Therapeutic Ultrasound Applications in Chronic Wound Healing

Therapeutic ultrasound has emerged as a versatile modality for enhancing the repair of chronic wounds by harnessing both mechanical and biological effects. Low-frequency and high-intensity ultrasound waves can remove devitalised tissue (debridement), stimulate cellular proliferation, modulate inflammation and promote angiogenesis. Microbubble-enhanced cavitation enables targeted drug or growth factor delivery, while pulsed focused ultrasound can influence systemic immune pathways. In clinical practice, ultrasound has been applied to diabetic foot ulcers, pressure injuries, venous leg ulcers, burns and pathological scars. Reported benefits include accelerated wound closure, reduced bacterial load, improved extracellular matrix remodelling and minimised scar formation. However, standardisation of dose parameters, waveform characteristics and treatment schedules remains a priority to translate experimental success into routine patient care. Integrating mechanistic insights with robust clinical trials is crucial to establish ultrasound as a mainstream option for chronic wound management worldwide.

Research from Nature Portfolio

Short-term high-intensity ultrasound has been shown to activate human dermal fibroblasts in vitro, enhancing proliferation, migration and synthesis of collagen and fibronectin. Transcriptomic analysis revealed up-regulation of p38 and ERK1/2 MAPK pathways, indicating mechanotransduction as a key driver of matrix remodelling. In parallel, ultrasound-mediated cavitation of lysozyme microbubbles coated with epidermal growth factor in a dressing format achieved sustained local delivery of bioactive molecules, inhibited bacterial colonisation by over 95% in vitro and accelerated wound closure in vivo during a 21-day study. Together, these foundational investigations demonstrate that ultrasound can be engineered both as a mechanical stimulus and a drug delivery platform to enhance tissue repair processes.

Therapeutic Ultrasound Applications in Chronic Wound Healing publication trend

The graph below shows the total number of articles in therapeutic ultrasound applications in chronic wound healing across all publications each year (not limited to Nature Index journals).

Technical terms

Cavitation: Formation and oscillation or collapse of gas-filled bubbles under ultrasound, generating localised mechanical forces.

Debridement: Removal of necrotic or non-viable tissue from a wound bed to facilitate healing.

Extracellular matrix (ECM): Network of proteins and polysaccharides that provides structural support and biochemical cues to cells.

Focused ultrasound: Technique that concentrates acoustic energy at a defined target to provoke thermal or mechanical effects.

Microbubble: Microscopic gas-filled sphere used to enhance ultrasound contrast or facilitate drug delivery via cavitation.

References

1. Ultrasound-based Techniques as Alternative Treatments for Chronic Wounds: A Comprehensive Review of Clinical Applications. Cureus (2017).
2. Non pharmacological high-intensity ultrasound treatment of human dermal fibroblasts to accelerate wound healing. Scientific Reports (2021).
3. Ultrasound-Mediated EGF-Coated-Microbubble Cavitation in Dressings for Wound-Healing Applications. Scientific Reports (2018).
4. Efficacy and safety of ultrasound-assisted wound debridement in the treatment of diabetic foot ulcers: a systematic review and meta-analysis of 11 randomized controlled trials. Frontiers in Endocrinology (2024).
5. Exploring the Potential of Ultrasound Therapy to Reduce Skin Scars: An In Vitro Study Using a Multi-Well Device Based on Printable Piezoelectric Transducers. Bioengineering (2023).
6. Accelerating cutaneous healing in a rodent model of type II diabetes utilizing non-invasive focused ultrasound targeted at the spleen. Frontiers in Neuroscience (2022).