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Clinical Research
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A novel approach to management of complicated wounds with exposed tendon, bone and joint utilizing ultrasound* Samies JH, Gehling ML, Regional Medical Center Orangeburg and Calhoun Co., Orangeburg, SC Management of wounds with exposed tendons, bone and joints is challenging and frequently is complicated by secondary wound infection resulting in high rates of limb loss or functional impairment. Rapid granulation over these structures is of theoretic benefit in avoidance of complications, but is difficult to achieve. Modalities, which have been employed with varying success, include free or rotational tissue transfer, sub atmospheric pressure therapy, pulsed electromagnetic fields, hyperbaric therapy, growth factors and bioengineered tissue equivalents. The effects of these modalities on the integrity and strength of these structures is uncertain. The application of low frequency noncontact ultrasound for wound healing with involvement of these structures is not documented, but an animal model suggests potential value We describe a group of 13 patients with a variety of wound etiologies including trauma, ischemic ulceration, postoperative nonhealing wounds and pressure ulceration who were treated for exposed tendon, bone and joints with MIST ultrasound. 5 had exposed tendons, 9 had exposed bone (2 with exposed joints). We demonstrated early granulation tissue formation with complete coverage of these structures. No patient had limb loss, functional loss, secondary infection or loss of tendon integrity with this modality. 6 of 13 patients initial diagnosis included infection at the wound site. All had resolution of the infection with systemic antibiotic therapy, topical antimicrobials and MIST ultrasound. No patient experienced increased pain or other complications believed to be related to the MIST therapy. This report suggests that MIST ultrasound may be beneficial and safe in the promotion of granulation over exposed tendons, joints and bone in wounds with a variety of etiologies and may aid in treatment and prevention of infection. Further study on the use of MIST ultrasound for treatment of complicated wounds with exposed tendons, joints and bone is warranted *MISTTM is a registered trademark of Celleration, Inc., Eden Prairie, MN Saini NS, Roy KS. A preliminary study on the effect of ultrasound therapy on the healing of surgically severed Achilles tendons in dogs. J Vet Med A Physiol Pathol Clin Med. 2002;49(6):321Ð328 Upton J, Baker T. Fascial flap coverage of Achilles tendon defects. Plast Renconstr Surg. 1995;95(6):1056Ð1061 Ichioka S, Ohura N. The positive experience of using a growth factor product on deep wounds with exposed bone. J Wound Care. 2005;14(3):105Ð109 Moller HD, Evans CH. Current aspects of tendon healing. Orthopade. 2000;29(3):182Ð187 Faglia E, Mantero M. A combined conservative approach in the treatment of a severe .Achilles tendon region ulcer in a diabetic patient: a case report. WOUNDS. 1999;(5):105Ð109. |
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