The purpose of this case study was to investigate the healing capabilities of low-frequency ultrasound therapy to heal chronic painful ulceration. In this case, a 61-year-old African American female with a past medical history of hypertension, chronic venous insufficiency, and ovarian cancer on chemotherapy presented to the clinic complaining of a painful chronic ulceration to the left ankle. The patient attributed the re-ulceration of this chronic wound to her current chemotherapy treatment drug doxorubicin. After the initial consultation, patient therapy that recommended was ultrasound therapy due to the patient stating the lesion was too painful for frequent sharp debridement in the clinical setting even when utilizing a topical anesthetic. The recommended interval treatments included a seven-minute session to the wound three times a week over a period of nine months. There were noted changes in the appearance of the wound base after the first week of therapy and changes in the size by the second week of therapy.  Throughout the treatment regimen, the patient’s pain tolerance to the wound improved as well. After nine-month, there was noted complete healing of the tissues without any complications. In conclusion, ultrasound therapy often referred to as MIST therapy can be a useful device to heal chronic painful wounds in immunocompromised patients when therapy options are limited.

Low-Frequency Ultrasound Therapy usage on chronic non-healing wounds has been proven to decreased to bacterial load by penetrating both into and below the wound bed by removing barrier biofilm, decreasing inflammation, and decreasing matrix metallopeptidase 9 (MMP-9).  Most wound care therapies are limited to treating the wound surface; however, ultrasound therapy sound waves penetrate into and below the wound bed to accelerate the normal healing process. Studies link this therapy in increased vasodilation, angiogenesis, collagen deposition, and growth factors [1-3].

The Patient: A 61-year-old African American female with worsening chronic left medial ankle ulceration for greater than a month presented to our facility by referral from her oncologist. The patient reported that this ulceration was “achy” in nature with a 10/10 on the pain scale. After the initial consultation, patient therapy that recommended was ultrasound therapy due to the patient stating the lesion was too painful for frequent sharp debridement in the clinical setting even when utilizing a topical anesthetic.  The patient-related that the chemotherapy drug doxorubicin causes the ulceration to re-ulcerate. This patient’s past medical history consisted of hypertension, chronic venous insufficiency, stage 4 ovarian cancer on antineoplastic chemotherapy. Patient medications consisted of lactulose 10 grams, Vitamin D3 1000 unit tablet once daily, and doxorubicin 2mg/mL IV suspension at chemotherapy. The only known drug allergy for this patient was penicillin.

Physical

General Appearance: Patient awake, alert, well developed, well-nourished and well-groomed

Cardiovascular: There is edema of the lower extremities. The palpable pedal pulses are diminished bilaterally. 

Extremities: Pain on palpation to the lesion, moves all lower extremities, normal inspection 

Neurological: Deep tendon reflexes intact 2/4, no ankle clonus, Sensory testing all intact bilateral lower extremities. 

Dermatologic: Full Thickness ulceration to the level of subcutaneous tissue located at the medial malleolus with a fibrotic wound base and no granulation tissue and punched out wound as well. The wound was tender to touch. Measurement of the wound documented as 5cmx4xcmx0.5cm without signs of infection. The ulcer was noted to have an irregular border. Does not probe to bone (At Initial Presentation)

Therapy: The patient’s therapy consisted of performed ultrasound therapy using sterile saline solution for 7 minutes three times a week for nine months. 

                                                                                                                                    Figure 1A

                                                                                                                                       Figure 1B

                                                                                                                                   Figure 1C

                                                                                                                                     Figure D

Figure 1 A-D: Utilization/Illustration of Low-Frequency Ultrasound Therapy to Chronic Ulceration

Clinical Presentation Image Series:

Initial Presentation

Figure 2: Left Medial Full Thickness Ulceration to the level of Subcutaneous Tissue Medial Malleolus

3 Months After Initiation Low-Frequency Ultrasound Therapy

Figure 3: Healing Full Thickness Ulceration with Granular Base

9 Months After Initiation of Low-Frequency Ultrasound Therap

Figure 4: Complete Healed with Epithelialization

The patient’s wound was completed healed and epithelized nine months after the initial therapy without any re-ulceration or complications. Throughout the treatment regimen, the patient’s pain tolerance to the wound improved as well. Indicating that low-frequency ultrasound therapy often referred to as MIST therapy can be a useful device to heal chronic painful wounds in immunocompromised patients when therapy options are limited.

The authors disclose that this research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.