Ultrasound therapy used for healing venous (varicose) leg ulcers and to improve symptoms

Venous leg ulcers are common, especially in the elderly. They are caused by damage or blockages in the veins of the legs, which in turn lead to pooling of blood and increased pressure in these veins. Eventually, these changes can damage the skin and lead to ulcer formation.

Compression with stockings or bandages is the most widely used, and acceptable, treatment for venous leg ulcers. Ultrasound has been used as an additional intervention, especially for difficult, long-standing ulcers. The mechanisms by which ultrasound waves interact with healing tissues are not fully understood. We conducted a review to establish whether ultrasound speeds the healing and improve symptoms of venous leg ulcers, and examined all the available evidence from medical trials. This showed that there is no strong evidence that ultrasound hastens ulcer healing. There is, however, some weak evidence from poor-quality research that high-frequency ultrasound may increase the healing of venous leg ulcers. This finding, however, requires confirmation in larger and rigorously conducted medical trials before we can be certain that it is true and can be trusted. There is no evidence that low frequency ultrasound improves the healing of venous leg ulcers.

Authors' conclusions: 

The trials evaluating US for venous leg ulcers are small, poor-quality and heterogeneous. There is no reliable evidence that US hastens healing of venous ulcers. There is a small amount of weak evidence of increased healing with US, but this requires confirmation in larger, high-quality RCTs. There is no evidence of a benefit associated with low frequency US.

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Background: 

Venous leg ulcers pose a significant burden for patients and healthcare systems. Ultrasound (US) may be a useful treatment for these ulcers.

Objectives: 

To determine whether US increases the healing of venous leg ulcers.

Search strategy: 

We searched the Cochrane Wounds Group Specialised Register (searched 24 February 2010); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2010); Ovid MEDLINE (1950 to February Week 2 2010); In-Process & Other Non-Indexed Citations (searched 24 February 2010); Ovid EMBASE 1980 to 2010 Week 07; EBSCO CINAHL 1982 to 24 February 2010.

Selection criteria: 

Randomised controlled trials (RCTs) comparing US with no US.

Data collection and analysis: 

Two authors independently assessed the search results and selected eligible studies. Details from included studies were summarised using a data extraction sheet, and double-checked. We tried to contact trial authors for missing data.

Main results: 

Eight trials were included; all had unclear, or high, risks of bias, with differences in duration of follow-up, and US regimens. Six trials evaluated high frequency US and five of these reported healing at 7 - 8 weeks. Significantly more patients healed with US than without it at 7 - 8 weeks (pooled RR 1.4, 95% CI 1.0 to 1.96), but later assessments at 12 weeks showed the increased risk of healing with US was no longer statistically significant (pooled RR 1.47, 95% CI 0.99 to 2.20). One poor-quality study of high-frequency US found no evidence of an effect on healing after three weeks’ treatment.

Two trials evaluated low frequency US and reported healing at different time points. Both trials reported no evidence of a difference in the proportion of ulcers healed with US compared with no US: both were significantly underpowered.

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