What is the current evidence for using UltraMist for wound treatment?

UltraMist for Wound Treatment: Current Evidence Since 2020

Based on current evidence, ultrasonic debridement therapies like UltraMist are not recommended for diabetic foot ulcers or chronic wounds due to low certainty evidence regarding wound healing outcomes and lack of cost-effectiveness data. 1

Current Guidelines on Ultrasonic Therapies

• The International Working Group on the Diabetic Foot (IWGDF) 2023 update does not recommend ultrasonic debridement for diabetic foot ulcers over standard care due to insufficient evidence of benefit 1
• Most studies evaluating ultrasonic debridement have been found to be at high risk of bias with none being blinded, which significantly affects the certainty of the evidence 1
• Current guidelines recommend selecting wound dressings principally based on exudate control, comfort, and cost rather than specific technologies 1, 2
• Sharp debridement remains the recommended method for removing slough, necrotic tissue, and surrounding callus in diabetic foot ulcers, with consideration for contraindications such as severe ischemia 1

Evidence for Negative Pressure Wound Therapy vs. Ultrasonic Therapy

• The IWGDF conditionally recommends negative pressure wound therapy (NPWT) as an adjunct therapy only for post-surgical diabetes-related foot wounds (Conditional; Low evidence) 3
• NPWT is explicitly not recommended for non-surgically related diabetic foot ulcers (Strong recommendation; Low evidence) 3
• The evidence behind NPWT is of low certainty, with moderate desirable effects observed only in post-surgical wounds 3
• No new good quality evidence on NPWT has been published in the last 4 years according to the 2023 IWGDF update 3
• By comparison, ultrasonic therapies like UltraMist have even less supporting evidence than NPWT 1

Resource Implications and Cost-Effectiveness

• Ultrasonic debridement has higher resource implications compared to standard care, with no formal cost-effectiveness data to justify the additional expense 1
• The IWGDF notes that for many advanced wound therapies, there are moderate costs involved that may reduce equity in some healthcare systems, particularly in lower-income countries 3
• When evaluating new technologies, the IWGDF emphasizes the importance of considering whether costs incurred are offset by clinical benefits, which has not been established for ultrasonic therapies 3

Historical Context of UltraMist Research

• Earlier studies from 2006 suggested that low-frequency, non-contact ultrasound therapy (like UltraMist) might be effective for chronic wound healing, with 69% of wounds healing in one small study 4
• However, these earlier studies had significant methodological limitations and were not blinded 5, 4
• A 2008 systematic review concluded there was insufficient evidence to determine whether ultrasonic mist therapy effectively debrides necrotic tissue in chronic wound beds 5

Current Recommended Approaches for Wound Management

• The American College of Physicians recommends hydrocolloid dressings for reducing wound size in pressure ulcers (weak recommendation, low-quality evidence) 2
• For diabetic foot ulcers, the IWGDF strongly recommends against using pharmacological agents that supplement vitamins and trace elements or that promote perfusion and angiogenesis 3
• Electrical stimulation has moderate-quality evidence supporting its use as an adjunctive therapy to accelerate wound healing 3
• Recent advances in wound healing include novel formulations using metallic nanoparticles and topical insulin, which may be promising therapeutic options in the future 6

Conclusion

Since 2020, no significant new research has emerged supporting the use of UltraMist or similar ultrasonic debridement technologies for wound treatment. Current guidelines from the IWGDF explicitly recommend against using ultrasonic debridement for diabetic foot ulcers due to low certainty evidence and lack of cost-effectiveness data.