A Pilot Study of Ultrasonically-assisted Treatment of Residual Burn Wounds

10/14/2009
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Author(s):

Xiaolu Li, MD, PhD; Shunli Liu; Xinan Lai, PhD; Gaoxing Luo, MD, PhD; Hong Yan, MD, PhD; Xianhui Huang; Yuesheng Huang, MD, PhD; Yizhi Peng, MD, PhD

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 Briefs

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).

Discussion

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.

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