Ultrasound therapy in chronic leg ulceration: a meta-analysis

We reviewed all articles on ultrasound therapy published since 1950 to assess the evidence for an effect of this therapy in the treatment of chronic leg ulcers. Fourteen studies concerning ultrasound therapy, chronic leg ulcers, and wound healing were found. The six studies that fulfilled inclusion criteria for a randomized controlled trial were generally found lacking with respect to description of ulcer etiology-treated area, ultrasound head area, control of ultrasound apparatus, sham ultrasound apparatus, and follow-up evaluations. However, all six studies presented their data in a way that made pooling possible with respect to a decrease in ulcer area as a percent of the starting area. A standardized effect size was applied and gave evidence for a significant effect of ultrasound, showing a 16.9% (CI95: 6.3% to 27.5%, p = 0.011) mean difference in healing after 4 weeks of treatment and a 14.5% (CI95: 6.6% to 22.3%, p = 0.005) mean difference after 8 weeks of treatment compared with control treatment. In three studies, the number of healed ulcers was assessed, and pooling showed a nonsignificant (p = 0.06) therapeutic gain of 15% (CI95: 1% to 30%). This analysis would suggest that ultrasound has the best effect being delivered in low doses around the edge of the ulcer, but further studies are required to confirm this possible effect and to evaluate a possible dose-response relationship.