March 2013

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A recent abstract validating the use of low frequency, high intensity, contact ultrasound for the debridement of venous leg ulcers will be among the poster abstracts presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society (SAWC Spring/WHS) in May.

   Researchers in this randomized trial assessed 76 patients with venous leg ulcers who received either ultrasonic debridement or sharp debridement with a curette. After the 24-week treatment period, authors note that patients receiving ultrasonic debridement healed significantly faster than patients who underwent surgical sharp debridement. Additionally, the incidence of complete healing was greater in the ultrasound patients, according to the study.

   Kazu Suzuki, DPM, CWS, concurs that ultrasound debridement is superior to sharp debridement not only when treating venous leg ulcers but also when treating other open wounds. According to Dr. Suzuki, who utilizes a 25 kHz, low-intensity, contact ultrasound device in his practice, ultrasound debridement gives practitioners the ability to clean out micro-debris and biofilm within the wound.

   Both the study authors and Dr. Suzuki note that a limitation to using ultrasound debridement is an increase in preparation and performance time. Researchers note that ultrasonic debridement took twice as long to set up and perform as sharp debridement (20.5 minutes versus 10.9 minutes). In light of the increased time, using conventional treatment might be more beneficial in cases of small, shallow or minor wounds, explains Dr. Suzuki, the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers in Los Angeles.

   In addition to an increase in time, Dr. Suzuki notes an added limitation with any debridement procedure is that patients may often require several office visits to completely clean out the non-viable tissues.

   “I often use collagenase ointment in between the wound care center visits to aid in debriding these remnants of non-viable tissues,” offers Dr. Suzuki. He notes that adequate blood flow and proper vascular examination can help ensure successful debridement in many cases.

   “In our center, we utilize a laser Doppler-based skin perfusion pressure monitor as well as a handheld Doppler to get the baseline perfusion on wound patients on the first visit,” explains Dr. Suzuki.

   According to Dr. Suzuki, when debriding a venous leg ulcer, specifically, “you may want to get a vascular specialist to check the patient for venous reflux and varicose veins,” which often connect to the leg ulcer.

   While ultrasound therapies have been studied extensively throughout Europe and proven effective in the United States, Dr. Suzuki notes he is in the process of drafting another ultrasound debridement study in Japan.

   The SAWC Spring/WHS will be held May 1-5 in Denver. For more info, visit www.sawcspring.com .

Can The Presence Of PAD Predict A Second Amputation?

By Brian McCurdy, Senior Editor

An abstract to be presented at the upcoming SAWC Spring/WHS is a reminder of the importance of assessing peripheral arterial status in patients who have received minor lower extremity amputations.

   The abstract focused on 163 patients with diabetes divided into two groups: minor amputation (initial minor amputation followed by at least one minor amputation) and major amputation (initial minor amputation followed by at least one major amputation). In the minor group, authors noted that 22.23 percent had severe peripheral arterial disease (PAD) whereas 71.15 percent in the major amputation group had severe PAD. The abstract authors emphasize that referral to a vascular surgeon may delay or prevent major amputation.

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