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 are not necessarily those of Celleration, Inc., ECPN, or HMP Communications, LLC.

Case Series #8

       The Gonda (Goldschmied) Vascular Center offers a continuum of care for patients with peripheral arterial disease (PAD). Persons with diabetes mellitus, high blood pressure, or high cholesterol are at increased risk of PAD. When PAD is left untreated, it can lead to gangrene or amputations. Patients with PAD often have wounds that do not heal or are very slow to heal. Successful wound healing can help to prevent amputations and additional bypass surgeries.
       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. We have been using MIST Therapy^® System (Celleration^®, Inc.) as an adjunct to standard wound treatment for nonhealing wounds since 2006.
       This is a retrospective review of the clinical effectiveness of the MIST Therapy System in 3 consenting patients with severe, nonhealing wounds and significant PAD. The patients received outpatient treatment at the Gonda (Goldschmied) Vascular Center. In these 3 patients, MIST Therapy was initiated after the majority of wound healing had already taken place and was at a point where healing was stalled with little progress being made. The patients received 3–9 minute MIST Therapy treatments 1–3 times weekly along with standard wound treatments.
       In this case series, wound healing was evaluated on the basis of the wound dimensions, drainage, tissue characteristics (granulation, slough, or eschar) at various time points during treatment, and wound-related pain using a visual analog scale (VAS) that allows patients to rate 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 photos of the three inpatients.  

Conclusion

       This is a case series of 2 men and 1 woman ranging in age from 57–91 with significant medical histories that included diabetes, severe PVD, CHF, renal insufficiency, lower extremity paralysis, past amputations, and revascularization.
       All of these patients presented to our center with PAD that was difficult to treat due to lack of appropriate vessels for revascularization or angioplasty and failed or potential future amputations. One complication of PAD is difficult wound healing. Each of these patients presented with recalcitrant wounds for which standard treatment had been unsuccessful. MIST Therapy was initiated for 1–3 sessions per week for 3–9 minutes per session for a total of 7–39 sessions per patient.
       One of the treated wounds (on patient 1) did not heal completely after 4 months of treatment. However, the exposed bone remains covered, the large tissue defect has filled in, and the wound remains healthy. All of the other wounds on the 3 patients rapidly and completely healed with 100% granulation and the absence of wound drainage. In addition, 2 of the 3 patients reported a decrease in pain as the wounds healed. The patient who did not report any pain associated with his wound at any of the time points was insensate.
       Most importantly, it was anticipated that 2 of the 3 patients were going to require additional amputations due to their PVD and their wounds. However, through the successful and rapid wound treatment, all additional amputations and bypass surgeries were avoided.
       At the Gonda (Goldschmied) Vascular Center, we have found MIST Therapy to be a valuable adjunct to standard of care treatment of patients with difficult-to-heal wounds. As illustrated by these 3 cases, MIST Therapy was initiated when the majority of the wound healing had already occurred but at a point where progress was no longer occurring. As we become more familiar with the technology, we are learning which categories of wounds benefit most from MIST Therapy. We have also learned that no patient is a “textbook” case. MIST Therapy has shown no detrimental side effects to the wounds or the patient, so we feel comfortable utilizing this modality on wounds with a variety of etiologies.

       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. Patients were selected for your educational benefit. The opinions herein my not be consistent with the labeling for MIST Therapy System. Visit www.celleration.com for the full package insert. Results may vary.