Clinical and immunohistopathological aspects of venous ulcers treatment by Low-Intensity Pulsed Ultrasound (LIPUS)

• Published in: Ultrasonics Vol. 53; no. 4; pp. 870 - 879
• Main Authors: de Ávila Santana, Luísiane, Alves, José Marcos, Andrade, Thiago Antônio Moretti, Kajiwara, João Kazuyuki, Garcia, Sérgio Britto, Gomes, Fernanda Guzzo, Frade, Marco Andrey Cipriani
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-04-2013
• Subjects: Aged; Anti-Infective Agents, Local - therapeutic use; Antigens, CD - metabolism; Antigens, Differentiation, Myelomonocytic - metabolism; Biopsy; Chronic Disease; Collagen - metabolism; Collagens; Female; Fibrin; Granulation; Granulation Tissue - metabolism; Humans; Image Enhancement - methods; Image processing; Immunoenzyme Techniques; Immunohistochemistry; Leg Ulcer - drug therapy; Leg Ulcer - immunology; Leg Ulcer - therapy; Male; Middle Aged; Phases; Photography; Silver Sulfadiazine - therapeutic use; Statistics, Nonparametric; Treatment Outcome; Ulcers; Ultrasonic Therapy - methods; Ultrasound; Varicose Ulcer - drug therapy; Varicose Ulcer - immunology; Varicose Ulcer - therapy; Vascular Endothelial Growth Factor A - metabolism; Venous ulcer; Wound healing; Wound Healing - immunology; Venous ulcer; Immunohistochemistry; Wound healing; Image processing; Ultrasound
• ISSN: 0041-624X; 1874-9968
• DOI: 10.1016/j.ultras.2012.12.009

► Treatment of chronic venous ulcers by ultrasound and daily 1% silver sulfadiazine. ► The healing process was assessed by quantitative image analysis. ► Ulcers were also biopsied for collagen, CD68+ protein and VEGF quantification. ► Quantification results by all methods were better on ultrasound treated ulcers. ► Peripheral ultrasound treatment accelerates chronic venous wound healing.
The immunological mechanisms that are triggered by Low-Intensity Pulsed Ultrasound (LIPUS) in wound healing are unknown. In the present study, experimental groups were used to assess the treatment of chronic venous ulcers with 30mW/cm2 SATA peripheral LIPUS three times per week compared to a daily treatment of 1% silver sulfadiazine (SDZ). The ulcers of the SDZ group (n=7) (G1) and LIPUS group (n=9) (G2) were photographed five times three months, and the images were analyzed using ImageJ software to quantify the total area (S), fibrin/sphacel area (yellow) and granulation area (red). The healing process was evaluated by the wound healing rate (WHR), granulation tissue rate (GTR) and fibrin/sphacel tissue rate (FTR). The ulcers were biopsied on days 1 and 45 and stained for collagen fiber quantification (picrosirius) and CD68+ protein and VEGF (vascular endothelial growth factor) expression using HRP-streptavidin (horseradish peroxidase-streptavidin). On day 90, G2 had a mean 41% decrease in the ulcer area, while no decrease was observed in G1 (p<0.05). An increased tendency toward positive labeling of collagen fibers and VEGF (p>0.05) was observed in G2 compared to G1, and the number of CD68+ cells was greater in G2 than in G1 (p<0.05). LIPUS presents superior activity compared to SDZ in stimulating the inflammatory and proliferative (angiogenesis and collagenesis, respectively) phases of chronic venous wound healing.