According to CMS, 15% of all Medicare beneficiaries experience chronic nonhealing wounds at an annual cost of nearly $32 billion. Normal wound healing involves the inflammatory, proliferative, and remodeling phases. When wound healing fails to progress properly and persists for longer than one month, it may be described as a chronic wound. Patients with chronic wounds often have multiple comorbidities which may hinder healing. Electrical stimulation is a biophysical agent known to assist in the progression of wound healing.

The Centers for Medicare & Medicaid Services (CMS) coverage decision memorandum for electrical stimulation for the treatment of chronic wounds states:

“Electrical stimulation is defined as the application of electrical current through electrodes applied directly to the skin in close proximity to the ulcer. Based on all the evidence that we reviewed in this matter, it is our intention to issue a positive coverage decision only on the use of electrical stimulation for “chronic” Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic
ulcers and venous stasis ulcers. All other uses of electrical stimulation for the treatment of wounds are not covered.”

Evidence for electrical stimulation in the treatment of wounds:

• The National Pressure Ulcer Advisory Panel (NPUAP), the European Pressure Ulcer Advisory Panel (EPUAP), and the Pan Pacific Pressure Injury Alliance (PPPIA) have all issued clinical practice guideline recommendations for electrical stimulation in pressure ulcer treatment with an “A” for strength of evidence. It is the only biophysical agent to receive this rating. The “A” recommendation is supported by direct scientific evidence from properly designed and implemented controlled trials on pressure ulcers in humans (or humans at risk of pressure ulcers), providing statistical results that consistently support the recommendation with Level 1 studies.¹
• Electrical stimulation was associated with faster wound area reduction or a higher proportion of wounds that healed in 14 out of 16 wound randomized controlled trials.²
• Both high volt electrical stimulation and ultrasound are promising methods for wound healing, and both electrotherapy modalities have been demonstrated to support the healing of pressure ulcers.³
• ACP’s Wound Healing clinical program pathway uses several types of biophysical agent modalities in the treatment of chronic wounds. High volt pulsed current bipolar applications are pictured below. For guidance and training in the treatment of chronic wounds, please contact ACP.⁴

References:
1.NPAUP, EPUAP, and PPPIA: Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline, 2017.
2. Thakral G, LaFontaine J, Najafi B, Talal TK, Kim P, Lavery LA: Electrical stimulation to accelerate wound healing. Diabetic Foot Ankle. Sep 2013.
3. Bora KP, Gurcay E, Karaahmet OZ, Cakci A: High-voltage Electrical Stimulation Versus Ultrasound in the Treatment of Pressure Ulcers. Adv Skin Wound Care; 30(12) 565-570, 2017.
4. ACP Wound Healing Clinical Solution.