Case Description: This 76-year-old Caucasian woman presented to our facility with two pressure ulcers of 2 to 3 months duration: a partial- and full-thickness ulcer of the sacral area and a full-thickness ulcer of the occipital area of the head. Her medical history includes myocardial infarction, heart disease, left ventricular thrombus, respiratory failure, infection of the wound and sputum, apical aneurysm, and a bowel perforation leading to ileostomy. Her medications include a nutritional supplement and megestrol acetate. On admission the head wound was covered with eschar and being treated with dry dressing and pressure relief. We initiated noncontact ultrasound (3 times/week), hydrogel, and dry dressing. Hydrogel was later replaced with papain-urea. Full granulation was achieved after 7 weeks of noncontact ultrasound therapy. Wound area decreased from 24 cm² to 9 cm². Hydrogel and dry dressing once a day are ongoing. On admission the sacral wound was infected with Enterobacter aerogenous; later culture was proteus mirabilis-positive. Initial treatment was enzymatic debridement and wet-to-dry dressings. Noncontact ultrasound was added 3 times/week. After 7 weeks of noncontact ultrasound (+NPWT for last 2 weeks), area was reduced from 121 cm² to 31.5 cm² and slough from 70% to 30%, with 70% granulation. Noncontact ultrasound, silver gel, and dry dressings are ongoing.
Discussion: Healing of these chronic pressure ulcers was complicated by medical comorbidity, infection, and extensive slough and eschar. Substantial improvement in wound size and tissue quality has been observed with 6 to 7 weeks of noncontact ultrasound therapy. Outcomes of ongoing therapy will be presented.

* MIST Therapy System, Celleration, Inc., Eden Prairie, Minnesota