New technology increases blood flow to heal wounds

Conway McLEAN, DPM

These are indeed strange times. Islands of trash are floating in the seas, violent storms inundate our cities, and the permafrost, vast regions of the far northern climes that were considered immutably frozen, are apparently not so permanent. I wouldn’t presume to even touch on the topic of politics, speaking of strange times. Even more surprising, people are living so long, they can suffer, and die, from ailments which occurred rarely, in one-in-a-million individuals.

Life spans have increased greatly in a relatively short period of time, and with the passing years, various problems have become commonplace. Certainly, the culture in which we live, with its sedentary lifestyle and fast food diet, are highly significant factors affecting our health. These two both seem to contribute greatly to the development of arterial disease, a problem that readers should be well acquainted with. Blood is an amazing substance, with its varied components and complex chemistry. So much of our health is dependent on this flow, the elixir of life. Every living cell of the body depends on its presence, and the delivery of that magic molecule that is oxygen. This is essential for the normal processes taking place in each cell, every second.

But rather than talk to you about what blood does for the body, in all its wonder, I’d like to spend a few minutes discussing what occurs in the absence of sufficient quantities. The flow of blood to the organs and the extremities is a process, and a complex one, dependent on a multitude of factors. Unfortunately, inadequate flow is not a rarity, but a common situation, and the consequences can be seen in many Americans.

These pages have carried an essay or two on this topic, but the signs and symptoms of ischemia (a term referring to reduced blood flow to a body part) bear repeating. Some typical examples include such diverse changes as thinning skin, cold digits, hair loss, as well as the development of pain in the calf or feet with exercise. Soft tissues of the affected limb become less pliable, more easily traumatized, leading with even minimal pressure or trauma to the development of open sores, though all these changes tend to be gradual. One term (and many are appropriate) for this entity is that of an ischemic ulcer.

The reasons someone may experience reduced blood flow to the lower legs are many. Heart function, obviously reduced in the presence of heart disease, is a common cause. Heart disease is an extremely generalized term, and includes a plethora of possibilities, with some general categories being heart muscle problems, valve pathology, and malfunctioning rhythmicity. Also very common is the production of plaque inside the arteries. This causes a narrowing inside the vessel wall, which predictably allows less blood through. If there is enough plaque deposited, the tissues supplied will undergo some of the changes mentioned above.

The saying in wound care is “we are held hostage by the blood flow.” The truth of this statement is unquestionable. No matter what fancy dressing or wound product we put on a wound, or pressure we take off, a wound will not heal without sufficient blood flow. One important aspect of this is “how much is enough?” How much blood flow to a wound will allow healing to occur? The work of the vascular surgeon is essential to wound healing. Better surgical techniques have been developed, and these are able to provide better flow to foot wounds, despite blockage farther away from the heart, even into the ankle. Despite these advances, it is common for these desperate attempts at improving the blood supply to fail. Another common scenario is for the person so afflicted to be unable to undergo this type of surgery because of other illnesses. Be it heart disease, diabetes, lung problems, or a whole host of co-morbidities (other diseases), sometimes the surgeon or anesthesiologist has to say “No.” Although this type of surgery is often performed through an endoscopic, minimally invasive technique, it is still surgery. There are risks to every surgical procedure, no matter how minor.

What to do when either of these situations arises? An ischemic wound is present, but the patient is not a good surgical candidate, or they underwent an angioplasty procedure to open up a vessel and it did not stay open. But there is a new tool in our bag of tricks, our “armamentarium,” those procedures and techniques that are appropriate for treating some particular condition. A new device has allowed us to provide more blood flow to some area of the body without surgery. Perhaps you know what this means? Improved rates of wound healing, meaning more limbs will be saved, and so more lives.

An Italian scientist about 15 years ago developed a new form of electric stimulation, in which small, specialized charges are sent through the skin, into deeper tissues. The result? — An increase in blood flow to the cells of that tissue. This device, using a concept called “Frequency Rhythmic Electrically Modulated Stimulation,” aka FREMS, does not open up the large vessels, but it does seem to stimulate better flow to the tissues using whatever blood supply is available. The original intent of this Italian doctor was to treat the nerve problems experienced by many diabetics, the most debilitating being the inability to feel pain when they should. This problem leads to many of the amputations suffered by diabetics. FREMS appears to treat this condition by increasing blood flow to the nerves on a microscopic scale. A critical effect since, whatever the cause, inadequate blood flow affects everything, and the health of every cell, and that includes wound healing.

When evaluating someone who has a chronic wound, one of the first questions to ask yourself is “why”? Why did this wound not go through the normal stages of healing? The science of wound healing has advanced to the point where we know the different needs for healing of various types of wounds. With wounds not healing because of an inadequate blood supply, there are many concerns. Is recurrent swelling inhibiting blood getting from the tubes (arteries) to the cells? Is heart function insufficient to drive the blood through the arterial “tree?” (This is the complex arrangement of branching vessels providing the essential nutrients to the billions of cells composing the human body.)

The ability of the FREMS device to promote new capillary growth (tiny blood vessels) has been useful in the treatment of neuropathy, and has garnered some recognition for this in Europe. But its real potential may be in the treatment of chronic wounds, and the benefits of enhanced flow to the cells of the tissues, the all-important “perfusion.” The tissues themselves, where the cells reside, is where the magic juice is needed. How much can FREMS do to improve the current abilities of modern wound care? Only further research can tell us.

In wound care, we must take advantage of every tool, every piece of leverage we can find to save limbs. It appears (despite the lack of insurance coverage), this may be a useful method of bettering the health of damaged cells. Many new technologies have been, and are being developed to further lower the amputation rate. This is the real measure of success for any new wound care product or device. Unfortunately, not every invention is brought to market, thoroughly researched, completed and utilized. There have been others … will FREMS be the next?

Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.