Institutional Experience with Ultrasonic Debridement for the Treatment of Complex Wounds

Objective: Non-healing lower extremity wounds serve as a debilitating problem that can lead to chronic complications if not treated appropriately. 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 eighty-nine lower extremity wounds was conducted in sixty-five patients, who underwent treatment with a direct, low-frequency (22.4kHz), high-intensity (~60 W/cm2) ultrasonic device at the University of Pennsylvania from 2010-2016. Wound healing was assessed at 60, 120, and 180-day post-ultrasonic debridement. Descriptive statistics, post-debridement outcomes, and regression analysis was conducted.

Results: Mean age was 57.0 years and average BMI was 31.1kg/m2. High-risk comorbidities included smoking (43%, n=28), diabetes (55.4%, n=36), peripheral vascular disease (56.9%, n=37), and hypertension (68%, n=44). The average wound age at initial presentation was 555.7 days and average wound size was 9.8cm x 7.4cm. At 60-days post-ultrasonic debridement, 68.5% (n=61) of patients had greater than 25% wound reduction, with 35% (n=31) achieving 50%-100% wound reduction. At 180-day outcomes, 75% (n=67) received greater than 25% reduction with 65% (n=58) reaching 50-100% wound reduction. Amputations occurred in 8.9% (n=10), resulting in a 91.1% (n=79) limb salvage rate. Regression model analysis showed a history of smoking (p=0.028) or diabetes (p=0.004) was independently associated with decreased wound healing outcomes at 120-days. The absence of diabetes was associated with successful wound healing rates (p=0.035) at 180-day outcomes.

Conclusion: The use of a direct, low-frequency, high-intensity, ultrasonic debridement tool* improves time to healing with positive wound healing outcomes and an increase in limb salvage rates. 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.