Sound Evidence - April 2008 - (Page 62) Sound Evidence Acoustic Pressure Wound Therapy in the Treatment of a VasculopathyAssociated Digital Ulcer: A Case Study Christopher Paul Fleming, RN, WCC Monticello-Big Lake Hospital Wound Care Center, Monticello, Minnesota Digital vasculopathy and subsequent digital ulceration are common and painful complications of limited cutaneous systemic sclerosis. Although the use of hydrocolloid occlusive dressings has been found to reduce pain, frequently required surgical or chemical debridement can be intensely painful in such ulcers. Acoustic pressure wound therapy is a noncontact, low-frequency ultrasound therapy used for painless debridement in a variety of acute and chronic wounds. It was administered to treat an intensely painful, methicillin-resistant Staphylococcus aureus-infected finger ulcer resulting from peripheral, bilateral vasculopathy in a 68year-old man with a history of three prior fingertip amputations secondary to limited cutaneous systemic sclerosis-associated digital vasculopathy. At treatment initiation, 90% of the 11 cm2 wound was covered with firmly adherent fibrin slough. Acoustic pressure wound therapy was performed three times weekly for 5 minutes per treatment and the wound was covered with a hydrocolloid occlusive dressings. Pain scores decreased from 10 (visual analog scale, 0 = none, 10 = extreme) at the beginning of treatment to 0 at the week 8 assessment and his analgesics were discontinued. After 10 weeks (31 acoustic pressure wound therapy treatments), the wound was completely closed. Key words: acoustic pressure wound therapy, debridement, noncontact ultrasound, wounds Ostomy Wound Management 2008;54(4):62–65 igital ulceration resulting from digital vasculopathy is reported to occur in 30% to 60% of patients with systemic sclerosis (SSc), or scleroderma.1-3 Severe digital vasculopathy may occur in either the diffuse cutaneous form (dcSSc) or the limited cutaneous form (lcSSc) — formerly known as CREST syndrome, an acronym for its hallmark characteristics of calcinosis, D Raynaud’s phenomenon, esophageal motility dysfunction, sclerodactylia, and telangiectasia. The multifactorial etiology of these skin ulcers, typically around digital joints, reflects the multifaceted nature of this disease. Ischemia due to vascular disease (Raynaud’s), skin tightening over digits (sclerodactylia), dry skin (Raynaud’s), mineral crystal deposits under the skin (calcinosis), and microtrauma Support for Sound Evidence is provided by an educational grant from Celleration, Inc. to HMP Communications/Ostomy Wound Management. The opinions and statements herein, as well as the selection of metrics to measure wound healing, are specific to the authors and are not necessarily those of Celleration, Inc., OWM, or HMP Communications, LLC. Please note: these articles are subject to peer review. The opinions herein may not be consistent with the labeling for MIST Therapy System. Patients are selected for your educational benefit. View celleration.com for the full package insert. Results may vary. 62 OstomyWound Management http://celleration.com
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