The difficulty in wound therapy can include poor healing, excess growth of unwanted tissues, infection, dead or devitalized tissue.  There have always been a large number of products availed to this issue, most of which are either ineffective or have unwarranted claims.  One of the biggest issues includes inadequate wound preparation followed by the placement of these wound products on these unprepared wounds.  We like to refer to this as: "Junk on Junk". 
The following sequence of pictures depicts the use of a novel treatment used in Human Medicine but never used in Veterinary Medicine.  Dr. Liberman has been using this technology for several years in the treatment of difficult wounds.  This is an Ultrasonic Curette that oscillates at about 35 kHz. Saline is required in its use. This will completely debride the surface of tissue to remove one of the primary problems in chronic wounds – Biofilm.
 A biofilm is any group of microorganisms in which cells stick to each other on a surface. These adherent cells are frequently embedded within a self-produced matrix of extracellular polymeric substance (EPS). Biofilm EPS, which is also referred to as slime (although not everything described as slime is a biofilm), is a polymeric conglomeration generally composed of extracellular DNA, proteins, and polysaccharides. Biofilms may form on living or non-living surfaces and can be prevalent in natural, industrial and hospital settings. Microbes form a biofilm in response to many factors, which may include cellular recognition of specific or non-specific attachment sites on a surface, nutritional cues, or in some cases, by exposure of planktonic cells to sub-inhibitory concentrations of antibiotics. 

The reduction of Bio Burden is due to a mechanical effect of the ultrasonic pressure waves that break up the hard cell wall of the bacteria and kill these bacteria in significant numbers but also the biofilm that protects these bacteria.  This enables the topical and systemic antibiotics to penetrate more effectively to continue in the elimination of infection. 

The debridement of these infected tissues is very thorough in the removal of devitalized tissues.  The ultrasound will cause cavitation in the wound bed.  The typical wound bed will have a large surface area with many “nooks and crannies” This “scrubbing bubbles” effect removes bacteria and senescent cells that hide in the irregular wound bed surface.  The result will be reduction of Biofilm, death of bacteria causing the infection, Cell Stimulation for healing and increased blood flow to the wound bed.  

 As numerous high level peer reviewed published studies from the Human Arena have documented, this ultrasonic device will kill bacteria including MRSA, Pseudomonas, E.coli and many others.  The effects of the ultrasound at this specific wavelength on these bacterial cells occurs due to them being single celled organisms, Prokaryotic, rather than the complex array of Eukaryotic cells that comprise the tissue structure.  The tissue cells in turn are stimulated to restart the cascade of healing stages and for improved blood flow, therefore, greater healing capability. 
Enjoy the following pictorial examples of the use of this device.... 


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