Conway McLean, DPM, Journal columnist

It’s a hidden epidemic, affecting about 7 million Americans. Understandably so, who wants to talk about their smelly leg ulcer? (Besides me, that is.) The topic is the chronic wound, defined as any opening in the skin (aka ulcer, wound, sore, etc) that doesn’t heal in a timely fashion.

These are not a common problem in the young and healthy, but because of our aging population, the obesity epidemic, and more, they are becoming a tremendous burden on our health care system. Those so afflicted usually suffer from one of the “highly branded” diseases such as diabetes or obesity. A sharp rise in the incidence of diabetes has impacted the occurrence of chronic wounds internationally. This phenomenon seems to have overshadowed the significance of chronic wounds as a unique health condition. Estimates claim an excess of $25 billion is spent annually on the treatment of chronic wounds and the burden is growing rapidly.

The science of wound care is a new one, with methods of care in prior years based on hearsay and rumor. Health care providers often know little about the current standards of care. Even general surgeons, who create wounds for a living, may be misinformed about the currently recognized best methods for healing these resistant sores. If these techniques, at the very least, aren’t being used, then substandard care is being provided.

Without good research to guide techniques, all manner of medicines and potions have been applied over the course of history. In my decades of practice alone, our understanding of the art and science of getting these challenging lesions to heal has changed radically. We know so much more now about why these injuries to skin and deeper structures don’t heal. We know that, contrary to popular opinion, wounds do not heal better when exposed to the air. This and a multitude of other bad practices have been used in the past…..and many still are.

Much of the cost and disability resulting from chronic wounds is, as the name describes, due to their enduring nature: they often require months of treatment. And the dollars add up. The products required to properly treat chronic wounds are often exorbitant. The consequences of these lasting lesions can be deadly, often because of infection: our most important barrier to bacterial invasion, intact skin, is impaired. Microbes gain access through the wound, often leading to hospitalization, amputation, even death.

Any method which helps to close these faster is going to find a place in healthcare. Many new techniques and technologies have been developed in the last decade or two. Only a few are truly impactful and have altered the landscape which is modern wound care. One of these is vac therapy (technically referred to as NPWT, negative pressure wound therapy). This technology has saved many limbs with its ability to stimulate the growth of new tissue.

A newer device produces a watery mist that has been charged with ultrasonic energy. The generic term for this is non-contact, high frequency ultrasound and it has many important and consequential effects. Notice the term “newer” was used; this technology has been in use for nearly two decades. This has allowed well-constructed studies and clinical trials to be performed, confirming the effects on wounds. The data has resulted in this technology being accepted by hospitals, governmental agencies (like Medicare), even private insurers like the “Blue’s.”

There are many types of chronic wounds, but most share certain findings. The chemistry of the tissues at the base of one of these is changed, with high levels of inflammation. Blood flow to these is usually reduced for one of many reasons, and often is the primary reason the wound exists. Although they don’t commonly invade into the tissues (which would then be infection), bacteria frequently live on the surface of a wound. There they form colonies with various other bacteria, creating a “biofilm”, a tough resistant structure nearly impervious to removal. And it’s detrimental to healing.

Non-contact ultrasonic energy has some well-proven effects on human wounds, with positive consequences. For one, ultrasonic energy, transported in the form of a watery mist, has the ability to revitalize these resistant lesions. This energy is delivered to the wound surface without contact. No instrument or applicator touches the skin. The abilities of this “super-charged” mist are exciting and entirely positive. And in just two and a half minutes of treatment, eighty percent of the surface bacteria are killed.

These wounds are often exquisitely painful, sometimes requiring narcotics for even a dressing change. The physical removal of dead or infected tissue, a procedure called debridement, is essential for healing of the great majority of these wounds. It is considered internationally the standard of care. As you might imagine, this removal process can be agonizing. But debridement is generally necessary for healing.

The piece of technology producing this energized mist is called the “Ultramist” and the treatment is painless, an attribute appreciated by all who are able to receive its benefit. Its ability to break up and remove those harmful tissues that are clogging most wounds are shocking and of critical benefit. Also important, this energetic mist kills those microbes on the wound that impede healing.

Maybe most important, this ultrasonic energy penetrates into and below the tissues of the wound. A result is increased blood flow from local blood vessels into the wound itself, always a good thing. Improvements in that department, blood flow, is guaranteed to promote the normal healing process. Blood getting into tissues from the vessels is called perfusion: a vital necessity when it comes to wound healing. This penetrating ultrasonic energy seems helpful in this respect, as well.

It’s difficult to find a wound care technique or treatment that can simultaneously reduce inflammation, kill biofilm and the bugs it houses, and last but not least, increase perfusion. This non-contact, painless method seems able to do all that. It’s exciting to have this at hand for these common and often challenging conditions. No one wants to talk about it, but it’s likely you or someone you know is involved in this kind of care. The more effective weapons we have, the better, in the war on chronic wounds. Ultrasonic mist would seem to be an important one.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments at drcmclean@outlook.com.