Purpose: This case report describes the course and outcomes of noncontact, low-frequency, ultrasound therapy* to hasten the healing of a lower extremity trauma wound in a prednisone-dependent patient with cardiovascular comorbidity.

Case Description: This 57-year-old Caucasian woman in a manually controlled wheelchair presented on July 16, 2007 with a trauma wound on her right calf resulting from a collision with a footstool 9 weeks prior. Her medical history includes congestive heart failure, coagulopathy, mitochondrial myopathy, myalgia, severe osteoporosis, and hysterectomy. Her current medications include cephalexin, prednisone, furosemide, esomeprazole magnesium, and nitroglycerin tablets. The patient is prednisone-dependent, which predisposes her to delayed healing response. Treatment to this point had been a topical antiseptic twice a day and oral antibiotics. The wound presented with rolled edges (epiboly) and 50% slough but was free of odor, drainage, and erythema. Noncontact ultrasound treatments were started twice per week for 3 minutes per session. The wound was dressed with skin care protectant spray, hydrogel, telfa, and a perforated skin tape. As shown in the figure, wound volume measured zero as of August 22, after 5.5 weeks of treatment. At this time, the patient was hospitalized at another facility for an exacerbation of her congestive heart failure. Noncontact ultrasound was discontinued at this point and dressings were continued. On return to the clinic September 12, after her release from the hospital, the wound had closed completely (see figure).

Discussion: With 5.5 weeks of noncontact ultrasound therapy, this trauma wound healed in 8.5 weeks despite the poor healing response typically associated with prednisone dependence.

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