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 #6

       At the Memorial Regional Rehabilitation Center, we have been using the MIST Therapy^® System (Celleration^®, Inc) since February of 2006. Here we report a series of 6 consenting patients treated with MIST Therapy for wounds in which healing was inhibited by thick yellow slough, necrosis, or exposed bone or tendon. The wounds in this series originated from trauma, burns, or diabetes. These cases were selected for their educational value rather than through a systematic (ie, consecutive) selection or random assignment process.
       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.
       The cases reported here reflect the initial trial of MIST Therapy at our clinic, in which we administered MIST to assist with debridement. MIST was administered until the wounds were fully granulated, at which point we stopped MIST and continued only the dressings until the wounds closed.
       Typically, MIST Therapy is administered 2–3 times weekly for 3–5 minutes per treatment, depending on the size of the wound (ie, longer treatment times for larger wounds). In this case series, wound healing was evaluated on the basis of wound dimensions and tissue characteristics (granulation, slough, or eschar) over time. In addition, wound-related pain was evaluated using the 10-point visual analog scale (VAS) for which patients rated their 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 graphs of the six inpatients

Conclusion

       In this case series, 4 women and 2 men with chronic wounds originating from trauma, burns, and diabetes were treated with MIST Therapy in an attempt to promote healing that had been inhibited by either thick yellow slough, necrosis (eschar), or exposed bone or tendon. Patients ranged in age from 37–91 years. MIST treatments were administered 2–3 times per week for 4–9 weeks. Duration of each treatment session ranged from 3–13 minutes. Substantial granulation tissue was achieved in no longer than 9 weeks. Furthermore, all wounds (with the exception of the wound requiring a skin graft) came to complete closure within 6–20 weeks. For the 1 patient who was destined for a skin graft, granulation tissue covering the exposed tendon developed within 4 weeks of initiating MIST Therapy, adequately preparing the wound for a successful graft procedure.
       Additionally, no patient reported pain associated with MIST treatments. In fact, all patients who reported wound-related pain (5 of 6) reported substantially lower pain scores after starting MIST Therapy. Four of these patients were able to discontinue use of topical anesthetics.
       The wounds in this series were treated with MIST until substantial (90–100%) granulation tissue had developed. This strategy of treating to full granulation rather than closure was based on three main factors: our primary objective of debridement; granulation tissue formation as a reliable indicator of healing progression; and the cost associated with a new, non-reimbursable modality for which we did not yet have objective evidence of efficacy. As shown in the case graphs, the bulk of wound volume reduction occurred during the MIST treatment periods. Since beginning to experiment with MIST Therapy in February of 2006, we have had numerous opportunities to utilize it with a variety of patients and wound types, and we now administer MIST until closure. MIST Therapy has helped to loosen adherent yellow and black eschar, particularly in patients suffering from burns. MIST accelerated or initiated granulation tissue formation and increased cell growth for our more recalcitrant wounds and those for which healing progression had stalled. In our experience, MIST has been an effective adjunct therapy to improve granulation tissue formation, especially over exposed tendon and bone where other modalities have not been as beneficial. In our clinical experience, MIST Therapy also appears to alleviate pain associated with chronic open wounds, especially during sharp debridement. We have also noticed a reduction in usage of narcotics and topical analgesics among the patients we have treated with MIST.