What new evidence supports the use of UltraMist (hypochlorous acid solution) for wound treatment since 2020?

Research on UltraMist for Wound Treatment Since 2020

Current evidence does not support the use of UltraMist (ultrasonic mist therapy) for wound healing in diabetic foot ulcers over standard care. 1

Current Guidelines on Ultrasonic Debridement

• The 2023 International Working Group on the Diabetic Foot (IWGDF) guidelines specifically evaluated ultrasonic debridement for diabetic foot ulcers and do not recommend its use over standard care 1
• The evidence for ultrasonic debridement shows only small desirable effects with low certainty evidence regarding wound healing outcomes 1
• While some studies suggest decreased time to wound healing with ultrasonic debridement versus standard care, these findings should be interpreted with caution due to high risk of bias in the studies 1

Evidence Quality Issues

• Most studies evaluating ultrasonic debridement were found to be at high risk of bias with none being blinded 1
• Only one study showed differences between groups in time to healing, but this result should be treated with caution given the high risk of bias 1
• No significant differences in complete wound healing or sustained healing were reported between ultrasonic debridement and standard care 1

Resource Implications

• Ultrasonic debridement has higher resource implications compared to standard care 1
• No formal cost-effectiveness data has been found to justify the additional expense 1
• The IWGDF guidelines note that it is uncertain whether the higher costs incurred could be offset by the small desirable effects in terms of decreased time to healing 1

Equity and Accessibility Concerns

• Due to the additional resources required to provide ultrasonic debridement, equity is probably reduced, particularly in lower-income regions 1
• While the intervention is probably acceptable to patients and feasible in healthcare systems, the cost-benefit ratio does not currently support widespread adoption 1

Historical Context

• Earlier studies (pre-2020) on ultrasonic mist therapy showed some promise but had significant methodological limitations 2, 3
• A 2008 review concluded there was insufficient evidence to determine whether ultrasonic mist therapy effectively debrides necrotic tissue in chronic wound beds 2
• Some older case series suggested potential benefits when combining ultrasonic therapy with other modalities like negative pressure wound therapy 4, 5

Current Recommendations for Wound Care

• Current guidelines recommend selecting dressings principally on the basis of exudate control, comfort, and cost rather than specific technologies 1
• Sharp debridement remains the recommended method for removing slough, necrotic tissue, and surrounding callus, taking relative contraindications such as severe ischemia into account 1
• Antimicrobial dressings are not recommended for the goal of improving wound healing or preventing secondary infection 1

In conclusion, while ultrasonic mist therapy (UltraMist) has been investigated for wound treatment, current high-quality evidence and guidelines do not support its use over standard care for diabetic foot ulcers. The IWGDF explicitly recommends against using ultrasonic debridement over standard care due to low certainty of evidence of benefit and absence of cost-effectiveness data 1.