Acoustic Pressure Wound Therapy* for Debridement of Infected, Nonhealing Wounds: A Case Series

Purpose: Necrotic tissue and wound infection adversely affect healing progression. Debridement of such tissue is therefore required to allow for revival of the wound healing process. Acoustic pressure wound therapy (APWT)* is a novel, noncontact, low-frequency ultrasound therapy indicated for cleansing and maintenance debridement of slough, fibrin, tissue exudates, and bacteria.¹

Case Descriptions: APWT was administered to 3 patients with infected, necrotic wounds unresponsive to conventional wound therapies in an effort to cleanse wound beds. All patients received I.V. antibiotics. Patient 1 is a 60-year-old diabetic woman with a dehisced sternal incision. Initial treatment: wet-to-dry dressings and autolytic debridement. After 3 months, wound area was 24.5 cm² with 20% slough. Patient 2 is a 75-year-old woman with lower-extremity arterial disease and prior below-the-knee amputation of the right leg. She developed an arterial ulcer with cellulitis infection on the left lower leg. Initial treatments: pulsed lavage, soaking, hydrofiber and wet-to-dry dressings. After 3 months, wound area was 45.5 cm² with 90% slough. Patient 3, a 74-year-old diabetic woman with a trauma wound to the left lower leg, was facing potential limb amputation. Initial treatments: soaking, antibiotic ointment, wet-to-dry dressing, and 2 skin grafts. After 5 months, wound area was 84 cm² with 80% slough. APWT 2 to 3 times weekly was initiated in all 3 patients with dressings of silver and either hydrocolloid ointment or calcium alginate. 

Outcomes: With 3 to 4 weeks of APWT and moist dressings, outcomes were as follows: Patient 1, 100% granulation and 96% volume reduction, near complete closure. Patient 2, 90% granulation and 82% volume reduction, family reported wound closure one month later. Patient 3, 100% granulation, 85% wound closure, and ultimately limb salvage.

Discussion: In this series of patients, débridement with APWT appears to have helped restart a stalled healing process in infected, nonhealing wounds.