Use of high-resolution ultrasound to monitor the healing of leg ulcers: a prospective single-center study.
BACKGROUND
The quality and extent of leg ulcer healing in deeper skin layers remains poorly defined using standard visual inspection alone. High-resolution ultrasound (HR-US) offers a non-invasive, quantitative and objective assessment of dimensional and structural changes deep within the wound.


METHODS
In a prospective, single-center study, healing of chronic, treatment-resistant leg ulcers was monitored by standard photography and HR-US.


RESULTS
Twenty patients with 22 ulcers were enrolled. After study entry, treatment comprised continuation of conventional management (n=4) or application of Apligraf (n=17) or Thiersch (n=1). All ulcers receiving a graft were classified as 'clinically healed' by visual inspection within a maximum of 5 weeks. With conventional management, closure required a period of several months in three out of four cases. After covering the ulcer with Apligraf, the skin reconditioned, resulting in fair skin color and a smooth skin surface in all but one case. HR-US images, however, revealed large subepidermal deficits of elastic and collagenous fibers at the time of 'clinical healing' in 14/18 engrafted ulcers, findings that are strongly indicative of a weakened skin scaffolding.


CONCLUSIONS
We suggest that the healing process for chronic ulcers can be monitored with both standard visual inspection (photography) and HR-US to allow early intervention.
Kuhn
Christoph
C
Clinic Piano, Gottstattstrasse, Biel, Switzerland.
Angehrn
Fiorenzo
F
D000328:Adult; D046169:Dermoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007871:Leg Ulcer / Q000473:pathology* / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D014945:Wound Healing; D055815:Young Adult