title: 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: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA. Recio@kennedykrieger.org
authors.forename: Albert C
authors.initials: AC
authors.lastname: Recio
authors.forename: Cara E
authors.initials: CE
authors.lastname: Felter
authors.forename: Anna Corrine
authors.initials: AC
authors.lastname: Schneider
authors.forename: John W
authors.initials: JW
authors.lastname: McDonald
mesh_terms: D019468:Disease Management; D004599:Electric Stimulation Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000209:etiology* / Q000534:rehabilitation*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014945:Wound Healing