Evidence-Based Use of Pulsed
Electromagnetic Field Therapy in
Clinical Plastic Surgery
Berish Strauch, MD; Charles Herman, MD; Richard Dabb, MD;
Louis J. Ignarro, PhD; and Arthur A. Pilla, PhD
Background: The initial development of pulsed electromagnetic field (PEMF) therapy and its evolution over the last century for use in clinical surgery has been slow, primarily because of lack of scientifically-derived, evidence-based knowledge of the mechanism of action. Objective: Our objective was to review the major scientific breakthroughs and current understanding of the mechanism of action of PEMF therapy, providing clinicians with a sound basis for optimal use. Methods: A literature review was conducted, including mechanism of action and biologic and clinical studies of PEMF. Using case illustrations, a holistic exposition on the clinical use of PEMF in plastic surgery was performed.
Results: PEMF therapy has been used successfully in the management of postsurgical pain and edema, the treatment of chronic wounds, and in facilitating vasodilatation and angiogenesis. Using scientific support, the authors present the currently accepted mechanism of action of PEMF therapy. Conclusions: This review shows that plastic surgeons have at hand a powerful tool with no known side effects for the adjunctive, noninvasive, nonpharmacologic management of postoperative pain and edema. Given the recent rapid advances in development of portable and economical PEMF devices, what has been of most significance to the plastic surgeon is the laboratory and clinical confirmation of decreased pain and swelling following injury or surgery. (Aesthetic Surg J 2009;29:135–143.)
ulsed electromagnetic field (PEMF) technologies
have shown usefulness as adjunctive therapy for
the treatment of both delayed-union fractures1 and
chronic wounds.2 These relatively simple devices use an
external, non-invasive PEMF to generate shorts bursts of
electrical current in injured tissue without producing heat
or interfering with nerve or muscle function. Recently,
Dr. Strauch is Professor and Emeritus Chair of Plastic and
Reconstructive Surgery at the Albert Einstein College of Medicine, Bronx, NY. Dr. Herman is the Medical Director of Plastic and Reconstructive Surgery, Pocono Health System, East Stroudsburg, PA, and is Assistant Clinical Professor of Surgery at the Albert Einstein College of Medicine, Bronx, NY. Dr. Dabb is Associate Professor of Surgery, The Johns Hopkins University, Baltimore, MD; and Clinical Professor of Surgery, Milton S. Hershey
Medicine Center, Hershey, PA. Dr. Ignarro is a Nobel Laureate and Distinguished Professor of Pharmacology, University of California –Los Angeles School of Medicine, Beverly Hills, CA. Dr. Pilla is Professor in the Department of Biomedical Engineering, Columbia University, New York, and in the Department of Orthopaedics, Mount Sinai School of Medicine, New York, NY.
Aesthetic Surgery Journal
increased understanding of the mechanism of action of
PEMF therapy has permitted technologic advances yielding economical and disposable PEMF devices. With these devices, PEMF therapy has been broadened to include
the treatment of postoperative pain and edema in both
outpatient and home settings,3 offering the physician a
more versatile tool for patient management.
The initial development of PEMF technology and its
evolution over most of the last century was marred by
poor presentation and, in many cases, insufficient
knowledge of the scientific basis of action. However,
plastic and reconstructive surgeons have been early
adopters of the therapy and pioneers, along with their
basic science colleagues, in developing what is now a
significant and rigorous body of evidence around the
mechanism of action. In this review, we describe the history, development, and eventual transformation of a marginal therapy into a technology that, should it fulfill
its promise, will...