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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 #7
In our practice at St. Agnes Continuing Care Center, the Mercy Rehabilitation wound team has been using the MIST Therapy® System (Celleration®, Inc) consistently since August 2006 on a variety of patients and wounds, including wounds of surgical, diabetic, arterial, pressure, and atypical origin. Our patients are often very medically complex with multiple comorbidities. For this case series, we selected 6 consenting patients based on the availability of clear photographs of their wounds taken on days that corresponded with wound measurements. MIST Therapy was initiated in these patients to assist with debridement of significant amounts of necrotic tissue and to reduce topical signs of infection—typically, excessive drainage and foul odor. 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. As specified in the product labeling, we administered MIST Therapy 2–3 times weekly. Typically, wounds are treated for 3–5 minutes per treatment, but treatment time ultimately depends on the size of the wound. For the larger wounds in this series, we used longer treatment durations. Also, all wounds were treated with sharp debridement as needed to remove necrotic tissue. It is important to note that, in our facility, MIST Therapy is primarily used to stabilize and improve wounds so that patients can be moved to a more aggressive rehabilitation facility for therapy. Thus, patients often leave our facility prior to complete wound closure. Wound healing was evaluated on the basis of wound dimensions, exudate, and tissue characteristics (granulation, slough, or eschar) over time. Due to comorbid conditions that affected patients’ ability to sense or communicate pain, we could not obtain patient-reported ratings of wound pain. Editor's note: Click here to download a PDF of the full article, including the clinical results and photos of the six inpatients.
Conclusion Here we have reported on the use of MIST Therapy for debridement and drainage reduction in 4 women and 2 men ranging in age from 55–85 years. MIST was administered for 2–5 weeks at the standard 2–3 times per week. Treatment durations (3–11 minutes, median 8 minutes) were longer than the typical 3–5 minutes seen with MIST Therapy due to larger wound surface areas.
In this series of patients whose care was complicated by extensive medical comorbidity and associated polypharmacy, administration of MIST Therapy appeared to reduce purulent drainage and assist with debridement to promote the development of granulation tissue. Over treatment periods ranging from 2–5 weeks, our objective of full granulation was achieved. It is important to remember that complete wound closure was not expected to occur in these patients while in our care. The care plans for these patients included discharge to a more aggressive rehabilitation facility prior to complete closure.
We have found MIST Therapy very effective for assisting with debridement of wounds with significant amounts of necrotic tissue. In our experience, using MIST in coordination with sharp debridement (as able) greatly increases the rate of removal of necrotic tissue. As illustrated in this case series, signs and symptoms of topical wound infection (ie, odor and drainage) typically decrease after only 3–5 MIST sessions. The achievement of 90–100% granulation tissue appeared to coincide with improvements in exudate from copious and purulent to moderate and serosanguineous. Although others have reported reductions in wound pain associated with MIST Therapy, we could not assess wound pain due to neurologic and mental status complications. Most importantly, we have seen promising healing rates with MIST Therapy that typically would not be expected even with similarly aggressive plans of care. 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. |
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