Neuromuscular Electrostimulation of the Common Peroneal Nerve Increases Microvascular Flux in the Wound bed of Diabetic Foot Ulcers.

Abstract

ObjectiveTo measure the effect of neuromuscular stimulation of the common peroneal nerve on the microvascular blood flow within the wound bed of diabetic foot ulcers.Research Design and Methods13 patients with diabetic foot ulcers (11 neuropathic, 2 neuroischemic) were recruited. Microvascular flux and pulsatility were measured in real time in the wound bed, and at the wound edge, using Laser Speckle Contrast Imaging (Moor FLPI-2; Moor Instruments Ltd, Axminster, United Kingdom). Changes from baseline were measured when the leg muscle pump was activated by 1 Hz neuromuscular stimulation of the common peroneal nerve, using a wearable device (geko, Firstkind Ltd Daresbury, United Kingdom).ResultsIn the 11 neuropathic ulcers, significant increases were seen in all microvascular parameters. Wound bed flux increased by 36% (95%CI 11%-68%, P = .002), and peri-wound flux increased by 92% (95%CI 46%-160%, P = .001). Pulsatility in the wound bed increased by 183% (95%CI 61%-517%, P = .005), while pulsatility in the peri-wound increases by 359% (95%CI 264%-455%, P = .001). Additionally, an increase in flux and pulsatility was observed in the neuroischemic ulcers.ConclusionsNeuromuscular stimulation of the common peroneal nerve presents a mode of activating the leg muscle pump without additional pressure insult to the foot and has potential to support the microcirculation during wound-healing, effectively emulating exercise without any of the attendant risks of exercise to the neuropathic or neuroischemic foot.