The purpose of this study is to detemrine the effectiveness of transcutaneous nerve stimulation (TENS) on healing of decubitus ulcers. Specifically, the study will aim to: (1) compare the rate of healing of decubitus ulcers treated with conventional therapy and those treated with conventional therapy augmented with TENS, and (2) compare the rate of ulcer healing and the presence of specific patient variables or ulcer condition variables. The sample will consist of 40 subjects, 18 years of age and older, who have at least one decubitus ulcer that has been resistant to healing for at least three months. Subjects will be obtained from in-patient units of a Veterans' Administration facility and will be randomly assigned to one of two treatment approaches. One group will receive conventional treatment to their decubitus ulcer consisting of packing the ulcer with fine mesh gauze dampened with .25% acetic acid and covering it with a single layer of cotton filled 4 x 4 dressing. The dressing will be changed three times a day (morning, midday and evening). The second group will receive the same conventional treatment to their ulcer combined with TENS applied for 30 minutes three times per day. Subjects will be followed for eight weeks or until their ulcer heals. Rate of healing will be determined by weekly measurement of ulcer circumference, surface area, depth and surface characteristics. Ulcer circumference, surface area, and depth will be measured with sterophotogram-metry, a method of remote three- dimensional measurement using steroscopic pairs of photographs that are analyzed using a computerized image processor. Ulcer surface characteristics will be assessed by direct observation and by photography. Data will also be collected on the type and scheduling of supportive therapies and the presence of patient variables and ulcer condition variables that may influence rate of healing. A group by time repeated measures analysis of variance will be used to examine differences in rate of healing treatment groups. A Friedman two-way analysis of variance will be applied to determine differences in ulcer surface characteristics between the treatment groups. Within treatment groups, patient and ulcer condition variables will be correlated with differences in measures of rate of healing.
