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    Low-frequency ultrasound, saline accelerate wound healing after CO2 laser peels

    A nonthermal low-frequency ultrasound system combined with a normal saline mist spray is proving beneficial in healing wounds seen post-laser resurfacing.

    The MIST Therapy System (Celleration Corp.) is a noncontact low-frequency (40 KHz) ultrasound (NCLU) device that sprays a saline mist, through which the ultrasonic waves are delivered to the targeted area during treatment. The system is designed to accelerate wound healing by reducing local inflammation and bacterial count as well as increasing collagen deposition at the treatment site.

    A 42-year-old female patient before (left) full-face CO2 laser peel, one day after (middle) laser peel using MIST therapy, and 50 days after full-face CO2 laser peel and MIST therapy. (Photos credit: Robert A. Shumway, M.D., F.A.C.S.)
    "As a cosmetic surgeon, I use the MIST System primarily after ablative resurfacing, but it could also be used post-Fraxel therapy as well. Laser therapy can cause quite a large surface area wound in the patient. I find the MIST therapy to be a very effective and painless wound-treatment technique in my patients," says Robert A. Shumway M.D., F.A.C.S., Shumway Cosmetic Surgery, La Jolla, Calif., Scripps Memorial Hospital Campus. "Each time I use the device, the treated wounds look better, cleaner, less inflamed and are less painful."

    Approved in 2005 for the promotion of wound healing, the system can be used to heal lacerations and wounds with minor dehiscence. It may have its greatest utility, however, in treating the wounded skin of patients following laser procedures such as postablative laser resurfacing.

    "I have been using the MIST system for about a year now in my postablative cosmetic laser resurfacing patients who appreciate the immediate cooling effect during treatment. Using the device, I can achieve quicker downtimes in my patients, as well as significantly reduce their pain post-laser resurfacing," Dr. Shumway says.

    BATTLING BACTERIA According to Dr. Shumway, MIST therapy can accelerate the wound-healing process as well as stem bacterial infections. A recent study with the MIST System showed extensive reduction of at least 11 types of bacteria, including Staphylococcus aureus, Pseudomonas species, Escherichia coli and Enterobacter (Kavros SJ, Schenck EC. J Am Podiatr Med Assoc. 2007;97(2):95-101).

    "All wound infections greatly retard the tissue-healing process and can be very dangerous to the patient's health. The ability of the ultrasound to disrupt those bacterial cells and stimulate the healthy cells can accelerate the healing process," Dr. Shumway says.

    Dr. Shumway performed a full-face and split-face pilot study comparing the healing effects of the MIST System to traditional debridement techniques following laser resurfacing. Results showed less secondary acne and/or viral infections on the NCLU-treated side and a difference in overall healing between the NCLU-treated side and the nontreated side.

    The same results were evident for all patients who received full-face NCLU therapy. Dr. Shumway presented information regarding his noncontact ultrasound therapy study at the Society of Plastic Surgical Skin Care Specialists (SPSSCS) meeting in Boston in May. A summary of the presentation is expected to appear in the fall 2011 issue of Specialty Skin Care, the official publication of the SPSSCS.

    During the follow-up visits after a laser-resurfacing procedure, physicians typically treat the skin with saline soaks and manually clean and debride the wounded skin to remove cellular debris. This is usually done at days one, three and five postprocedure. According to Dr. Shumway, traditional wound therapy can still be done when using the MIST System; however, less intensive manual debridement is needed.

    "Less manual debridement is required due to the accelerated healing and wound improvements achieved with the MIST. You can still manually debride the wound, but this hands-on approach will be uncomfortable to the patient. The MIST allows you to gently and effectively clean the wound without actually touching it, which in my experience is the preferred approach of my patients," Dr. Shumway says.

    Dr. Shumway reports no relevant financial interests.