Dermatology and Cutaneous Surgery, University of Miami, Miami, FL 33136, USA.
Int Wound J. 2012 Oct;9(5):570-8. doi: 10.1111/j.1742-481X.2011.00921.x. Epub 2012 Feb 1.
Venous insufficiency is the most common cause of leg ulcers in the United States. Venous leg ulcers cost the health care system billions of dollars annually, and healing rates are less than 70% with standard of care; therefore, new therapies are needed to increase healing times and minimize associated costs. Non contact ultrasound therapy has been used to treat a variety of chronic wounds including venous leg ulcers, and it is thought that ultrasound has an effect on decreasing the bacterial count in wounds, although the exact mechanism of action of ultrasound is yet to be determined. We conducted an open labelled pilot study of 10 refractory venous ulcers of large size to determine the effect of non contact ultrasound on wound closure, bacterial counts, expression of inflammatory cytokines and pain reduction. We lacked a sham control group but we compared the baseline and end of treatment assessments and noted the differences. We found a significant reduction in wound area (P = 0·0039) over the 4-week treatment period. We also found a decline in individual and total bacterial counts; however, these differences were not significant. For all patients, there was also a trend toward reduced inflammatory cytokine expression compared with baseline levels; however, this reduction did not reach statistical significance. Interestingly, there was a correlation between healing and change in cytokine expression, which showed statistically significance for tumour necrosis factor (TNF)-αP = 0·0395, IL-1a P = 0·0351, IL-6 P = 0·0508, IL-8 P = 0·0990. Pain as measured by the visual analogue scale (VAS) was reduced from 4 at the baseline to 2·7 by the end of the study. In conclusion, we found that patients treated with ultrasound therapy and compression therapy show clinical improvement over the course of 4 weeks and had a decrease in inflammatory cytokines, bacterial counts and pain.
静脉功能不全是美国腿部溃疡最常见的原因。静脉性腿部溃疡每年使医疗保健系统花费数十亿美元，而标准治疗的愈合率不到 70%；因此，需要新的治疗方法来缩短愈合时间并最大限度地降低相关成本。非接触式超声波疗法已用于治疗多种慢性伤口，包括静脉性腿部溃疡，并且认为超声波对减少伤口中的细菌计数有影响，尽管超声波的确切作用机制尚未确定。我们对 10 例大尺寸难治性静脉溃疡进行了开放性标记试点研究，以确定非接触式超声波对伤口闭合、细菌计数、炎症细胞因子表达和疼痛减轻的影响。我们缺乏假对照，但我们比较了基线和治疗结束时的评估，并注意到了差异。我们发现，在 4 周的治疗期间，伤口面积显著减少（P = 0·0039）。我们还发现个体和总细菌计数下降；然而，这些差异并不显著。对于所有患者，与基线水平相比，炎症细胞因子的表达也呈下降趋势；然而，这种减少没有达到统计学意义。有趣的是，愈合与细胞因子表达变化之间存在相关性，肿瘤坏死因子（TNF）-α的相关性具有统计学意义（P = 0·0395），IL-1a P = 0·0351，IL-6 P = 0·0508，IL-8 P = 0·0990。通过视觉模拟量表（VAS）测量的疼痛从基线时的 4 分降至研究结束时的 2·7 分。总之，我们发现，接受超声治疗和加压治疗的患者在 4 周的治疗过程中表现出临床改善，并且炎症细胞因子、细菌计数和疼痛减少。
