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Studies show that anode and cathode electrical stimulation (ES) promotes the healing of wounds, but specific protocols for both electrodes are not available.To compare the effectiveness of cathodal versus cathodal+anodal ES in the treatment of Category II-IV pressure ulcers (PrUs).Prospective, randomized, controlled, clinical study.Three nursing and care centers.Sixty-three participants with PrUs were randomly formed into a cathodal ES group (CG: N = 23; mean age of 79.35; SD 8.48), a cathodal+anodal ES group (CAG: N = 20; mean age of 79.65; SD 11.44) and a placebo ES group (PG: N = 20; mean age of 76.75; SD 12.24).All patients were treated with standard wound care and high-voltage monophasic pulsed current (HVMPC; twin-peak impulses; 154 μs; 100 pps; 0.25 A; 250 μC/s) for 50 minutes per day, 5 times a week, for 6 weeks. The CG, CAG, and PG received, respectively, cathodal, cathodal+anodal, and sham ES through electrodes placed on a moist gauze pad. The treatment electrode was placed on the wound, and the return electrode was positioned on healthy skin at least 20 cm from the PrU.Measurements were made at baseline, and after each of the 6 weeks of treatment. Primary outcome was percentage wound surface area reduction at week 6.Wound surface area decreased in the CG by 82.34% (95% confidence interval [CI] 70.06-94.63) and in the CAG by 70.77% (95% CI 53.51-88.04). These reductions were significantly greater than in the PG (40.53%; 95% CI 23.60-57.46). The CG and CAG were not statistically significantly different regarding treatment results.The time of treatment proved insufficient for PrUs to close.Cathodal and cathodal+anodal HVMPC similarly reduced the area of Category II-IV PrUs.