Low-frequency ultrasonic debridement and topical antimicrobial polyhexamethylene biguanide for use in chronic wounds: A case series

Background: Chronic wounds can be difficult to heal, or sometimes never heal. Current evidence indicates that wound biofilm can interfere with healing. Combining two treatments targeting chronic wound biofilm may improve outcomes when standard care is unsuccessful. The aim of this study was to determine feasibility and acceptability of combining low-frequency ultrasonic debridement (LFUD) and the antiseptic polyhexamethylene biguanide (PHMB) post treatment. Methods: This was an exploratory case study of four patients with non-healing wounds with suspected microbial involvement, who were subjected to a combination therapy approach. Data collection included retrospective health care record audit, wound observations and structured individual interviews. Interview data captured patient feedback about the acceptability of the therapy and provided information regarding feasibility of conducting larger trials. Results: Standard care for the four participants had failed to assist with healing. The new combination therapy was acceptable and appeared to accelerate wound healing, with nil adverse effects. Conclusions: Chronic wounds with suspected biofilm have the potential to heal if treatment is multifactorial. The combination of techniques used in this series was acceptable to patients and shows promise as an effective treatment, as it may have assisted the healing process. Further trials are needed to determine the efficacy.