A Pilot Study of Ultrasonically-assisted Treatment of Residual Burn Wounds
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Comprehensive efficacy improved significantly in the treatment group compared to that of the control group. A statistically significant difference was found in the “obviously effective” rate between the two groups (t = 2.52, P < 0.05; Figure 1).
Bacterial clearance rate. The log count (CFU/mL) for any microbe present at baseline and the fourth treatment were compared to determine if the ultrasound treatment affected colony counts. Overall, the results demonstrated a greater reduction in log colony counts for the treatment group wounds (P < 0.01; Table 1).
Safety assessment. No significant differences between the two groups were found in routine blood, liver, and renal function tests. No local allergic or systemic symptoms were found. Side effects were not found with the use of the ultrasound treatment in any of the 19 patients.
Case 1: A 36-year-old woman with a residual burn wound on the left chest area 123 days after flame injury. The original area of the wound was 38 cm2 and the bacterial colony count was 10,000 CFU/mL at baseline. After 4 ultrasound treatments, the bacterial colony count was zero. Two weeks later the wound measured 2 cm2 (Figures 2, 3).
Case 2: A 37-year-old man with a residual burn wound on the left ankle 2 years after injury. The baseline area of the wound was 1.34 cm2. The wound had pus, slough, and was both reddish and odorous. The bacterial count was 6.7 x 105/CFU/mL/cm2 before the treatment. The count decreased to 2.47 x 102/CFU/mL/cm2 after 4 ultrasonic therapy treatments. Two weeks later, 0.2 cm2 remained unhealed (Figures 4, 5).
Residual burn wounds are common, usually festered, and infected blisters often reoccur during the long healing process associated with deep burn wounds.7 There are two main causes for the formation of residual wounds: 1) blocking of the sebaceous and sweat glands that remain inside the dermis, which induce consequent infections during wound healing in deep, second degree burns; 2) newly grown skin is too thin to bear pressure and is prone to repeated infections. Therefore, the ideal nonoperative method for treating residual burn wounds is to control infection, improve circulation, and regenerate cells.1 The topical instrument dealing with residual wounds should reduce slough and bacteria and increase circulation to the wound.
It has been more than 70 years since ultrasound was first utilized as therapy for soft tissue injuries.8 Ultrasound has since been used to treat a wide variety of disorders. Therapeutic ultrasound has been recognized as one of several treatment methods used to enhance healing of pressure ulcers, in addition to wound cleansing, sharp debridement, wound dressings, and electrical stimulation.9 Low-intensity ultrasound produces two effects—stable cavitation and acoustic streaming.
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.