| Sumario: | Aim: Pyoderma gangrenosum (PG) typically presents as painful destructive cutaneous ulcerations. The hallmark of the disease is painful ulcerations exacerbated by minor trauma leading to exaggerated skin injury. Surgical debridement is generally contraindicated in PG. We propose introducing low frequency ultrasound energy as an alternative to surgical debridement. Method: This is a 60 YO WF with chronic wounds 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. The facility wound care team deemed the patient would benefit most from non-contact, non-thermal, 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. The treatment was performed 3 times weekly, with an average duration of 20 min using 360 cc of normal saline. At each visit, the wound care team assessed the wound response to treatment looking at reduction in necrotic tissue, increase in granulation tissue, decrease in pain, and decrease in size. Results / Discussion: Wound surface area was dramatically reduced to full closure 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. There were no readmissions to the hospital and no re-infections of the wound. Conclusion: Based on these results, 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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