BACKGROUND: The quality and extent of leg ulcer healing in deeper skin layers remains poorly defined using standard visual inspection alone. High-resolution ultrasound (HR-US) offers a non-invasive, quantitative and objective assessment of dimensional and structural changes deep within the wound. METHODS: In a prospective, single-center study, healing of chronic, treatment-resistant leg ulcers was monitored by standard photography and HR-US. RESULTS: Twenty patients with 22 ulcers were enrolled. After study entry, treatment comprised continuation of conventional management (n=4) or application of Apligraf (n=17) or Thiersch (n=1). All ulcers receiving a graft were classified as 'clinically healed' by visual inspection within a maximum of 5 weeks. With conventional management, closure required a period of several months in three out of four cases. After covering the ulcer with Apligraf, the skin reconditioned, resulting in fair skin color and a smooth skin surface in all but one case. HR-US images, however, revealed large subepidermal deficits of elastic and collagenous fibers at the time of 'clinical healing' in 14/18 engrafted ulcers, findings that are strongly indicative of a weakened skin scaffolding. CONCLUSION: We suggest that the healing process for chronic ulcers can be monitored with both standard visual inspection (photography) and HR-US to allow early intervention.
BACKGROUND: The quality and extent of leg ulcer healing in deeper skin layers remains poorly defined using standard visual inspection alone. High-resolution ultrasound (HR-US) offers a non-invasive, quantitative and objective assessment of dimensional and structural changes deep within the wound. METHODS: In a prospective, single-center study, healing of chronic, treatment-resistant leg ulcers was monitored by standard photography and HR-US. RESULTS: Twenty patients with 22 ulcers were enrolled. After study entry, treatment comprised continuation of conventional management (n=4) or application of Apligraf (n=17) or Thiersch (n=1). All ulcers receiving a graft were classified as 'clinically healed' by visual inspection within a maximum of 5 weeks. With conventional management, closure required a period of several months in three out of four cases. After covering the ulcer with Apligraf, the skin reconditioned, resulting in fair skin color and a smooth skin surface in all but one case. HR-US images, however, revealed large subepidermal deficits of elastic and collagenous fibers at the time of 'clinical healing' in 14/18 engrafted ulcers, findings that are strongly indicative of a weakened skin scaffolding. CONCLUSION: We suggest that the healing process for chronic ulcers can be monitored with both standard visual inspection (photography) and HR-US to allow early intervention.
Authors: Mary Jo Grap; Ruth Srednicki Burk; Valentina Lucas; Cindy L Munro; Paul A Wetzel; Christine M Schubert Journal: Intensive Crit Care Nurs Date: 2014-10-16 Impact factor: 3.072
Authors: Ruth S Burk; Mary Jo Grap; Valentina Lucas; Cindy L Munro; Paul A Wetzel; Christine M Schubert Journal: Adv Wound Care (New Rochelle) Date: 2017-11-01 Impact factor: 4.730
Authors: Maximillian A Weigelt; Hadar A Lev-Tov; Marjana Tomic-Canic; W David Lee; Ryan Williams; David Strasfeld; Robert S Kirsner; Ira M Herman Journal: Adv Wound Care (New Rochelle) Date: 2021-07-21 Impact factor: 4.730