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Usefulness of high-frequency ultrasound to assess the healing progress of shin ulcers

Agnieszka Krauze
Agnieszka Krauze
, 
Witold Woźniak
Witold Woźniak
 e 
Robert Krzysztof Mlosek
Robert Krzysztof Mlosek
   | 18 dic 2020
Journal of Ultrasonography's Cover Image
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Article Category: research-article
Pubblicato online: 18 dic 2020
Pagine: 254 - 260
Ricevuto: 27 set 2020
Accettato: 07 ott 2020
DOI: https://doi.org/10.15557/jou.2020.0045
Parole chiave
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

SMARTs laser biostimulation device (Lasotronix, Piaseczno, Poland)
SMARTs laser biostimulation device (Lasotronix, Piaseczno, Poland)

Fig. 2.

Figure showing measurements necessary to determine ulceration depth (N – distance between reflection from the epidermis and deep fascia; O – distance between the external surface of the ulcer base and deep fascia)
Figure showing measurements necessary to determine ulceration depth (N – distance between reflection from the epidermis and deep fascia; O – distance between the external surface of the ulcer base and deep fascia)

Fig. 3.

Example measurement of granulation tissue thickness. A. Ultrasound examination of the ulcer before laser therapy with granulation tissue thickness measurement. B. Ultrasound examination of the ulcer during laser therapy with an evident increase in the amount of granulation tissue and its measurement. C. Photographic image before laser therapy (the arrow marks the granulation tissue). D. Photographic image during laser therapy (the arrow marks the granulation tissue)
Example measurement of granulation tissue thickness. A. Ultrasound examination of the ulcer before laser therapy with granulation tissue thickness measurement. B. Ultrasound examination of the ulcer during laser therapy with an evident increase in the amount of granulation tissue and its measurement. C. Photographic image before laser therapy (the arrow marks the granulation tissue). D. Photographic image during laser therapy (the arrow marks the granulation tissue)

Fig. 4.

Figure showing measurements of migrating epidermis and SLEB thickness. A – epidermal thickness, B – SLEB thickness
Figure showing measurements of migrating epidermis and SLEB thickness. A – epidermal thickness, B – SLEB thickness

Fig. 5.

Degree of ulcer vascularity A. Low. B. Moderate. C. High
Degree of ulcer vascularity A. Low. B. Moderate. C. High

Fig. 6.

Example ulceration in an 81-year-old female patient before and after laser therapy in whom ulcer size was reduced by over 30%. A. Ultrasound examination of the ulcer before laser therapy [migrating epidermis was not visualized, but granulation tissue is evident (arrow)]. B. Ultrasound examination of the ulcer after laser therapy [granulation tissue (arrow) and migrating epidermis (arrow head) were visualized]. C. Photographic image before laser therapy. D. Photographic image after laser therapy
Example ulceration in an 81-year-old female patient before and after laser therapy in whom ulcer size was reduced by over 30%. A. Ultrasound examination of the ulcer before laser therapy [migrating epidermis was not visualized, but granulation tissue is evident (arrow)]. B. Ultrasound examination of the ulcer after laser therapy [granulation tissue (arrow) and migrating epidermis (arrow head) were visualized]. C. Photographic image before laser therapy. D. Photographic image after laser therapy

Fig. 7.

Example ulceration in a 46-year-old male patient before and after laser therapy in whom the ulcer healed completely. A. Ultrasound examination of the ulcer before laser therapy which shows epidermal loss and partial dermal loss (ellipse). B. Ultrasound examination of the ulcer after laser therapy with evident reconstruction of the epidermis and dermis on the previous ulcer site (ellipse). C. Photographic image before laser therapy. D. Photographic image after laser therapy
Example ulceration in a 46-year-old male patient before and after laser therapy in whom the ulcer healed completely. A. Ultrasound examination of the ulcer before laser therapy which shows epidermal loss and partial dermal loss (ellipse). B. Ultrasound examination of the ulcer after laser therapy with evident reconstruction of the epidermis and dermis on the previous ulcer site (ellipse). C. Photographic image before laser therapy. D. Photographic image after laser therapy

Data on ulcer depth and granulation tissue amount before and during treatment

No. Duration of laser therapy [weeks] Ulcer depth [mm] WSI Granulation tissue thickness [mm] Time of examination from laser therapy start [weeks] Ulcer depth [mm] WSI Granulation tissue thickness [mm]
Before biostimulation During biostimulation
1 12 4.53 0.54 1.43 8 3.07 0.39 2.9
2 4 1.03 0.23 2.5 * * * *
3 6 3.43 0.53 0.9 2 1.93 0.32 2.03
4 5 2.67 0.38 2.57 2 1.73 0.31 2.6
5 7.5 2.1 0.22 2 2 1.57 0.19 2.57
6 24 3.63 0.28 2.27 3 3.5 0.28 2.3
7 14 2.37 0.25 2.7 3 -1.33 -0.18 3.83
8 15.5 -1.33 -0.23 3.4 10 -1.07 -0.12 3.3
9 19 2.9 0.21 6.13 2 1.4 0.11 4.17

Description of ulcers and laser therapy duration

No. Sex Age Side Ulcer aetiology Duration [months] Ulcer surface [cm2] Duration of laser therapy [weeks] Ulcer status after treatment
1 M 78 P CVI 120 6 12 healed
2 M 71 P CVI 15 7 4 healed
3 K 77 P CVI 96 102 6 healed after transplant
4 K 75 P CVI 360 11 5 reduction by 40%
5 K 81 P CVI/DM 180 24 7,5 reduction by 30%
6 M 60 P CVI/DM 7 12 24 healed
7 M 60 L CVI/DM 8 45 14 healed
8 K 74 P CVI 30 8 15,5 healed
9 M 46 P CVI 18 2 19 healed

Data on epidermal and SLEB thickness before and during treatment

No. Migrating epidermis thickness [mm] Thickness of epidermis surrounding the ulcer [mm] SLEB [mm] Vascularity Time of examination from laser therapy start [weeks] Migrating epidermis thickness [mm] Thickness of epidermis surrounding the ulcer [mm] SLEB [mm] Vascularity
Before biostimulation During biostimulation
1 ** 0.47 1.13 3 8 1 0.47 0.67 3
2 0.90 0.43 0.7 3 * * * * *
3 ** 0.77 1.03 1 2 1.1 0.43 0.53 2
4 1.00 0.5 1.1 1 2 1.6 0.57 1.43 2
5 ** 0.47 0.9 3 2 0.7 0.37 0.7 2
6 1.00 0.43 0.13 2 3 1.1 0.47 0.13 2
7 0.50 0.5 0.67 2 3 1 0.33 0.23 2
8 1.20 0.53 0.83 3 10 1.3 0.4 0.37 3
9 ** 0.4 0.53 3 2 0.8 0.47 0.57 3
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