High-voltage electrical stimulation for the management of stage III and IV pressure ulcers among adults with spinal cord injury: demonstration of its utility for recalcitrant wounds below the level of injury

Abstract

Context: patients with spinal cord injury (SCI) have many factors that are associated with pressure ulcer formation, including paralysis, loss of sensation, poor nutrition, anemia, and skin maceration related to incontinence. Treatment of these ulcers involves relieving pressure, improving nutrition and skin hygiene, treating infections, removing necrotic tissues, and applying the appropriate dressings. However, some cases are not responsive to the above treatment. Electrical stimulation (ES) is thought to enhance soft tissue healing through promotion of protein synthesis, inhibition of bacterial growth, facilitation of epithelial tissue migration, improvement of blood flow, and tensile strength. This data is mainly based on evidence from animal studies and very few rigorously controlled studies conducted in humans.

Objective: To demonstrate the effectiveness of ES in the treatment of recalcitrant pressure ulcers.

Methods: Retrospective case series describing the care of adults with SCI and recalcitrant pressure ulcers. ES was applied directly into the wound bed: 60 minutes per session, 3-5 times per week; with an intensity of 100 milliamperes and a frequency of 100 pulses per second. Polarity was negative initially and was switched weekly. The amplitude and wave form were maintained throughout.

Results: The long-standing (11-14 months) pressure ulcers were completely healed after 7 to 22 weeks of treatment with high-voltage ES.

Conclusion/clinical relevance: This case series demonstrates the effectiveness of ES for enhanced healing of Stage III-IV ulcers otherwise unresponsive to standard wound care. Further study is needed to identify the most effective protocol for ES therapy in the treatment of recalcitrant pressure ulcers.

Figure 1

Patient A's recalcitrant pressure ulcer at initial evaluation and the progression of wound healing after application of high voltage electrical stimulation (HVES). Source: Kennedy Krieger Institute.

Figure 2

Patient B's recalcitrant pressure ulcer at initial evaluation and the progression of wound healing after application of HVES. Source: Kennedy Krieger Institute.

Figure 3

Patient C's recalcitrant pressure ulcer at initial evaluation and the progression of wound healing after application of HVES. Source: Kennedy Krieger Institute.

Graph 1

Patient A, B, and C's measured WSA pre- and post-application of HVES for recalcitrant pressure ulcers.