(CS-064) Low frequency, non contact, non thermal ultrasound energy as a viable treatment option for pathergy in Pyoderma Gangrenosum

Co-Author(s):

Cullen Chiu, ANP, CWS – Chief Nursing Officer, Kane Wound Care; Michael Jensen, MD, CWSP – Chief Medical Officer, Kane Wound Care

Introduction:

Pyoderma Gangrenosum (PG), a rare non-infectious neutrophilic dermatosis, presents as painful destructive cutaneous ulcerations often appearing on the lower extremities. The hallmark of the disease is painful ulcerations exacerbated by minor trauma leading to exaggerated skin injury or pathergy. Surgical debridement is contraindicated in pyoderma gangrenosum. This is a 60 YO WF with a history of chronic wounds ( >30 days) from suspected PG, who originally presented to the ED in August 2021 with malodorous draining bilateral thigh wounds. Surgical debridement was not performed due to pathergy. A punch biopsy was performed, confirming the diagnosis of PG. 

Methods:

The facility wound care team deemed the patient would benefit most from low frequency ultrasound energy to address the significant necrotic tissue to the left medial thigh wound. This modality acts by selective emulsification and fibrinolysis of necrotic tissue, by up-regulation of intracellular activity with enhanced growth factor synthesis, and by disrupting biofilm. The treatment was performed 3 times weekly, with a duration of 20 min using 360 cc of normal saline. At each visit, the wound care team assessed the wound for reduction in necrotic tissue, increase in granulation tissue, decrease in pain, and decrease in size.

Results: Wound surface area was dramatically reduced by a factor of 5.3 over a 6-month period of ultrasound treatment coupled with significant reduction in necrotic tissue and pain. The wound bed displayed prominent increase in granulation tissue. During the treatment period, there were no readmissions to the hospital and no re-infections of the wound.

Discussion: Based on the outcomes of this case study, we suggest a clear healing benefit using non-contact low frequency ultrasound energy in PG wounds, with the added benefit of being atraumatic and largely pain-free.

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