Combination of occlusive dressings and electrical stimulation in pressure ulcer treatment

Introduction: Knowledge of the greater efficiency of wound healing in a moist environment dates back to the early 1960s, when Winter [1] first demonstrated significantly faster wound epithelisation in occluded experimental wounds in pigs as compared to air-exposed controls. In 1963, the beneficial effect of occlusion was also established in human wounds [2]. This discovery gained considerable attention, yet not until two decades later, when the development of new technologies facilitated the production of a new generation of wound dressings, was it employed in routine wound treatment. As they are based on the control of the wound microenvironment, mainly tissue hydration, these dressings are known as occlusive. Occlusive dressings experienced a great upswing in a very short period, despite the limited knowledge of the full biological effects of wound occlusion. Winning recognition for non-conventional wound treatments, one of them being electrical stimulation, is much more difficult than for this new concept in conventional wound care. Various applications of electricity have been studied for their capacity to enhance wound healing [3]. In the present preliminary study, we combined conventional wound care with occlusive dressings with electrotherapy, which proved successful for pressure ulcer management in an earlier extensive clinical trial [4]. This combined treatment is in line with an almost ten year old vision by Turner [5]. He foresaw the evolution of chronic wound dressings in three stages: traditional "passive" wound dressings have been overtaken by "interactive" occlusive dressings, which are able to control the wound microenvironment but do not release any active substances into the wound. In the future he foresaw the development of "active" dressings, which would actively affect the healing process. The combined treatment employed in our preliminary research can be observed as an active electronic dressing, in which the concept of wound environment control is supplemented by electrical stimulation, which actively influences healing. Looking for the optimum therapy for chronic wounds, the main purpose of the present study was thus to assess the efficacy of the combination of occlusive wound dressings and electrical stimulation in the treatment of pressure ulcers and to compare it with that of occlusive dressings alone and of electrical stimulation alone.