Cellular Proliferation, Dermal Repair, and Microbiological Effectiveness of Ultrasound-Assisted Wound Debridement (UAW) Versus Standard Wound Treatment in Complicated Diabetic Foot Ulcers (DFU): An Open-Label Randomized Controlled Trial.

José Luis Lázaro-Martínez,Yolanda García-Álvarez,David Sevillano-Fernández,Irene Sanz-Corbalan,Francisco Javier Álvaro-Afonso,Esther García-Morales

doi:10.3390/jcm9124032

Abstract

We aimed to evaluate the effects of ultrasound-assisted wound (UAW) debridement on cellular proliferation and dermal repair in complicated diabetic foot ulcers as compared to diabetic foot ulcers receiving surgical/sharp wound debridement. A randomized controlled trial was performed involving 51 outpatients with complicated diabetic foot ulcers that either received surgical debridement (n = 24) or UAW debridement (n = 27) every week during a six-week treatment period. Compared to patients receiving surgical debridement, patients treated with UAW debridement exhibited significantly improved cellular proliferation, as determined by CD31 staining, Masson’s trichrome staining, and actin staining. Bacterial loads were significantly reduced in the UAW debridement group compared to the surgical group (UAW group 4.27 ± 0.37 day 0 to 2.11 ± 0.8 versus surgical group 4.66 ± 1.21 day 0 to 4.39 ± 1.24 day 42; p = 0.01). Time to healing was also significantly lower (p = 0.04) in the UAW group (9.7 ± 3.8 weeks) compared to the surgical group (14.8 ± 12.3 weeks), but both groups had similar rates of patients that were healed after six months of follow-up (23 patients (85.1%) in the UAW group vs. 20 patients (83.3%) in the surgical group; p = 0.856). We propose that UAW debridement could be an effective alternative when surgical debridement is not available or is contraindicated for use on patients with complicated diabetic foot ulcers.

Highlights

Standard of care in patients with diabetic foot ulcers includes pressure off-loading, treatment of infection, restoration of tissue perfusion, metabolic control of diabetes, treatment of co-morbidities and local ulcer care [1].Wound debridement is a fundamental part of wound bed preparation (WBP) during diabetic foot ulcer (DFU) treatment
In order to build upon these previous findings, the main aim of the current study was to elucidate the effects of ultrasound-assisted wound (UAW) debridement on cellular proliferation and dermal repair in complicated diabetic foot ulcers (DFU) as compared to DFUs treated with surgical/sharp wound debridement over a six-week treatment period
Based on CD31 staining, Masson’s trichrome staining and actin staining, this study demonstrates that patients with complicated diabetic foot ulcers treated with UAW debridement exhibit significantly improved cellular proliferation compared to patients receiving surgical debridement

Summary

Introduction

Standard of care in patients with diabetic foot ulcers includes pressure off-loading, treatment of infection, restoration of tissue perfusion, metabolic control of diabetes, treatment of co-morbidities and local ulcer care [1]. Wound debridement is a fundamental part of wound bed preparation (WBP) during diabetic foot ulcer (DFU) treatment. While surgical debridement is considered the gold standard in DFU treatment and should be utilized over other techniques, it is not always available, practical or suitable or for each patient [4,5]. When considering co-morbidities, vascular status, level of infection, ulcer location, and patient preference, practitioners may find that alternative debridement methods are more appropriate as the primary treatment or in tandem with other treatments over time. Surgical debridement has certain limitations: it is not ideal for patients with poor vascular status; it requires specific surgical skills; for the procedure is required an operating room; and surgical debridement has the potential for large damage to wound beds with exposure bone, joint tissue or ligament [6]

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