New Research Emerges On Benefits Of Ultrasound Use

By Brian McCurdy, Associate Editor

Emerging research on the therapeutic and diagnostic uses of ultrasound will be among the abstracts presented at the 17th Annual Symposium on Advanced Wound Care (SAWC) in May. Two of the studies focus on the potential benefits of using ultrasound to assist in treating problematic wounds. Paul Quintavalle, DPM, says there has been an increase of studies in recent years on the use of therapeutic ultrasound in wound healing. “It has been shown to be a safe and potentially effective treatment,” notes Dr. Quintavalle. “It is a widely used modality in Europe, but has not become widely used in the United States.” For one of the SAWC abstracts, “The Use of Low-Frequency Ultrasound in the Treatment of Chronic Foot Ulcerations,” researchers tracked 51 patients with chronic wounds who were treated with the modality. Of the patients studied, 65 percent had diabetes and 20 percent had a history of amputation in addition to ulcers. For the patients who received ultrasound treatment in addition to the standard of care, researchers saw a 93.3 percent reduction in wound size over an average of six weeks. “It appears to have some significant advances for wound healing and wound bed preparation in the studies that we have done,” says study author Steven J. Kavros, DPM. “I think it has a very strong position for people who are dealing with wounds.” “I believe that these statistics represent a relatively quick healing time, indicating that the ultrasound intervention has a positive benefit to wound healing,” notes Dr. Quintavalle. “Although more work needs to be done studying the efficacy of ultrasound treatment, it appears that it can be a valuable adjunct to wound care.” Mary Dyson, PhD, recalls a 1997 study by Peschen, et. al., in which low-frequency ultrasound significantly increased the reduction of 24 chronic venous ulcers. As she explains, the researchers applied ultrasound through water to generate acoustic streaming, which facilitated the removal of superficial necrotic tissue. This technique can be used in place of sharp debridement, according to Dr. Dyson. “The confirmation of the technique as a method of reducing wound size is of clinical value,” says Dr. Dyson. Can Ultrasound Be Beneficial For MRSA And VRE? On that subject, a second SAWC abstract explores using low-frequency ultrasonic wound treatment as an alternative method for wound debridement. The abstract, “Ultrasonic-Assisted Wound Treatment (SONOCA) vs. MRSA and VRE: A Case Series,” notes this modality penetrates into deep tissue with associated microcavitations causing bacterial destruction. As the abstract authors note, low-frequency ultrasound has been used to treat patients with recalcitrant chronic wounds and multiple drug resistant strains of bacteria such as MRSA and VRE. After performing these treatments, the researchers noted that patients who previously had positive cultures for MRSA and VRE infection had negative cultures for such infections following ultrasonic debridement. As Dr. Dyson notes, ultrasound can be bactericidal in vitro. She emphasizes that demonstrating this in vivo with a technique that activates cells involved in healing wounds makes this study potentially one of “considerable clinical significance.” While Dr. Quintavalle believes the modality has “great adjunctive potential” in wound care, he says more controlled animal studies would answer the question of whether ultrasound can reduce a wound’s bacterial load. Tracking The Origin Of Heel Ulcers A third SAWC abstract, “The Use of High-Frequency Ultrasound to Investigate the Pathogenesis of Heel Pressure Ulcers,” tracks 15 patients who were scanned with ultrasound after the application of constant controlled heel pressure for varying time periods. As Dr. Quintavalle notes in his study, high-frequency ultrasound provides microscopic detail of subcutaneous soft tissue. The study offers a timeline that shows the beginning of the patient’s edema, its peak and ends with the resolution of the condition. The technology allows clinicians to detect edema that is localized to the subcutaneous layer before it is apparent in the skin. Dr. Quintavalle notes that tissue damage can occur before clinical signs and this diagnostic tool may help in initiating preventative measures. “This study will allow for a better understanding of the pathogenesis of heel pressure ulcers and demonstrates that by removing pressure, the body can repair damaged tissue before ulcer formation,” notes Dr.

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