Institutional Experience with Ultrasonic Debridement for the Treatment of Complex Wounds

Purpose

Non-healing lower extremity wounds are morbid and debilitating. If not treated appropriately, these wounds can lead to chronic complications, oftentimes necessitating numerous debridements and reoperations. Technological advancements have been implemented to the current treatment paradigm to promote a healthy granular wound bed and re-epithelization. The aim of this study was to critically assess wound healing outcomes following direct, low-frequency, high-intensity, ultrasonic debridement for non-healing lower extremity wounds, in a complex patient population. 

Methods

A retrospective analysis of 107 lower extremity wounds were identified in 68 patients, who underwent treatment with a direct, low-frequency (22.4kHz), high-intensity (~60 W/cm²) ultrasonic device at the University of Pennsylvania between January 2010 and January 2016. Eighty-two wounds in fifty-one patients met inclusion criteria and were retrospectively reviewed. Wound healing outcomes were assessed at 180-day post-ultrasonic debridement. Descriptive statistics, cost, and univariate analysis were conducted for analysis. 

Results

Mean age was 57.0 years and average BMI was 30.8kg/m². 43.1% (n=22) of patients presented with more than 1 lower extremity wound. Primary wound location was ankle to knee region at 72% (n=59), followed by foot (23%, n=19), and knee to hip or gluteal region (5%, n=4). The patient population had several comorbidities that have been shown to decrease wound healing (1), such as smoking (47%, n=24), hypertension (76%, n=38), diabetes (45%, n=23), and peripheral vascular disease (51%, n=26). These chronic wounds persisted for an average of 1,013 days with an average wound size of 9.0cm x 7.4cm. At 180-days post-ultrasonic debridement, 60% (n=49) of patients had improved wound healing (greater than 50% wound reduction). Readmission (47%, n=24) and reoperation (45%, n=23) rates were divided by encounter type: further wound healing or wound complication treatment. Readmission for wound healing (70%, n=39) was primarily for further debridements (41%, n=16). Whereas, wound infection (30%, n=7) was the most common readmission for wound complications (30%, n=17). Ninety-six percent (n=51) or reoperations consisted of treatments for further wound healing. Average length of hospital stay was 9.1 days.

Conclusion

The use of a direct, low-frequency, high-intensity, ultrasonic debridement tool provides beneficial wound-healing outcomes and preliminary improvements in time-to- healing. By showing positive findings at 180-days post-debridement, this study lays the foundation for future comparative studies to assess long-term outcomes of ultrasonic debridement, in conjunction with other wound debridement modalities. In a complex patient population, our results suggest that ultrasonic surgical debridement is a safe and effective adjunctive therapy in the management of chronic wound healing.

References

1. Gregg EW, Sorlie P, Paulose-Ram R, et al. Prevalence of lower-extremity disease in the US adult population 40 years of age with and without diabetes: 1999-2000 National Health and Nutrition Examination Survey. Diabetes Care, 27(7), 1591-1597.