Girgis et al. 2023
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Girgis B, Carvalho D, Duarte JA. The effect of high-voltage monophasic pulsed current on diabetic ulcers and their potential pathophysiologic factors: A systematic review and meta-analysis. Wound Repair Regen. 2023 Mar;31(2):171-186.
Design: Systematic Review and Meta-Analysis • including RCTs focusing on HVMPC application for the treatment of diabetic ulcers, neuropathic ulcers, ischemic ulcers, pressure ulcers and acute wounds. The definitions of pressure ulcers (PrUs) and DFUs might overlap, since any pressure ulcer on the foot of a patient with diabetes is defined as a diabetic foot ulcer. Results: • 32 studies matched the eligibility criteria, including 1061 patients with 1103 skin lesions; 12 RCTS were included in the quantitative meta-analysis. • HVMPC plus standard wound care (SWC) likely increased the probability of complete wound healing of pressure ulcers (PrUs) compared with sham/no stimulation plus SWC; relative risk (RR) 2.08; 95% CI: [1.42, 3.04], p = 0.0002; I2 = 0%, p = 0.61; eight studies, 358 ulcers. • Nonetheless, several aspects remain to be clarified for safe and effective application of electrical stimulation for wound healing. • Minor adverse events: some studies documented minor and rare reactions such as red, raised, itchy skin beneath the dispersive electrode that was attributed to contact dermatitis. These were usually resolved in 1-2weeks. • Serious adverse events did occur in one study, though unlikely that any were related to the HVMPC intervention.
Key message: The present review found direct evidence, with moderate certainty, for the efficacy of HVMPC to treat pressure ulcers albeit its safety needs to be confirmed. Moreover, the positive observations on many of the skin lesions with pathophysiologic factors potentially contributing to diabetic ulcers might indirectly suggest that its efficacy may not be limited to pressure ulcers.
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