Ultrasound Devices to Treat Chronic Wounds: The Current Level of Evidence

Abstract

Chronic wounds cause considerable morbidity and utilize significant health care resources. In addition to addressing wound etiology and treating infection, regular debridement is a key component of wound care with a proven ability to accelerate healing. In this regard, a significant innovation in wound care has been the development of ultrasound debridement technology. The purpose of this review is to evaluate the current evidence behind the technology with an emphasis on noncontact low-frequency (NCLF) ultrasound. A number of studies, especially those evaluating NCLF technology, have demonstrated the potential of ultrasound debridement to effectively remove devitalized tissue, control bioburden, alleviate pain, and expedite healing. However, most of the studies are underpowered, involve heterogeneous ulcer types, and demonstrate significant methodological limitations making comparison between studies difficult; there is a paucity of data on cost-effectiveness. Future clinical trials on ultrasound debridement technology must address the design issues prevalent in current studies, and report on clinically relevant endpoints before adoption into best-practice algorithms can be recommended.

Debridement in Diabetic Foot Ulcer

“…The International Working Group on the Diabetic Foot recommended that the sharp/surgical debridement in preference to other techniques such as topical debridement agents (i.e., autolytic dressing or biological debridement) because it is the least expensive, fastest method of wound bed preparation and is available in all geographic areas. Sharp/surgical debridement requires specific clinical skills as there is the potential for extensive damage to the wound bed with exposure of bone, joint tissue, or ligament [11][12][13][14]. Scalpel Debridement: Topical treatments have been developed to remove or maintain callus sites such as salicylic acid pads and keratin dissolving agents.…”

Evaluation of the effectiveness of combination ultrasound treatment and basic care in the healing of pressure ulcers: A Systematic Review

“…10,18,19 The LFUS wound debridement offers a less traumatic, less painful surgical debridement, achieving destruction of the bacterial biomembrane, removing necrotic tissues, fibrosis, exudate and accelerating the formation of granulation tissue. [20][21][22] The LFUS waves act through two mechanisms: microcavitation and acoustic flow. Cavitation leads to cellular changes, destruction of periwound tissue in the ultrasound wave, also causes a rapid lysis of the necrotic tissue and ulceration fibrosis.…”

Effect of ultrasound‐supported wound debridement in subjects with diabetic foot ulcers: A meta‐analysis

“…The application of ultrasound is the only distinction between the two modalities: Although a sterile saline fine mist is administered between 5 and 15 mm from the wound, non-contact ultrasound-assisted wounds transfer ultrasonic energy to the wound bed. 7 The cavitation and micro-streaming properties of ultrasound contribute to the effectiveness of USSD. Cavitation is the process of oscillating gas microbubbles forming in a fluid medium.…”