Wound-Relevant Electric Fields and Directional Keratinocyte Migration in Skin Repair: A Preclinical Systematic Review

Skin wounds generate small natural electric fields. Researchers have long proposed that these fields help guide repair of the epidermis. Cell movement guided by an electric field is called electrotaxis, also known as galvanotaxis. This review asked whether wound-relevant electric fields direct epithelial or keratinocyte migration in preclinical models. We searched the PubMed biomedical literature database and Web of Science using broad terms related to wound bioelectricity. A second search added electrotaxis and galvanotaxis. We also checked Google Scholar, records indexed in MEDLINE (Medical Literature Analysis and Retrieval System Online), and papers suggested by colleagues. Eligible studies measured migration direction in keratinocyte, epidermal, or skin-wound models. Two reviewers assessed risk of bias using a tailored Office of Health Assessment and Translation approach. One author screened titles and abstracts. A second author assessed full texts. Two authors divided the extraction work. Each study was extracted once by one author. Screening and extraction were not performed in duplicate. Thirty-one studies were included. At the study level, 20 were classified as cathodal. Five were anodal. Three were classified as toward the wound center. Three were not polarity-specific. Most numerical field strengths were between 10 and 400 mV/mm. Risk of bias was rated as some concerns in 28 studies. It was rated as high in three. Available preclinical evidence suggests that electric fields can guide epithelial and keratinocyte migration. The response direction varies across experimental settings. These findings support a plausible mechanism. Confidence is limited by study-level risk of bias. No study had a low risk of bias. Null findings may be underrepresented. This systematic review is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020.