Photobiomodulation and electro-stimulation for enhanced healing of hard-to-heal wounds: a literature review

Objective: Hard-to-heal (chronic) wounds constitute a major healthcare problem and a financial burden. Traditional wound care methods mostly fail to achieve complete or prompt healing. Additional biochemical or physical therapies for wound modulation are almost invariably required. Method: A literature review was conducted to explore the accumulated evidence about improved hard-to-heal wound healing with photobiomodulation (PBM) and electrostimulation (ES), and to analyse the clinical application of these two alternative therapeutic modalities. Results: The literature search yielded a limited number of clinical PBM and ES studies suitable for critical review. Retrieved studies were characterised by varying study designs, treatment approaches, parameters, blinding procedures, follow-up duration, outcome measures and outcomes, precluding any meaningful meta-analysis. Conclusion: Emerging experimental evidence of beneficial PBM and ES effects on wound healing mechanisms, although limited, seems undeniable. However, translating experimental findings to significant clinical applications in patients is hindered by limitations inherent in experimental models in addition to difficulties in replicating hard-to-heal wound environments in a laboratory setting. It appears that a single treatment modality is incapable of achieving complete healing of hard-to-heal wounds in most instances, and that the concerted effect of multiple modalities that may be complementary and synergistic may be the best approach.