A Pilot Study of Ultrasonically-assisted Treatment of Residual Burn Wounds
- 0 Comments
- 5934 reads
Two lesions, located in a similar body part, from each patient were recruited: one wound was treated with ultrasound (treatment group), the other was treated with traditional wound dressings (control group). One patient had diabetes, three had hypertension, and two had contaminated wounds. The other 13 patients did not have any diseases. Sixteen cases had wounds on the extremities; the remaining three cases had wounds located on the trunk. Standard wound assessment forms were completed for each patient during enrollment.
Exclusion criteria. Patients who were younger than 18 years or older than 60 years; those who had difficult healing wounds related to malignant disease; those who had a serious disease of the heart or liver, or had a blood producing disorder, inclination to uncontrolled vessel thrombosis, uncontrolled high blood sugar level, shock, serious systemic infection, and pregnant or breastfeeding women. Patients with residual defects on the head or face were also excluded from the study.
Patient removal or dropout. Patients who could not continue with the treatment and had to withdrawal from the study (various reasons); those who could not finish all the test items (various reasons); those who encountered unexpected events during the treatment and had to stop medication; those who annulled their agreement acknowledging their awareness of the conditions; and those who had serious complications/infections were removed from the trial.
Experimental methods. The initial wound size (cm2) was calculated by multiplying the maximum length and width of the wound, which was measured at each visit. The wound was categorized as “healed” when the skin healed completely. One certified clinician completed the respective therapies once every 2 days. All dressings were left undisturbed until the next scheduled treatment. Serial color digital photos of the wounds were taken at the end of every treatment to evaluate the response following each visit. Standard questionnaires were completed during the treatment and any symptoms or side effects were also recorded. All patients were followed up for a minimum of 4 weeks.
Ultrasound therapy. The Haiwei180 ultrasound (Chuanyi Company, Sichuan, China) is a compact unit that produces a low 25-kHz frequency through a handheld probe. No thermal energy is generated; hence, no cooling system is required. During the treatment, isotonic normal saline was used as an irrigation medium between the handheld probe and the wound. The ultrasonic amplitude was set at maximum and the treatment was applied for 10 seconds per probe head area (1 cm x 1 cm) onto the edge and surface of all wounds. Each patient underwent 7 treatments at an interval of 2 days.
Traditional therapy. The wounds were washed with 500-mL of isotonic normal saline at each treatment. All the wounds in both groups were semi-exposed with one sheet of povidone iodine gauze used as a cover until the next treatment.
Observation and determination of indices. The wounds were observed dynamically in the process of medication. Wound secretion and other conditions (odor, swelling, pain, etc.) were recorded every 2 days—assessment after each treatment session was also recorded.
Wound healing time and percentage. A series of digital photographs of each wound, before and after each treatment, were taken with a ruler laid next to the wound. The length and width of the wound was recorded to calculate wound area. Wound healing percentage and time elapsed since the last treatment (treatment was finished if the wound healed completely during the study period).
Bacterial clearance rate.
1. Li A. Treatment for Burns. 2nd ed. Beijing: People’s Medical Publishing House. 1995;7–14.
2. Dyson M, Franks C, Suckling J. Stimulation of healing of varicose ulcers by ultrasound. Ultrasonics. 1976;14:232–236.
3. Nichter LS, Williams J. Ultrasonic wound debridement. J Hand Surg Am. 1988;13(1):142–146.
4. Byl NN, McKenzie A, Wong T, West J, Hunt TK. Incisional wound healing: a controlled study of low and high dose ultrasound. J Orthop Sports Phys Ther. 1993;18(5):619–628.
5. Suchkova V, Carstensen EL, Francis CW. Ultrasound enhancement of fibrinolysis at frequencies of 27 to 100 kHz. Ultrasound Med Biol. 2002;28(3):377–382.
6. Peschen M, Weichenthal M, Schöpf E, Vanscheidt W. Low-frequency ultrasound treatment of chronic venous leg ulcers in an outpatient therapy. Acta Derm Venereol. 1997;77(4):311–314.
7. Yuesheng H. The clinical courses of burns. In: Li A, ed. Treatment for Burns. 2nd ed. Beijing: The People’s Health Press; 1995:81.
8. Wood RW, Loomis AL. The physical and biological effects of high frequency sound waves of great intensity. Philos Mag J. 1927;4:417–436.
9. Bergstrom N, Allman RM, Alvarez OM, et al. Clinical Practice Guideline Number 15: Treatment of Pressure Ulcers. Rockville, MD: US Department of Health and Human Services. Public Health Service. Agency for Health Care Policy and Research; 1994. AHCPR Publication 95-0652.
10. Mortimer AJ, Dyson M. The effect of therapeutic ultrasound on calcium uptake in fibroblasts. Ultrasound Med Biol. 1988;14(6):499–506.
11. Schoenbach SF, Song IC. Ultrasonic debridement: a new approach in the treatment of burn wounds. Plast Reconstr Surg. 1980;66(1):34–37.
12. Walmsley AD. Potential hazards of the dental ultrasonic descaler. Ultrasound Med Biol. 1988;14(1):15–20.
13. Fyfe MC, Chahl LA. Mast cell degranulation and increased vascular permeability induced by 'therapeutic' ultrasound in the rat ankle joint. Br J Exp Pathol. 1984;65(6):671–676.
14. Byl NN, McKenzie AL, West JM, Whitney JD, Hunt TK, Scheuenstuhl HA. Low-dose ultrasound effects on wound healing: a controlled study with Yucatan pigs. Arch Phys Med. Rehabil. 1992;73(7):656–664.
15. Young SR, Dyson M. The effect of therapeutic ultrasound on angiogenesis. Ultrasound Med Biol. 1990;16(3):261–269.
16. Mortimer AJ, Dyson M. The effect of therapeutic ultrasound on calcium uptake in fibroblasts. Ultrasound Med Biol. 1988;14(6):499–506.
17. Brossman E, Giernat L, Slusarczyl-Zalobna A, Torzecki Z. Histological effects on collagen production in late vitro growth phase of human fibroblasts. Rheumatologica. 1981;19:177–181.
18. Enwemeka CS. The effects of therapeutic ultrasound on tendon healing. A biomechanical study. Am J Phys Med Rehabil. 1989;68(6):283–287.
19. Chen Z, Lai X, Wang L, et al. Experimental study on effect of bacterial clearance and accelerating healing of contaminated wound by low intensity ultrasonic wave irrigation. Acta Acad Med Milit Tertiae. 2001;23(5):617–619.
20. Zhao H, Lai X, Chen J, et al. Design and development of a medical ultrasonic irrigative and therapeutic apparatus. Chin Med Equip J. 2004;9:20–21.