Efficiency of Therapeutic Ultrasound for Healing Venous Leg Ulcers in Surgically-treated Patients

  • Mon, 1/5/09 - 12:55pm
  • 0 Comments
  • 4981 reads
Author(s): 
Patrycja Dolibog, PhD, MD; Andrzej Franek, PhD, MD; Jakub Taradaj, PhD, MD; Edward Blaszczak, PhD, MD; Lech Cierpka, PhD, MD; From the Department of Medical Biophysics, Medical University of Silesia, Ligota, Poland; Department of General, Vascular, and Transplant Surgery, Medical University of Silesia, Katowice, Poland

Abstract: The aim of this study was to evaluate the efficiency of therapeutic ultrasound (US) for healing of venous leg ulcers in surgically treated patients. Study endpoints were the number of completely healed wounds and the clinical parameters predicting the outcome. Seventy patients with venous leg ulcers were included in this study, and ultimately allocated into two comparative groups. Group A consisted of 33 patients (21 women, 12 men). They were treated with the US, compression stockings, and drug therapy. Group B (control) consisted of 37 patients (22 women, 15 men). They were treated with the compression stockings and drug therapy only, administered just as in group A. Ten patients in group A and 12 in group B healed completely (P > 0.05). Comparison of Gilman Index and relative change of the total surface area, length, width, and volume did not demonstrate any difference (P > 0.05) between the groups. A more statistically efficient decrease of pus (P = 0.03) and greater promotion of granulation (P = 0.03) were observed in group A compared to group B. However, the noted changes did not have an influence on acceleration of therapy or final stage of the wound healing process because no differences were detected in the epidermization rate of the ulcers in either group. There are no specific indications that US application promotes healing in patients after surgical operation.



Address correspondence to:
Jakub Taradaj, PhD, MD
Department of Medical Biophysics
Medical University of Silesia
ul. Medyków 18, bud. C2 40-752
Katowice, Ligota
Poland
Phone: 48 32 252 8422
E-mail: jtaradaj@slam.katowice.pl




   Leg ulcers are a major complication of chronic venous insufficiency (CVI). The disease mainly affects people between 60- and 80-years-old, with women affected 3 times more frequently than men.1 Venous leg ulcers are typically chronic conditions with periods of ulceration followed by healing and then recurrence; 50% of ulcers in the long-term outcomes have been open for more than 10 years, and 60% of patients have experienced previous episodes of ulceration. 1,2


   Whenever possible, surgical treatment is provided, as it seems to be the most efficient option. The effect of the operation is to eliminate the transmission of hypertensive blood from superficial and deep veins to microcirculation. 3

   Despite surgical repair of blood reflux, which is the main factor in CVI, many difficulties provoking complete wound closure remain. Therefore, modern and effective methods in postoperative therapy are needed. 4–7

   Ultrasound (US) has been employed therapeutically for decades and is currently used by clinicians to treat a wide variety of soft tissue disorders. Application of US may produce a number of biophysical effects that are relevant to wound healing. These include alternations in cellular protein synthesis and release, blood flow and vascular permeability, angiogenesis, and collagen content and alignment. Such effects have been suggested to provide a rationale for the use of therapeutic US at each stage of the wound-healing process. In the management of cutaneous wounds, frequencies from 0.5 MHz–3 MHz have been found to enhance the healing process in incisional lesions, and diabetic and venous ulcers. 8,9

   All of the published clinical studies involved application of US only in conservative therapy of venous leg ulcers. 10–18 The researchers never applied the US in patients with leg ulcers following a surgical procedure, thus it was estimated whether promising results could be expected in postoperative therapy.

   The aim of this study was to evaluate the efficiency of therapeutic US for healing of venous leg ulcers in surgically treated patients.

References: 

1. Margolis DJ, Berlin JA, Strom BL. Risk factors associated with the failure of a venous leg ulcer to heal. Arch Dermatol. 1999;135(8):920–926.
2. Valencia IC, Falabella A, Kirsner RS, Eaglstein WH. Chronic venous insufficiency and venous leg ulceration. J Am Acad Dermatol. 2001;44(3):401–421.
3. Scriven JM, Hartshorne T, Thrush AJ, et al. Role of saphenous vein surgery in the treatment of venous ulceration. Br J Surg. 1998;85(6):781–784.
4. Brizzio EO, Blattler W, Rossi G, et al. Healing venous ulcers with different modalities of leg compression. Phlebologie. 2006;35(5):249–255.
5. Franek A, Polak A, Kucharzewski M. Modern application of high voltage stimulation for enhanced healing of venous crural ulceration. Med Eng Phys. 2000;22(9):647–655.
6. Franek A, Taradaj J, Polak A, Cierpka L, Blaszczak E. Efficacy of high voltage stimulation for healing of venous leg ulcers in surgically and conservatively treated patients. Phlebologie. 2006;35(3):127–133.
7. Steins A, Jünger M. Physical therapy in patients with chronic venous insufficiency. Phlebologie. 2000;29(2):48–53.
8. Poltawski L, Watson T. Transmission of therapeutic ultrasound by wound dressings. WOUNDS. 2007;19(1):1–12.
9. Robertson VJ, Baker KG. A review of therapeutic ultrasound: effectiveness studies. Phys Ther. 2001;81(7):1339–1350.
10. Dyson M, Franks C, Suckling J. Stimulation of healing of varicose ulcers by ultrasound. Ultrasonics. 1976;14(5):232–236.
11. Roche C, West J. A controlled trial investigating the effect of ultrasound on venous ulcers referred from general practitioners. Physiotherapy. 1984;70:475–477.
12. Franek A, Chmielewska D, Brzezinska-Wcislo L, Slezak A, Blaszczak E. Application of various power densities of ultrasound in the treatment of leg ulcers. J Dermatolog Treat. 2004;15(6):379–386.
13. Eriksson SV, Lundeberg T, Malm M. A placebo controlled trial of ultrasound therapy in chronic leg ulceration. Scand J Rehabil Med. 1991;23(4):211–213.
14. Lundeberg T, Nordström F, Brodda-Jansen G, et al. Pulsed ultrasound does not improve healing of venous ulcers. Scand J Rehabil Med. 1990;22(4):195–197.
15. 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.
16. Mohr P, Stegmann W, Breitbart EW. Low-frequency ultrasound treatment of chronic venous ulcers. Wound Repair Regen. 1997;5(1):18–22.
17. Johannsen F, Gam AN, Karlsmark T. Ultrasound therapy in chronic leg ulceration: a meta-analysis. Wound Repair Regen. 1998;6(2):121–126.
18. Watson J, Nelson EA. An exploration of the use of ultrasound in the treatment of chronic venous leg ulcers. J Wound Care. 2006;15(1):39–41.
19. Gilman TH. Parameter for measurement of wound closure. WOUNDS. 1990;2(3):95–101.

















image description image description