Adjunctive Therapies in Pressure Ulcers

  • Jakub TaradajEmail author
  • Elia Ricci


According to the newest “National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline” published one year ago, several forms of biophysical agents have been examined for healing pressure ulcers. The recommendation for these alternative therapies is due to direct scientific evidence from properly designed and implemented clinical studies on pressure ulcers in humans (or on humans at risk for pressure ulcers); providing statistical results that consistently support the final statement. One of the proposed adjunctive method in this document its electrical stimulation with the strongest evidence (grade A) and with the highest recommendation level. Electrotherapy is an algorithm for wound healing, which is well-documented and supported by literature. However, there are some other interesting biophysical agents, but at this moment with a much smaller (B or C) recommendation level (negative pressure wound therapy, laser stimulation and extracorporeal shock wave therapy, Topical Oxygen Therapy), which are also discussed in this chapter. Other “new devices” are proposed continuously from researcher to clinicians, polarized light, phototherapy, biophotonic treatment, magnetic field, etc. There is not actually a literature that supports strongly this new treatment and we can’t include all in a chapter but the interesting fact is to deliver energy in the wound.


Electrical stimulation Electrotherapy HVPC LVMPC Laser therapy EWST Shock waves Pressure ulcers Wound healing HBOT TOTC 


  1. 1.
    National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. In: Haesler E, editor. Osborne Park, WA: Cambridge Media; 2014.Google Scholar
  2. 2.
    Houghton PE, Campbell KE, Fraser CH, Harris C, Keast DH, Potter PJ, et al. Electrical stimulation therapy increases rate of healing of pressure ulcers in community-dwelling people with spinal cord injury. Arch Phys Med Rehabil. 2010;91(5):669–78.CrossRefPubMedGoogle Scholar
  3. 3.
    Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JL. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury. Arch Phys Med Rehabil. 2009;90(2):213–31.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Ricci E, Afargan M. The effect of stochastic electrical noise on hard-to-heal wounds. J Wound Care. 2010;19(3):96–103.CrossRefPubMedGoogle Scholar
  5. 5.
    Franek A, Kostur R, Taradaj J, Blaszczak E, Szlachta Z, Dolibog P, et al. Effect of high voltage monophasic stimulation on pressure ulcer healing: results from a randomized controlled trial. Wounds. 2011;23(1):15–23.Google Scholar
  6. 6.
    Franek A, Kostur R, Polak A, Taradaj J, Szlachta Z, Blaszczak E, et al. Using high-voltage electrical stimulation in the treatment of recalcitrant pressure ulcers: results of a randomized, controlled clinical study. Ostomy Wound Manage. 2012;58(3):30–44.PubMedGoogle Scholar
  7. 7.
    Collins C, Roberts G, Zhao M, Mani R. The use of electrical stimulation of chronic wounds: a review of the evidence. JWT. 2009;6:10–9.Google Scholar
  8. 8.
    Koel G, Houghton PE. Electrostimulation: current status, strength of evidence guidelines, and meta-analysis. Adv Wound Care. 2014;3(2):118–26.CrossRefGoogle Scholar
  9. 9.
    Zhang QH, Yue JH, Sun ZR. Electroacupuncture for pressure ulcer: a study protocol for a randomized controlled pilot trial. Trials. 2014;6(15):7.CrossRefGoogle Scholar
  10. 10.
    Collins JJ, Imhoff TT, Grigg P. Noise enhanced tactile sensation. Nature. 1996;383:770.CrossRefPubMedGoogle Scholar
  11. 11.
    Adunsky A, Ory A. Decubitus direct current treatment (DDCT) of pressure ulcers: results of a randomized double-blinded placebo controlled study. Arch Gerontol Geriatr. 2005;41:261–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Woodruff LD, Bounkeo JM, Brannon WM, Dawes KS, Barham CD, Waddell DL, et al. The efficacy of laser therapy in wound repair: a meta-analysis of the literature. Photomed Laser Surg. 2004;22(3):241–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Taradaj J, Halski T, Kucharzewski M, Urbanek T, Halska U, Kucio C. Effect of laser irradiation at different wavelengths (940, 808, and 658 nm) on pressure ulcer healing: results from a clinical study. Evid Based Complement Alternat Med. 2013;960240:1–7.CrossRefGoogle Scholar
  14. 14.
    Dymarek R, Halski T, Ptaszkowski K, Slupska L, Rosinczuk J, Taradaj J. Extracorporeal shock wave therapy as an adjunct wound treatment: a systematic review of the literature. Ostomy Wound Manage. 2014;60(7):26–39.PubMedGoogle Scholar
  15. 15.
    Gottrup F, Hunt TK, Hopf WT. Role of oxygen in wound healing and infection. JWT. 2010;9:6–11.Google Scholar
  16. 16.
    Kranke P, Bennett M, Roeckl-Wiedmann I, Debus S. Hyperbaric oxygen therapy for chronic wounds (review). Chocrane Libr. 2005;3.Google Scholar
  17. 17.
    ECHM ETRS Consensus document, 2006 Ravenna.Google Scholar
  18. 18.
    Wild T, Eberlein T, Frye C. Review of evidence of topical oxygen therapy and chronic wounds. JWT. 2010;9:22–7.Google Scholar
  19. 19.
    Kloth LC. Electrical stimulation technologies for wound healing. Adv Wound Care (New Rochelle). 2014;3(2):81–90.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Physiotherapy Basics at Academy School of Physical EducationKatowicePoland
  2. 2.College of Rehabilitation Sciences at University of ManitobaWinnipegCanada
  3. 3.Difficult Wound Healing UnitSt. Luca’s ClinicPecetto TorineseItaly

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