Sound Evidence - March 2008 - (Page 57) Surgery and skin grafts are usually required for fullthickness burns.6 Burn treatment varies according to type, depth, and extent of injury. Standard burn treatment includes daily cleansing, debridement, application of topical antimicrobials, nonadherent dressings, and pain management.4 Acoustic pressure wound therapy (APWT; MIST® Therapy System [Celleration, Eden Prairie, Minn]), is a noncontact, low-frequency, nonthermal ultrasound treatment utilizing positive pressure to accelerate healing, cleanse, and debride. In APWT, ultrasound waves delivered via sterile saline mist stimulate fibroblasts to accelerate healing and remove bacteria from the wound bed.7-9 The effectiveness of APWT has been demonstrated in acute and chronic wounds,10-13 including burns,14 and has been associated with reductions in wound-related pain.15 This retrospective case series study was conducted to assess the clinical effectiveness of APWT in treating mixed partial- and full-thickness burns in a rural wound care center lacking specialized burn care. Figure 1a. Initial evaluation of patient 14 with partial- and fullthickness burns pre-APWT. Methods Data were manually extracted from the charts of 14 consecutively treated outpatients with mixed partial- and full-thickness burns who received APWT with standard burn care from August 2006 to October 2007. Data included demographic characteristics (age, sex, and ethnicity), medical histories, burn data (date of burn, type, severity, dimensions, and percent body surface area affected), total number of APWT treatments necessary for complete healing, pre- and post treatment pain scores, and the number of APWT treatments necessary to decrease pain. Burn thickness was assessed by clinical appearance. Burns were classified as full-thickness if eschar was present and no blanching was evident with pressure. All burns had areas of partial-thickness. Treatment continued until burns were healed. Patients were followed for up to 6 months. Outcome effectiveness of APWT was evaluated based on scarring characteristics (ie, cosmetic appearance) of healed wounds and pain resolution. The authors determined scarring characteristics by visual inspection. Patients rated pain using a 10-point visual analog scale (VAS; 0 = no pain, 10 = severe pain) before each APWT treatment. Figure 1b. Patient 14 following first APWT session. \Summary of Cases Patients were 5 months to 78 years old. Seven patients (50%) had medical histories significant for diabetes or cardiovascular disease (see Table 1). Most (13 out of 14) burns were thermal; one was chemical. Burns were located on extremities, trunk, or both. The average body surface area affected was 7% (range: 1% to 24%). Most patients (71%) experienced pre-treatment burn-related pain (VAS 2 to 10). Patients received between two and 108 APWT treatments, depending on their rate of healing (see Table 1). March 2008 Vol. 54 Issue 3 57
Table of Contents Feed for the Digital Edition of Sound Evidence - March 2008 Sound Evidence - March 2008 Acoustic Pressure Would Therapy for Management of Mixed Partial- and Full-Thickness Burns in a Rural Wound Center Sound Evidence - March 2008 Sound Evidence - March 2008 - Acoustic Pressure Would Therapy for Management of Mixed Partial- and Full-Thickness Burns in a Rural Wound Center (Page 56) Sound Evidence - March 2008 - Acoustic Pressure Would Therapy for Management of Mixed Partial- and Full-Thickness Burns in a Rural Wound Center (Page 57) Sound Evidence - March 2008 - Acoustic Pressure Would Therapy for Management of Mixed Partial- and Full-Thickness Burns in a Rural Wound Center (Page 58) Sound Evidence - March 2008 - Acoustic Pressure Would Therapy for Management of Mixed Partial- and Full-Thickness Burns in a Rural Wound Center (Page 59)
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