Sound Evidence - October 2008 - (Page 59) A chronic wounds.8 An in vitro study showed that APWT destroyed bacterial cells.9 Case series evidence suggests that APWT reduces wound-related pain.10 This case series describes the outcomes of APWT for the treatment of extensive and severe scalp wounds with a 3-year history in 3-year-old twins with HWS. Case Report Non-Hispanic Caucasian 3-year-old fraternal twins (male and female) were referred to the authors’ clinic in February 2008 for worsening wounds. They presented with scalp wounds reaching from ear to ear and from frontal to parietal lobe, with a crusty build-up around the perimeter (see Figure 1a,b). The boy’s wounds extended to one side of his face and both ears. The girl had more extensive and recalcitrant wounds. The wound beds were pale pink with thick, viscous, creamy discharge. They were friable and bled easily and profusely. The children cried with dressing changes, suggesting they were experiencing or anticipating pain. At presentation, their dressings consisted of a hydrocortisone 1% cream/bactroban mixture, compounded by their pharmacist, and petroleum gauze. The parents changed the dressings daily. In addition to scalp lesions, the children had HWSassociated cleft lip and palate, blocked tear ducts, multiple eye and ear infections, light sensitivity, anhidrosis, absence of hair, spontaneous hydronephrosis, dentition abnormalities, and episodes of hypothermia. Both children had surgical repair of the cleft lip, nose, and palate, as well as dental surgery. At birth, the girl had two small scalp lesions that did not heal and required surgical excision. These wounds remain closed. Shortly after birth, both babies developed a scaly scalp crust that was treated as cradle cap. The crusts thickened and extended, covering the scalps of both babies. Upon debridement, full-thickness wounds were found. These wounds persisted since the children were 3 months (boy) and 5 months (girl) old. Previous management at other wound clinics included multiple topical treatments (ie, foam, oxidized, regenerated-cellulose/collagen with silver, calcium alginate, silver sulfadiazine cream, and biologic tissue matrix), resulting in minimal, short-term improvements. Informed consent was obtained from the parents to publish their children’s photographs and clinical data. October 2008 Vol. 54 Issue 10 B Figure 1a,b. Three-year-old fraternal twins (girl, a; boy, b) with HayWells Syndrome before acoustic pressure wound therapy (February 2008). scalp. Bacterial wound infections are universally reported within the sparse literature of this disorder. Lesions require intensive wound care.4-6 Acoustic pressure wound therapy (APWT; MIST® Therapy System; Celleration, Eden Prairie, Minn) is a noncontact, low-frequency, nonthermal ultrasound therapy that stimulates fibroblasts critical for wound healing and cleanses and debrides wounds.7 Acoustic energy is delivered to the wound via sterile, saline mist. The effectiveness of APWT has been demonstrated in controlled and case series clinical studies of acute and 59
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