Viana Lisley, Pompeo Matthew
Texas Health Presbyterian Hospital Dallas, Dallas, TX.
Wounds. 2017 Aug;29(8):231-239.
Contact and noncontact ultrasounds are types of low-frequency ultrasonic treatments for wound care.
The purpose of this research was to collect data in order to see if healing rates are accelerated when both forms of ultrasound therapies are utilized.
The Viana-Pompeo (VIP) Ultrasound Protocol consists of high-intensity, low-frequency, contact ultrasound therapy followed by low-intensity, low-frequency, noncontact ultrasound therapy. A total of 11 subjects with a total of 24 chronic or subacute lower extremity wounds were enrolled in the study. Of the 11 subjects, 6 finished the protocol (12 wounds). All subjects started with contact ultrasound for debridement at a frequency of 25 kHz and at the maximum intensity the subject could tolerate (equipment range, 20%-100% of 1.0 W/cm²). Once the wound was sufficiently clean with ≤ 20% of necrotic tissue or adherent slough, therapy was switched to noncontact, low-frequency ultrasound (NLFU) for cellular stimulation at 40 kHz and intensities of 0.1 W/cm² to 0.5 W/cm². Subjects received ultrasound treatment 3 times weekly for the 12-week study. Progress was analyzed based on reductions in wound area, volume, and slough and increases in granulation and epithelialization. Wounds were divided into 2 groups: group A, wound duration between 4 and 21 weeks; and group B, wound duration ≥ 47 weeks. There were no wounds between 21 and 47 weeks.
In group A (4 wounds), all wounds improved in wound area and epithelialization; 75% achieved an improvement of > 99% before or at 12 weeks of treatment. In addition, all wounds saw a wound volume reduction of 93% to 100%. Granulation in group A was 100%, and by visit 10 of 36, all wounds had 0% slough or eschar. In group B (8 wounds), 50% of wounds improved with a wound volume reduction of 50%; all wounds increased in granulation, with 50% achieving 75% to 100% granulation. Sixty-two percent of wounds in group B saw an increase in epithelialization, and 75% of wounds had 85% to 100% reduction in slough and eschar by the last visit (end of week 12). There was a strong positive correlation between wound age and healing time (r = 0.94).
Both groups benefited from the VIP Protocol, which promoted wound closure or wound bed preparation for graft. The results seem to favor an earlier start of the protocol for best outcomes and indicate that contact and noncontact ultrasound therapies are not exclusionary but rather complementary.
接触式超声和非接触式超声是用于伤口护理的低频超声治疗类型。
本研究的目的是收集数据，以观察同时使用这两种超声治疗形式时愈合率是否会加快。
维亚纳 - 庞佩奥（VIP）超声方案包括高强度、低频接触式超声治疗，随后是低强度、低频非接触式超声治疗。共有11名受试者，总计24处慢性或亚急性下肢伤口纳入本研究。11名受试者中，6名完成了该方案（12处伤口）。所有受试者均从以25kHz频率、受试者能耐受的最大强度（设备范围为1.0W/cm²的20% - 100%）进行接触式超声清创开始。一旦伤口坏死组织或附着的腐肉≤20%，伤口足够清洁，治疗就切换为以40kHz频率、0.1W/cm²至0.5W/cm²强度进行非接触式低频超声（NLFU）细胞刺激。在为期12周的研究中，受试者每周接受3次超声治疗。根据伤口面积、体积和腐肉的减少以及肉芽组织形成和上皮化的增加来分析进展情况。伤口分为两组：A组，伤口持续时间为4至21周；B组，伤口持续时间≥47周。21至47周之间没有伤口。
在A组（4处伤口）中，所有伤口的伤口面积和上皮化均有改善；75%的伤口在治疗12周前或12周时改善>99%。此外，所有伤口的伤口体积减少了93%至100%。A组肉芽组织形成率为100%，到第36次就诊时，所有伤口的腐肉或焦痂均为0%。在B组（8处伤口）中，50%的伤口有改善，伤口体积减少50%；所有伤口的肉芽组织均增加，50%的伤口肉芽组织形成率达到75%至100%。B组62%的伤口上皮化增加，到最后一次就诊（第12周结束）时，75%的伤口腐肉和焦痂减少85%至100%。伤口年龄与愈合时间之间存在强正相关（r = 0.94）。
两组均从VIP方案中受益，该方案促进了伤口闭合或为植皮进行伤口床准备。结果似乎支持尽早开始该方案以获得最佳效果，并表明接触式超声和非接触式超声治疗并非相互排斥，而是互补的。
