References
Electromedical devices in wound healing management: a narrative review
Abstract
Wound healing is the sum of physiological sequential steps, leading to skin restoration. However, in some conditions, such as diabetes, pressure ulcers (PU) and venous legs ulcers (VLU), healing is a major challenge and requires multiple strategies. In this context, some electromedical devices may accelerate and/or support wound healing, modulating the inflammatory, proliferation (granulation) and tissue-remodelling phases. This review describes some helpful electromedical devices including: ultrasonic-assisted wound debridement; electrotherapy; combined ultrasound and electric field stimulation; low-frequency pulsed electromagnetic fields; phototherapy (for example, laser therapy and light-emitting diode (LED) therapy); biophotonic therapies, and pressure therapies (for example, negative pressure wound therapy, and high pressure and intermittent pneumatic compression) The review focuses on the evidence-based medicine and adequate clinical trial design in relation to these devices.
Wounds can be either acute or hard-to-heal. Acute wounds usually heal in a regular time line; however, wounds that are hard-to-heal depend on topography, ageing, nutrition, pathophysiologic or metabolic factors.1 Wounds or ulcers that generally take longer than three weeks to heal are classed as hard-to-heal.2 vWhile primary or secondary intention skin healing is generally completed within two weeks.3 In hard-to-heal wounds, the healing phases stall, prolonging inflammation, with a consequent reduction in collagen and angiogenesis.4 These wounds are often associated with diabetes, venous stasis, pressure ulcers (PUs), burns and traumatic injuries.5 Thus, early diagnosis and treatment is essential as hard-to-heal wounds have a great impact on patients' quality of life (QoL).
A wide range of stimulation protocols are described for the treatment of hard-to-heal wounds, such as drugs and bioactive dressings, with variable outcomes.6,7,8 Novel wound healing strategies have been developed to overcome shortcomings in standard care. These include tissue engineered scaffolds, gene therapy, stem cell-based therapy and biophysical therapeutic interventions based on light emission (photobiomodulation and biophotonic gels, low-level laser/light therapy), ultrasounds, electrotherapy (or the combined use of electrical field and ultrasounds), compression therapy and electromagnetic field stimulation. These biomedical applications have been successfully applied to different kinds of hard-to-heal wounds, including burns, diabetic foot ulcers (DFU), venous, arterial, and mixed leg ulcers.
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