Effectiveness of Lower-Extremity Electrical Stimulation to Improve Skin Perfusion

Background: Although numerous studies suggest the benefit of electrical stimulation (E-Stim) therapy to accelerate wound healing, the underlying mechanism of action is still debated. In this pilot study, we examined the potential effectiveness of lower-extremity E-Stim therapy to improve tissue perfusion in patients with diabetic foot ulcers. Methods: Thirty-eight patients with diabetic foot ulcers underwent 60 min of active E-Stim therapy on acupuncture points above the level of the ankle joint using a bioelectric stimulation technology platform. Perfusion changes in response to E-Stim were assessed by measuring skin perfusion pressure (SPP) at baseline and during 30 and 60 min of therapy; retention was assessed 10 min after therapy. Tissue oxygen saturation (SatO₂) was measured using a noninvasive near-infrared camera. Results: Skin perfusion pressure increased in response to E-Stim therapy (P ¼ .02), with maximum improvement observed at 60 min (11%; P ¼ .007) compared with baseline; SPP reduced 10 min after therapy but remained higher than baseline (9%; P ¼ .1). Magnitude of improvement at 60 min was negatively correlated with baseline SPP values (r ¼ –0.45; P ¼ .01), suggesting that those with lower perfusion could benefit more from E-Stim therapy. Similar trends were observed for SatO₂, with statistically significant improvement for a subsample (n ¼ 16) with moderate-to-severe peripheral artery disease. Conclusions: This study provides early results on the feasibility and effectiveness of E-Stim therapy to improve skin perfusion and SatO₂. The magnitude of benefit is higher in those with poorer skin perfusion. Also, the effects of E-Stim could be washed out after stopping therapy, and regular daily application might be required for effective benefit in wound healing. (J Am Podiatr Med Assoc 111(6): 1-11, 2021).