SoundEvidence - August 2008 - (Page 53) dressings, proper positioning, pressure-reducing surfaces, and 2-hour turning schedules. For Patient 2, in which debridement with APWT exposed a larger wound bed, full granulation was reached in 10 weeks. Case reports at scientific congresses have described full granulation with adjuvant use of APWT ranging from 1.5 weeks to 3 months in lower-extremity wounds6-10 and 2.5 to 4 weeks in pressure ulcers.7,10 Small randomized studies have demonstrated greater proportions of wounds healed at 12 weeks when APWT is added to conventional wound care compared with conventional care alone in diabetic foot ulcers (proportion healed: 40.7% with APWT versus 14.3% without, P = 0.04)12 and ischemic lowerextremity wounds (>50% volume reduction: 63% with APWT versus 29% without, P <0.001).13 In this series of sacral pressure ulcers, APWT treatment ranging from 5 weeks to 5.5 months resulted in wound area decreasing by 71% to 97% and wound volume decreasing by 75% to 99%, with the exception of Patient 2, in whom removal of necrotic tissue exposed the true (larger) wound size. Ultimately, two ulcers closed completely in 7 weeks and 6.5 months, respectively. It has been estimated that Stage IV pressure ulcers often take one full year to heal completely.14 Outcomes in these five patients provide preliminary evidence that, in advanced-stage pressure ulcers, APWT may offer a less-invasive alternative to sharp or surgical debridement for removing necrosis and promoting granulation in preparation for subsequent treatment with ES or other appropriate wound healing modalities. Prospective randomized studies are needed to evaluate the utility of APWT as a therapy to hasten granulation of pressure ulcers. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Acknowledgement The authors thank Laurie LaRusso, MS, ELS, for her primary contribution to the writing of this manuscript. - OWM 13. References 1. Whitney J, Phillips L, Aslam R, et al. Guidelines for the treatment of pressure ulcers. Wound Repair Regen. 2006;14(6):663–679. 2. Redelings MD, Lee NE, Sorvillo F. Pressure ulcers: 14. more lethal than we thought? Adv Skin Wound Care. 2005;18(7):367–372. Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2001;24(suppl 1):S40–S101. MIST Therapy System Instructions for Use. Eden Prairie, Minn: Celleration, Inc.; 2006. Unger PG. Low-frequency, noncontact, nonthermal ultrasound therapy: a review of the literature. Ostomy Wound Manage. 2008;54(1):57–60. Buth L, Sacks P, Martinez R. Noncontact, low-frequency ultrasound therapy for debridement and closing of tunnels in infected chronic wounds. Poster presented at the Symposium on Advanced Wound Care. San Diego, Calif. April 24–27, 2008. Cole P. Low-frequency therapeutic ultrasound rapidly healed rapidly healed challenging wounds. Poster presented at the Symposium on Advanced Wound Care. Tampa, Fla. April 28–May 1, 2007. Haan J, Lucich S. Case studies demonstrate effectiveness of noncontact, low-frequency, therapeutic ultrasound in complicated wounds. Poster presented at the Symposium on Advanced Wound Care. Tampa, Fla. April 28–May 1, 2007. Thurman K. Effectiveness of noncontact, low-intensity, low-frequency therapeutic ultrasound in wound treatment: a case series study. Poster presented at the Symposium on Advanced Wound Care; Tampa, Fla. April 28–May 1, 2007. Turkos MA, Stoner K, Gardner JA. Utilizing low frequency non-contact ultrasound* in the management of chronic wounds. Poster presented at the Symposium on Advanced Wound Care. Tampa, Fla. April 28–May 1, 2007. Kent DJ. Getting misty over wound care. Learn how therapy with ultrasound waves and saline mist can help your patient’s wound heal. Nursing. 2007;37(9):36–37. Ennis WJ, Foremann P, Mozen N, Massey J, ConnerKerr T, Meneses P. Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study. Ostomy Wound Manage. 2005;51(8):24–39. Kavros SJ, Miller JL, Hanna SW. Treatment of ischemic wounds with noncontact, low-frequency ultrasound: the Mayo clinic experience, 2004–2006. Adv Skin Wound Care. 2007;20(4):221–226. Black J, Baharestani M, Cuddigan J, et al. National Pressure Ulcer Advisory Panel’s updated pressure ulcer staging system. Urol Nurs. 2007;27(2):144–150, 156. August 2008 Vol. 54 Issue 8 53
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