Complex, Recurrent Venous Ulcers Heal and Stay Closed with Modified Compression and Pulsed Radio Frequency Energy

We present a venous ulcer case which responded to compression and Pulsed Radio Frequency Energy (PRFE) therapy.  PRFE is indicated for adjunctive use in the palliative treatment of postoperative pain and edema in superficial soft tissue.  Preclinical science suggests that treatment stimulates an intrinsic anti-inflammatory cascade.  PRFE is designed for home-use and is easy to use.  PRFE penetrates through wound dressings, casts, compression dressings and is imperceptible. Treatment is 30 minutes twice/day until desired results are achieved.  We have found that adding PRFE Therapy into an appropriate conservative treatment regime enables the patient to return to a healthy lifestyle in a more timely manner.

Our patient is a 78 year old male with venous stasis and numerous co-morbidities including: Type II DM, HTN, CHF, and 8 year history of ulcers. On presentation, his ulcers were irregularly shaped, located at the left lateral and medial malleoli and tibial aspects of the leg (Figure 1), and highly exudative.  The skin was fibrosed and indurated with altered pigmentation in areas.  Non-pitting edema surrounded the ankle and foot.  Left peripheral pulses were diminished.

We started a 4 layer compression wrap and a hydrofiber dressing with silver for the left leg ulcers.  Nine days later, PRFE therapy was initiated.  After 4 weeks, the patient requested discontinuation of the 4 layer compression bandage. To keep the patient in as much compression as he could tolerate, we chose the closed toe compression stockings at 20-30mm/Hg.  This combination of PRFE, appropriate topical management and compression stockings resulted in 50% (+/- 4%) closure within the first month, and 68-81% closure within 2 months.  Complete closure of wounds occurred between months 7 and 8. Eight months later, the patient remains with intact skin. 

Summary:  PRFE helped reduce wound pain and aided in wound closure in this venous leg ulcer patient.