Title: “Therapeutic Ultrasound for Venous Leg Ulcers”

Authors: Cullum, N. & Liu, Z

Journal: Cochrane Database of Systematic Reviews

Publication Year: 2017

Citation: Cullum, N., & Liu, Z. (2017). Therapeutic ultrasound for venous leg ulcers. The Cochrane database of systematic reviews, 5(5), CD001180.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481488/

The goal of this study was to use a systematic review of previous studies to determine whether ultrasound therapy can effectively heal venous leg ulcers and improve symptoms. The article explains that common treatment methods for venous leg ulcers include compression bandages to improve blood flow, wound dressings, antibiotics, and less commonly ultrasound therapy. The article states that ultrasound therapy is really reserved for more difficult-to-treat, long-standing ulcers; so, it’s not as commonly used. The technique of ultrasound therapy is to use sound waves that pass through the skin (for 5-10 mins) causing the tissue underneath the probe to vibrate. Although the interaction of the ultrasound waves with the wound tissues is not fully understood, they somehow influence blood flow. Therefore, the article wanted to evaluate whether this therapy can impact blood flow in a positive way to improve the healing of leg ulcers.

Methods: The study included 11 randomized controlled trials with a total of 969 participants that evaluated the efficacy of ultrasound therapy for healing or improving the symptoms of venous stasis ulcers. The participants ranged from 59 to 70 years old, with over 50% being female. Eight of the studies included compared the use of ultrasound therapy to no ultrasound therapy, while the 3 remaining studies compared ultrasound therapy to sham ultrasound (mimic ultrasound without the actual use of ultrasound).

Results: The main result of the study was that the ultrasound therapy resulted in complete wound healing. However, although 9 out of the 11 studies reported this outcome, they each did so at different time points (e.g. some at 12 weeks, some by 8 weeks). Additionally, the study found that the therapy significantly reduced wound size, as reported by 2 studies. Also, one study showed no significant association between ultrasound therapy and quality of life, and a significant increase in adverse events of the ultrasound extremity (although most were not serious). In conclusion, based on the poor magnitude of the effects of the studies reviewed, the article found that overall it is unclear whether therapeutic ultrasound increases the healing of venous leg ulcers, and any effect is likely to be very small.

Limitations: Most of the studies used were small with low quality evidence based on the GRADE assessment used. In fact, there was only moderate quality evidence at 12 weeks. Additionally, while some studies followed up at 12 weeks, most had very short follow up periods, and therefore further research of the efficacy of this therapy over a longer period of time should be conducted. Also, the article admits that most of the RCTs used were at a high or unclear risk of bias.

My patient is a 76 year old male with a PMH of HTN, DM, and HLD, and has poor ambulation with sedentary lifestyle (all risk factors for endothelial damage, venous insufficiency, and venous stasis ulcers). He has a persistent ulcer for 1 month now that has not healed nor improved despite antibiotic treatment, and might be a candidate for this therapy if it is effective. Although the study showed unclear efficacy for treating venous stasis ulcers, the patient also has issues with medication compliance, and if this is something that is done outpatient by a clinician it might be easier for the patient to be compliant with a scheduled appointment (e.g. office can call the patients home to remind him for example) instead of having to remember to periodically apply wound dressings, compression devices, and antibiotics.