Limb Salvage Challenge: Use of Low Frequency Ultrasound Delivered Through Saline Mist for a Nonhealing Wound Complicated by PAD

79 y.o. male with polyneuropathy, gout, and peripheral arterial disease presented to the ED on 6/15/2011 with purulent drainage, edema, erythema of right foot and fever.  He was admitted with cellulitis, abscess and gangrene of his right foot.  Prognosis for limb salvage was poor.  Revascularization of the extremity was ruled out.

Extensive debridements of the right foot were necessary.  Final debridement on 6/20/2011 included amputation of the 5^th right toe .  Wound measured 15cm x 6cm, with 6cm tunnel.   NPWT was implemented after the final debridement in preparation for future skin grafting.  The patient was transferred from acute care to SNF.  NPWT was continued.  The patient required another hospital admission on 7/7/2011 and surgical debridement.  On 8/8/11 a partial thickness skin graft was attempted but unsuccessful. NPWT was discontinued after the 5^th postoperative day.  

At discharge from SNF on 9/25/2011, his family sought outpatient wound care for the nonhealing wound, concerned that amputation of the foot still remained a possibility.   After evaluation, low frequency ultrasound therapy delivered through saline mist was started on 10/3/11 and was continued 3x/weekly. This unique technology was implemented in conjunction with comprehensive wound care since other treatment modalities had not been successful in healing the wound.  Over 1.5 weeks, size of the wound decreased by 50%.  The wound continues to decrease in size after each treatment.  Closure is anticipated within the next 2 weeks.  His limb was salvaged without further surgery. 

 Low frequency ultrasound treatment delivered through saline mist is approved by the FDA for a variety of wounds.  Laboratory studies have shown it to decrease bioburden, increase blood flow and decrease inflammation of wounds. Clinical case studies have demonstrated positive outcomes.  Incorporation of this unique treatment into outpatient protocols will be further evaluated based on this patient’s outcome for a very complex wound.