{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:44Z","timestamp":1783509284067,"version":"3.55.0"},"reference-count":69,"publisher":"MDPI AG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,3]]},"abstract":"<jats:p>Background: While numerous studies suggest the benefit of electrical stimulation (E-Stim) therapy to accelerate wound healing, the underlying mechanism of action is still debated. In this pilot study, we examined the potential effectiveness of lower extremity E-Stim therapy to improve tissue perfusion in patients with diabetic foot ulcers (DFUs). Methods: Thirty-eight patients with DFUs were recruited. Participants underwent 60-minutes of active E-Stim therapy provided on acupuncture points above the level of the ankle joint using a bio-electric stimulation technology\u00ae (BEST) platform (Tennant Biomodulator\u00ae PRO). As primary outcome, changes in perfusion in response to E-Stim were assessed by measuring skin perfusion pressure (SPP) at baseline, 30-, and 60-min during therapy. In addition, retention was assessed 10-min post-therapy. As secondary outcome, tissue oxygen saturation (SatO2) was measured using a non-invasive near-infrared camera (Snapshot NIR, KENT Imaging Inc). Results: SPP increased in response to E-Stim therapy (p = 0.02) with maximum improvement observed at 60-min (11%, p = 0.007) compared to baseline. SPP reduced at 10-min post therapy, but remained higher than baseline (9%, p = 0.1). Magnitude of improvement at 60-min was negatively correlated with baseline SPP values (r = -0.45, p = 0.01) suggesting those with lower perfusion could benefit more from E-Stim therapy. Similar trends were observed for SatO2 with statistically significant improvement for a sub-sample (n=16) with moderate-severe peripheral arterial disease (Ankle brachial index &amp;lt; 0.8 or &amp;gt; 1.4). Conclusions: This study provides early results on the feasibility and effectiveness of E-Stim therapy to improve skin perfusion and SatO2. The magnitude of benefit is higher among those with poorer skin perfusion. Results also suggest the effects of E-Stim could be washed out after stopping therapy and thus regular daily application may be required for the effective benefit for wound healing.<\/jats:p>","DOI":"10.7547\/20-172","type":"journal-article","created":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T09:00:19Z","timestamp":1614762019000},"source":"Crossref","is-referenced-by-count":4,"title":["Effectiveness of Lower-Extremity Electrical Stimulation to Improve Skin Perfusion"],"prefix":"10.3390","author":[{"given":"Alejandro","family":"Zulbaran-Rojas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Lepow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bijan","family":"Najafi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"apms-111-06-01-b01","series-title":"Curr Geriatr Rep","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1007\/s13670-015-0136-7","article-title":"Current standards and advances in diabetic ulcer prevention and elderly fall prevention using wearable technology","volume":"4","author":"Miller","year":"2015","unstructured":"Miller\n\t\t\t\t\t\t\tJD\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tNajafi\n\t\t\t\t\t\t\tB\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tArmstrong\n\t\t\t\t\t\t\tDG:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tCurrent standards and advances in diabetic ulcer prevention and elderly fall prevention using wearable technology.\n\t\t\t\t\tCurr Geriatr Rep\n\t\t\t\t\t4: \n\t\t\t\t\t249,\n\t\t\t\t\t2015.\n\t\t\t\t10.1007\/s13670-015-0136-7"},{"key":"apms-111-06-01-b02","series-title":"J Foot Ankle Res","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13047-020-00383-2","article-title":"Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer","volume":"13","author":"Armstrong","year":"2020","unstructured":"Armstrong\n\t\t\t\t\t\t\tDG\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tSwerdlow\n\t\t\t\t\t\t\tMA\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tArmstrong\n\t\t\t\t\t\t\tAA\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tFive year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer.\n\t\t\t\t\tJ Foot Ankle Res\n\t\t\t\t\t13: \n\t\t\t\t\t16,\n\t\t\t\t\t2020.\n\t\t\t\t3220913610.1186\/s13047-020-00383-2"},{"key":"apms-111-06-01-b03","series-title":"J Diabetes Sci Technol","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1177\/1932296819849092","article-title":"Measuring plantar tissue stress in people with diabetic peripheral neuropathy: a critical concept in diabetic foot management","volume":"13","author":"Lazzarini","year":"2019","unstructured":"Lazzarini\n\t\t\t\t\t\t\tPA\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tCrews\n\t\t\t\t\t\t\tRT\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tvan Netten\n\t\t\t\t\t\t\tJJ\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tMeasuring plantar tissue stress in people with diabetic peripheral neuropathy: a critical concept in diabetic foot management.\n\t\t\t\t\tJ Diabetes Sci Technol\n\t\t\t\t\t13: \n\t\t\t\t\t869,\n\t\t\t\t\t2019.\n\t\t\t\t3103054610.1177\/1932296819849092"},{"key":"apms-111-06-01-b04","series-title":"J Diabetes Sci Technol","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1177\/193229681000400411","article-title":"Diabetic foot biomechanics and gait dysfunction","volume":"4","author":"Wrobel","year":"2010","unstructured":"Wrobel\n\t\t\t\t\t\t\tJS\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tNajafi\n\t\t\t\t\t\t\tB:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tDiabetic foot biomechanics and gait dysfunction.\n\t\t\t\t\tJ Diabetes Sci Technol\n\t\t\t\t\t4: \n\t\t\t\t\t833,\n\t\t\t\t\t2010.\n\t\t\t\t10.1177\/19322968100040041120663446"},{"key":"apms-111-06-01-b05","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","unstructured":"Armstrong\n\t\t\t\t\t\t\tDG\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBoulton\n\t\t\t\t\t\t\tAJM\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBus\n\t\t\t\t\t\t\tSA:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tDiabetic foot ulcers and their recurrence.\n\t\t\t\t\tN Engl J Med\n\t\t\t\t\t376: \n\t\t\t\t\t2367,\n\t\t\t\t\t2017.\n\t\t\t\t2861467810.1056\/NEJMra1615439"},{"key":"apms-111-06-01-b06","series-title":"Arch Dermatol","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1001\/archderm.1994.01690040093015","article-title":"Definitions and guidelines for assessment of wound and 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Foot","volume":"24","author":"Apelqvist","year":"2008","unstructured":"Apelqvist\n\t\t\t\t\t\t\tJ\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBakker\n\t\t\t\t\t\t\tK\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tvan Houtum\n\t\t\t\t\t\t\tWH\n\t\t\t\t\t\t\n\t\t\t\t\t\t:\n\t\t\t\t\t\n\t\t\t\t\tPractical guidelines on the management and prevention of the diabetic foot: based upon the International Consensus on the Diabetic Foot (2007) prepared by the International Working Group on the Diabetic Foot.\n\t\t\t\t\tDiabetes Metab Res Rev\n\t\t\t\t\t24\n\t\t\t\t\t(suppl 1): \n\t\t\t\t\tS181,\n\t\t\t\t\t2008.\n\t\t\t\t10.1002\/dmrr.848"},{"issue":"(suppl 1)","key":"apms-111-06-01-b08","series-title":"Diabetes Metab Res Rev","first-page":"e3239","article-title":"Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer-free days in remission","volume":"36","author":"Najafi","year":"2020","unstructured":"Najafi\n\t\t\t\t\t\t\tB\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tReeves\n\t\t\t\t\t\t\tND\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tArmstrong\n\t\t\t\t\t\t\tDG:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tLeveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer-free days in remission.\n\t\t\t\t\tDiabetes Metab Res Rev\n\t\t\t\t\t36\n\t\t\t\t\t(suppl 1): \n\t\t\t\t\te3239,\n\t\t\t\t\t2020.\n\t\t\t\t31909547"},{"key":"apms-111-06-01-b09","series-title":"Sensors (Basel)","doi-asserted-by":"publisher","first-page":"4527","DOI":"10.3390\/s20164527","article-title":"The potential role of sensors, wearables and telehealth in the remote management of diabetes-related foot 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ulcers","volume":"18","author":"Tecilazich","year":"2013","unstructured":"Tecilazich\n\t\t\t\t\t\t\tF\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tDinh\n\t\t\t\t\t\t\tTL\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tVeves\n\t\t\t\t\t\t\tA:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tEmerging drugs for the treatment of diabetic ulcers.\n\t\t\t\t\tExpert Opin Emerg Drugs\n\t\t\t\t\t18: \n\t\t\t\t\t207,\n\t\t\t\t\t2013.\n\t\t\t\t10.1517\/14728214.2013.80230523687931"},{"key":"apms-111-06-01-b12","series-title":"Diabetes Care","doi-asserted-by":"publisher","first-page":"692","DOI":"10.2337\/diacare.22.5.692","article-title":"Healing of diabetic neuropathic foot ulcers receiving standard treatment: a meta-analysis","volume":"22","author":"Margolis","year":"1999","unstructured":"Margolis\n\t\t\t\t\t\t\tDJ\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tKantor\n\t\t\t\t\t\t\tJ\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\tBerlin\n\t\t\t\t\t\t\tJA:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tHealing of diabetic neuropathic foot ulcers receiving standard treatment: a meta-analysis.\n\t\t\t\t\tDiabetes Care\n\t\t\t\t\t22: \n\t\t\t\t\t692,\n\t\t\t\t\t1999.\n\t\t\t\t10.2337\/diacare.22.5.69210332667"},{"key":"apms-111-06-01-b13","series-title":"Adv Wound Care","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1089\/wound.2013.0459","article-title":"Electrical stimulation technologies for wound healing","volume":"3","author":"Kloth","year":"2014","unstructured":"Kloth\n\t\t\t\t\t\t\tLC:\n\t\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\tElectrical stimulation technologies for wound healing.\n\t\t\t\t\tAdv Wound Care\n\t\t\t\t\t3: \n\t\t\t\t\t81,\n\t\t\t\t\t2014.\n\t\t\t\t10.1089\/wound.2013.0459"},{"key":"apms-111-06-01-b14","series-title":"Adv Skin Wound Care","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1097\/01.ASW.0000462328.60670.c3","article-title":"Treatment options for venous leg ulcers: effectiveness of vascular surgery, bioengineered tissue, and electrical 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