SLR - January 2019 - Jason Kim
References: Michailidis L, Bergin S, Haines T, Williams C. Healing Rates in Diabetes-Related Foot Ulcers Using Low-Frequency Ultrasonic Debridement Versus Nonsurgical Sharps Debridement: A Randomized Controlled Trial. BMC Research Notes (2018).Scientific Literature Review
Reviewed By: Jason Kim, DPM
Residency Program: NYU Langone Hospital Systems, Brooklyn, NY
Podiatric Reference: Foot ulcers are a common podiatric issue often encountered with the treatment of patients living with diabetes. Debridement is core in managing diabetic foot ulcers as it helps facilitate healing by preparing the wound bed and margins. While there are multiple methods of debridement, there is very little evidence to support one main method or the frequency, nor is there significant evaluation of the economics and cost effectiveness of the types of debridement. In this case, a randomized control study was done comparing healing rates for foot ulcers with low-frequency ultrasonic debridement versus nonsurgical sharps debridement.
Methods: A randomized control trial was performed with an inclusion criterion of patients who were more than 30 years old, ulcers present for greater than one month and greater than 1 cm in area. Patients were randomized into either the control group or the intervention group. The participants and treating physicians were unable to be blinded as the method of debridement could not be concealed. A total of 10 participants with 14 ulcers were in the study. Two ulcers were lost to follow-up with one from each group. Follow-up was within a six-month period.
Results: Of the patients examined, ulcers treated with nonsurgical sharps debridement healed in an average of 61.6 days with a standard deviation of 24.4 days while those treated with low-frequency ultrasonic debridement healed in an average of 117.6 days with a standard deviation of 40.3 days. Statistical significance was unable to be obtained due to the limited number of participants, and pain and quality of life scores were also unable to be analyzed statistically, again due to insufficient number of participants. Quality of life in both groups showed an improving trend as the ulcers progressed toward healing.
Conclusion: While it was observed through the study that nonsurgical sharp debridement healed at a faster rate than low-frequency ultrasonic debridement, the sample size was too small to find if this was statically significant. Findings were compared to four prior studies comparing the two methods of debridement and showed consistent findings. Limitations included, mainly, the difficulty of recruiting participants and not standardizing the type of dressings and offloading modalities. This study highlighted the first time direct-contact, low-frequency ultrasonic debridement was studied in a case.