Editor’s note: “MIST Therapy^® System: Thoughts on Therapy” is brought to you by an educational grant from Celleration^®, Inc. The opinions and statements herein are specific to the author and not necessarily those of Celleration, Inc., ECPN, or HMP Communications, LLC.

Case Series #5

       At the Archbold Center for Wound Management, we began using the MIST Therapy^® System (Celleration^®, Inc.) in late 2004 for a variety of wounds, especially those that were painful or complicated by bacterial infection, deep tissue problems (ie, infection or edema), or comorbid conditions. This retrospective review of the clinical effectiveness of MIST Therapy focuses on atypical wounds with a variety of complicating factors known to inhibit wound healing. These 6 consenting patients were nonrandomly selected to provide a varied sample of exceptionally recalcitrant wounds with complicating factors likely to severely delay or even prevent healing. The wounds in this case series originated from a variety of etiologies, including trauma, surgery, arterial or venous insufficiency, hidradenitis, and necrobiosis lipoidica diabeticorum (NLD).
       The MIST Therapy System is a noncontact, therapeutic ultrasound device cleared by the Food and Drug Administration to promote wound healing through wound cleansing and maintenance debridement by the removal of yellow slough, fibrin, tissue exudate, and bacteria. The low-frequency ultrasound waves of the MIST Therapy System are delivered via a sterile saline mist. Treatments are painless because the device does not contact the wound.
       Most clinical reports of MIST Therapy describe treatment times of 3–5 minutes, 2–3 times weekly, in ulcers of pressure, venous/arterial insufficiency, or diabetic origin, which, though recalcitrant, have typically been relatively uncomplicated. For the challenging wounds in this series, we often administered MIST Therapy (in addition to the standard of care) for longer durations, and, on average, these wounds required more total MIST treatments than did the less-complicated wounds described in previous reports. Wound healing was evaluated on the basis of increases in granulation tissue across wound beds in addition to a reduction in wound dimensions. There was also a secondary benefit in the reduction in wound-related pain using the 10-point Visual Analog Scale (VAS), for which the patients rated pain from 0 (no pain) to 10 (extreme pain).

       Editor's note: Click here to download a PDF of the full article, including the clinical results and photographs of the six inpatients.

Conclusion

       Five women and 1 man with complicated wounds of varying etiologies and durations were treated with MIST Therapy as an adjunct to the standard of care. Four patients were Caucasian and 2 African American, ranging in age from 39–82 years. These patients had wounds that were complicated by factors more challenging than most typical wound care patients, including lupus erythematosus, osteomyelitis, calcification with communicating fistula tracts, hydradenitis, and NLD. Treatment durations tended to be longer, in some cases markedly longer, than those used for patients with typical pressure, diabetic, or venous/arterial insufficiency ulcers. Overall, patients had from 14–205 MIST Therapy treatments with durations ranging from 4–24 minutes per session. Wounds were treated to the development of substantial granulation tissue, reduction in wound size, and even closure. The process took anywhere from 2 months to more than 2 years. The two patients with wound-related pain reported improvement of pain following MIST Therapy initiation, and one returned to a level of functional independence that had been lost for approximately 6 years.
       At the Archbold Center for Wound Management, we have found MIST Therapy to be a beneficial modality in the treatment of wounds. While it has been shown that MIST Therapy can accelerate healing in the diabetic foot ulcer, we have also found it to be effective in reducing pain and improving the condition of periwound tissues. We have found it to be the best treatment option when dealing with the difficulty of acute or chronic inflammation areas under and around partially intact tissues.

       Editor’s note: “MIST Therapy^® System: Thoughts on Therapy” is brought to you by an educational grant from Celleration^®, Inc. The opinions and statements herein, as well as the selection of metrics to measure wound healing, are specific to the author and not necessarily those of Celleration, Inc., ECPN, or HMP Communications, LLC. MIST Therapy is not indicated for the reduction of pain, and there have been no clinical studies done to substantiate that claim. Patients were selected for your educational benefit. The opinions herein may not be consistent with the labeling for the MIST Therapy System. Visit www.celleration.com for the full package insert. Results may vary.