bypass into the foot."

"It's not a silver bullet," Dr. Lavery said, noting that electric stimulation must be used in conjunction with other standard wound care measures. However, he said, "It's more promising than some pharmaceuticals that I've seen."

The authors report that the device they used is relatively new and that no previous clinical studies of its use for diabetic foot ulcers have been reported.

Arch Phys Med Rehabil 2001;82:721-724.