Use of heat for diabetic foot chronic wounds

NewsBot · Feb 9, 2008

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The influence of local versus global heat on the healing of chronic wounds in patients with diabetes.
Petrofsky JS, Lawson D, Suh HJ, Rossi C, Zapata K, Broadwell E, Littleton L.
Diabetes Technol Ther. 2007 Dec;9(6):535-44.

BACKGROUND: In a previous study, it was shown that placing a subject with chronic diabetic ulcers in a warm room prior to the use of electrical stimulation dramatically increased the healing rate. However, global heating is impractical in many therapeutic environments, and therefore in the present investigation the effect of global heat versus using a local heat source to warm the wound was investigated.

METHODS: Twenty-nine male and female subjects participated in a series of experiments to determine the healing associated with electrical stimulation with the application of local heat through a heat lamp compared to global heating of the subject in a warm room. Treatment consisted of biphasic electrical stimulation at currents at 20 mA for 30 min three times per week for 4 weeks in either a 32 degrees C room or, with the application of local heat, to raise skin temperature to 37 degrees C. Skin blood flow was measured by a laser Doppler imager.

RESULTS: Blood flow increased with either local or global heating. During electrical stimulation, blood flow almost doubled on the outside and on the edge of the wound with a smaller increase in the center of the wound. However, the largest increase in blood flow was in the subjects exposed to global heating. Further, healing rates, while insignificant for subjects who did not receive electrical stimulation, showed 74.5 +/- 23.4% healing with global heat and 55.3 +/- 31.1% healing with local heat in 1 month; controls actually had a worsening of their wounds.

CONCLUSIONS: The best healing modality was global heat. However, there was still a significant advantage in healing with local heat.
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Admin2 · Feb 9, 2008

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NewsBot · Oct 7, 2010

Enhanced healing of diabetic foot ulcers using local heat and electrical stimulation for 30 min three times per week.
Petrofsky JS, Lawson D, Berk L, Suh H.
J Diabetes. 2010 Mar;2(1):41-6.

Background: Electrical stimulation (ES) with heating is effective in healing chronic wounds. However, it this effect due to ES alone or both heating and ES? The aim of the present study was to deduce the individual roles of heat and ES in the healing of chronic wounds.

Methods: The study was performed on 20 patients (mean age 48.4 ± 14.6 years) with non-healing diabetic foot ulcers (mean duration 38.9 ± 23.7 months) who received local dry heat (37°C; n = 10) or local dry heat + ES (n = 10) three times a week for 4 weeks. Patients were given ES using biphasic sine wave stimulation (30 Hz, pulse width 250 μs, current approximately 20 mA).

Results: Skin blood flow in and around the wound was measured with a laser Doppler flow imager. In the ES + heat group, the average wound area and volume decreased significantly by 68.4 ± 28.6% and 69.3 ± 27.1%, respectively (both P < 0.05), over the 1-month period. During the average session, blood flow increased to 102.3 ± 25.3% with local heat and to 152.3 ± 23.4% with ES + heat. In the group receiving treatment with local heat only, wounds that had not healed for at least 2 months showed 30.1 ± 22.6% healing (i.e. a decrease in wound area) after 1 month. Although this level of healing was significant, it was less than that observed in the ES + heat group (P < 0.05).

Conclusions: Local dry heat and ES work well together to heal chronic diabetic foot wounds; however, local heat would appear to be a relevant part of this therapy because ES alone has produced little healing in previous studies.
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