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Comparison of Ultrasound/Ultraviolet-C and Laser for Treatment of Pressure Ulcers in Patients With Spinal Cord Injury

EL Nussbaum, MEd, BSc(PT), is Clinical Associate, Physical Therapy, Mount Sinai Hospital, and Assistant Professor, Department of Physical Therapy, University of Toronto, 256 McCaul St, Toronto, Ontario, Canada M5T 1W5.
I Biemann, BSc(PT), is Senior Physical Therapist, Lyndhurst Spinal Cord Centre, 520 Sutherland Dr, Toronto, Ontario, Canada M4G 3V9.
B Mustard, MSc, BSc(PT), was Clinical Specialist (Research), Lyndhurst Spinal Cord Centre, at the start of this study. She is currently a clinical and research consultant in private practice in Calgary, Alberta, Canada.

Background and Purpose. The purpose of this study was to compare in patients with spinal cord injury the effect on wound healing of nursing care alone with the effect on wound healing of nursing care combined with either laser treatment or a regimen of ultrasound and ultraviolet-C (US/UVC). Subjects. Twenty patients (22 wounds) were randomly assigned to the treatment groups. Methods. All patients received standard wound care consisting of wound cleaning twice daily, application of moist dressings, and continuous relief of pressure until the wounds were healed. The laser protocol consisted of three treatments weekly using a cluster probe with an 820-nm laser diode and 30 superluminous diodes (10 each at 660, 880, and 950 nm), an energy density of 4 J/cm², and a pulse repetition rate of 5,000 pulses per second. The US/UVC regimen consisted of five treatments weekly, alternating the treatment modality daily. The pulsed US was applied at a frequency of 3 MHz and a spatial average-temporal average intensity of 0.2 W/cm² (1:4 pulse ratio) for 5 minutes per 5 cm² of wound area. The UVC dosage (95% emission at 250 nm) was calculated each session according to wound appearance. The dosage level was E₁ for clean/granulating areas, E₃ for purulent/slow-granulating areas, E₄ for heavily infected areas, and 2E₄ for wound debridement. Wounds were traced every 14 days, and surface areas were calculated using the Sigma-Scan Measurement System. Weekly percentage changes in wound area were compared. Results. Results showed that US/UVC treatment had a greater effect on wound healing than did nursing care, either alone or combined with laser. Conclusion and Discussion. Ultrasound/ultraviolet-C may decrease healing time and may allow faster return to rehabilitation programs, work, and leisure activities for patients with spinal cord injury who have pressure ulcers.

Key Words: Laser • Pressure ulcers • Ultrasound • Ultraviolet • Wound healing

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