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A pilot study evaluating noncontact low frequency ultrasound and underlying molecular mechanism on diabetic foot ulcers.
MedLine Citation:
PMID:  23163982     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Non contact low frequency ultrasound (NCLF-US) devices have been increasingly used for the treatment of chronic non healing wounds. The appropriate dose for NCLF-US is still in debate. The aims of this pilot study were to evaluate the relationship between dose and duration of treatment for subjects with non healing diabetic foot ulcers (DFUs) and to explore the correlation between wound healing and change of cytokine/proteinase/growth factor profile. This was a prospective randomised clinical study designed to evaluate subjects with non healing DFUs for 5 weeks receiving standard of care and/or NCLF-US treatment. Subjects were randomly assigned to one of three groups: application of NCLF-US thrice per week (Group 1), NCLF-US once per week (Group 2) and the control (Group 3) that received no NCLF-US. All subjects received standard wound care plus offloading for a total of 4 weeks. Percent area reduction (PAR) of each wound compared to baseline was evaluated weekly. Profiles of cytokines/proteinase/ growth factors in wound fluid and biopsied tissue were quantified to explore the correlation between wound healing and cytokines/growth factors expression. Twelve DFU patients, 2 (16·7%) type 1 and 10 (83·3%) type 2 diabetics, with an average age of 58 ± 10 years and a total of 12 foot ulcers were enrolled. Average ulcer duration was 36·44 ± 24·78 weeks and the average ABI was 0·91 ± 0·06. Group 1 showed significant wound area reduction at weeks 3, 4 and 5 compared to baseline, with the greatest PAR, 86% (P < 0·05); Groups 2 and 3 showed 25% PAR and 39% PAR, respectively, but there were no statistically significant differences between Group 2 and Group 3 over time. Biochemical and histological analyses indicated a trend towards reduction of pro-inflammatory cytokines (IL-6, IL-8, IL-1β, TNF-α and GM-CSF), matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF) and macrophages in response to NCLF-US consistent with wound reduction, when compared to control group subjects. This proof-of-concept pilot study demonstrates that NCLF-US is effective in treating neuropathic diabetic foot ulcers through, at least in part, inhibiting pro-inflammatory cytokines in chronic wound and improving tissue regeneration. Therapeutic application of NFLU, thrice (3) per week, renders the best wound area reduction.
Authors:
Min Yao; Hatice Hasturk; Alpdogan Kantarci; Guosheng Gu; Silvia Garcia-Lavin; Matteo Fabbi; Nanjin Park; Hisae Hayashi; Khaled Attala; Michael A French; Vickie R Driver
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-19
Journal Detail:
Title:  International wound journal     Volume:  -     ISSN:  1742-481X     ISO Abbreviation:  Int Wound J     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101230907     Medline TA:  Int Wound J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors. International Wound Journal © 2012 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
Affiliation:
M Yao, MD, MPH, Limb Preservation and Wound Care Research, Department of Surgery, Center for Restorative and Regenerative Medicine, VA New England Health Care Division, Providence, RI, USA, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA H Hasturk, DDS, PhD, Department of Periodontology, Forsyth Institute, Cambridge, MA, USA A Kantarci, DDS, PhD, Department of Periodontology, Forsyth Institute, Cambridge, MA, USA G Gu, MD, PhD, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA S Garcia-Lavin, DPM, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA M Fabbi, MD, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA N Park, DPM, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA H Hayashi, MD, PhD, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA K Attala, MD, PhD, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA MA French, DJ, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA VR Driver, DPM, MS, FACFAS, Limb Preservation and Wound Care Research, Department of Surgery, Center for Restorative and Regenerative Medicine, VA New England Health Care Division, Providence, RI, USA, Department of Surgery, Boston University Medical Center, School of Medicine, Boston, MA, USA.
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