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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.