Clinical efficacy of ultrasound debridement in the treatment of purulent wounds

The OBJECTIVE was to study the clinical course of purulent wounds with topical application of ultrasound treatment.

METHODS and MATERIALS. The study involved 70 patients undergoing inpatient treatment in the department of purulent surgery in the period from 2023 to 2024. The study design was a prospective simple controlled randomized clinical trial in which two parallel patient groups were created. The main group consisted of 35 patients, where ultrasound debridement of wounds was used against the background of complex treatment, the comparison group consisted of 35 patients, where treatment was performed using traditional methods. Objective methods of studying the wound process have been applied: cytological, microbiological methods, an objective assessment of the wound process on the Bates-Jensen scale was performed, the dynamics of fibrinogen and C-reactive protein were studied.

RESULTS. During cytological examination in patients of the main group, in 82.9 % of cases, a regenerative type of smear-an imprint of a wound discharge was recorded, in the comparison group, the indicator was 51.4 %. By the 14th day of observation, according to the results of microbiological seeding, 88.6 % patient main group stopped isolating microorganisms from wounds, while in patients of the comparison group – 62.9 %. On the Bates-Jensen scale, on the 14th day of the study, the wound process in the main group was estimated at 22 points, in the comparison group, the dynamics of the wound process proceeded more slowly – 36 points. The level of fibrinogen and C-reactive protein in the blood decreases significantly faster in the main group compared to the comparison group.

CONCLUSION. The local effect of ultrasound waves has a positive effect on the regenerative processes in the wound, the elimination of microorganisms occurs, and the systemic inflammatory process decreases.

1. Zotov D. S., Grigoryan A. Yu., Zatolokina M. A. et al. Comparative assessment of the complex use of hexetidine and photoditazine in combination with ultrasound and phototherapy in the local treatment of purulent wounds. Man and his health. 2022;(2):24–30. (In Russ.). https://doi.org/10.21626/vestnik/2022-2/03.

2. Fedzianin S. D. Autologous bone marrow aspirates in the treatment of extensive purulent wounds. Bulletin of Pirogov National Medical and Surgical Center. 2020;15(2):103–107. (In Russ.). https://doi.org/10.25881/BPNMSC.2020.92.91.018.

3. Tretyakov A. A., Petrov S. V., Neverov A. N., Shchetinin A. F. Treatment of purulent wounds. News of surgery. 2015;23(6):680–687. (In Russ.)

4. Bystrov S. A., Bezborodov A. I., Katorkin S. E. Treatment of purulent wounds using foam-based wound coverings with Hydrofiber technology. Pirogov Russian Journal of Surgery. 2017;(7):49–53. (In Russ.). https://doi.org/10.17116/hirurgia2017749-53.

5. Pavlov A. V., Maskin S. S., Igolkina L. A. Acceleration of healing of experimentally simulated purulent wounds with local cryotherapy. Science of the Young – Eruditio Juvenium. 2022;10(4):391–400. (In Russ.). https://doi.org/10.23888/HMJ2022104391-400.

6. Bulavkin V. P., Fedzianin S. D., Matusevich E. A. et al. Treatment of osteomyelitis of the calcaneus using an automyelofibrinous-platelet clot. Bulletin of Vitebsk State Technological University. 2022;21(3):102–107. (In Russ.). https://doi.org/10.22263/2312-4156.2022.3.102.

7. Shevchenko Yu. L., Stoyko Yu. M., Ryabov A. L., Kulabuho V. V. Modern possibilities of complex treatment of purulent wounds. Bulletin of Pirogov National Medical & Surgical Center. 2009;4(2):9–12. (In Russ.).

8. Mitish V. A., Paskhalova Yu. S., Munoz Sepada P. A. et al. Ultrasonic cavitation in the treatment of the neuroischemic form of diabetic foot syndrome in the presence of biofilm forms of bacteria (literature review). Wounds and wound infections. Journal named after Professor B. M. Kostyuchenko. 2020;7(3):20–30. (In Russ.). https://doi.org/10.25199/2408-9613-2020-7-3-20-31.

9. Yakushkina A. S., Sergachev A. V., Madonov K. S. et al. Modern pathogenetically substantiated methods for assessing the reparative process in a wound (literature review). News of higher educational institutions. Volga region. Medical Sciences. 2024;1(69):213–233. (In Russ.). https:// doi.org/10.21685/2072-3032-2024-1-21.

10. Wang X. J., Wang Z., Zhang Z. T. et al. Plasma Fibrinogen as a Diagnostic Marker of Infection in Patients with Nonunions. Infect Drug Resist. 2020;13:4003–4008. https://doi.org/10.2147/IDR.S269719.

11. Stavchikov E. L., Zinovkin I. V., Marochkov A. V. C-reactive protein as a criterion for the effectiveness of treatment of patients with purulent-necrotic infection of soft tissues using vacuum therapy. Bulletin of Vitebsk State Medical University. 2020;19(6):92–98. (In Russ.). https:// doi.org/10.22263/2312-4156.2020.6.92.

12. Messa C. A. 4th, Chatman B. C., Rhemtulla I. A. et al. Ultrasonic debridement management of lower extremity wounds: retrospective analysis of clinical outcomes and cost. J Wound Care. 2019;28(Sup5):30–40. https://doi.org/10.12968/jowc.2019.28.

13. Murphy C. A., Houghton P., Brandys T. et al. The effect of 22.5 kHz lowfrequency contact ultrasound debridement (LFCUD) on lower extremity wound healing for a vascular surgery population: A randomised controlled trial. Int Wound J. 2018;15(3):460–472. https://doi.org/10.1111/iwj.12887.