For our Wound Research Voices feature in December, we are pleased to share a short summary of a PhD thesis by Dr. Sebastián Flores-Escobar, Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain. The English title of the thesis is Randomized clinical trial to elucidate the effects of low-frequency ultrasound debridement in patients with diabetic foot ulcers compared to conventional treatment. 

Spanish title: Ensayo clínico aleatorizado para dilucidar los efectos del desbridamiento con ultrasonidos de baja frecuencia en pacientes con úlceras de pie diabético, en comparación con su tratamiento convencional). 

Summary, methodology & clinical relevance 

Diabetic foot ulcers (DFUs) require regular debridement to remove devitalized tissue and promote healing. Sharp debridement is the standard technique, but it can be unsuitable for patients with limited vascular supply or increased pain sensitivity. Low-frequency ultrasound debridement (LFUD) offers a gentler alternative with demonstrated benefits in wound healing, yet the impact of its application frequency had not been evaluated. This randomized controlled trial included 30 patients with DFUs, allocated to weekly LFUD, biweekly LFUD, or standard care. Primary outcomes were healing rate and ulcer area reduction; secondary outcomes included granulation tissue formation, transcutaneous oxygen pressure (TcPO₂), and pain. 

Weekly LFUD achieved the highest healing rate (70%), the greatest ulcer area reduction (87.5%), and the shortest healing time (median 11 weeks). Both LFUD schedules significantly improved granulation tissue formation and increased TcPO₂, whereas no improvement was observed with standard care. Pain levels decreased significantly in the LFUD groups but not in the control arm. Although overall healing rates were similar across groups, weekly LFUD demonstrated clear advantages in healing speed, perfusion, and wound tissue quality These findings suggest that LFUD applied weekly could be a valuable therapeutic option in clinical practice, particularly for patients in whom sharp debridement is not a viable option or who require an alternative approach to promote wound healing. 

Publications 

1. Flores-Escobar S; García-Álvarez Y; Álvaro-Afonso FJ; López-Moral M; Gárcía-Madrid M; Lázaro-Martínez JL. 2025. Clinical Effects of Weekly and Biweekly Low-Frequency Ultrasound Debridement Versus Standard of Wound Care in Patients with Diabetic Foot Ulcers: A Pilot Randomized Clinical Trial. The International Journal of Lower Extremity Wounds. https://doi.org/10.1177/15347346251332795 
2. Álvaro-Afonso FJ; Flores-Escobar S; López-Moral M; García-Álvarez Y; García-Morales E; Lázaro-Martínez JL. 2023. A deeper look at low-frequency contact ultrasonic debridement in the clinical management of patients with diabetic foot ulcers. Wound Repair and Regeneration. 31-6, pp.745-751. https://doi.org/10.1111/wrr.13124 
3. Flores-Escobar S; Álvaro-Afonso FJ; García-Álvarez Y; López-Moral M; Lázaro-Martínez JL; García-Morales E. 2022. Ultrasound-Assisted Wound (UAW) Debridement in the Treatment of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 11-1911. https://doi.org/10.3390/jcm11071911 
4. Flores-Escobar S; Álvaro-Afonso FJ; García-Álvarez Y; Lópex-Moral M; García-Madrid M; Lázaro-Martínez JL. 2024. Low-Frequency Contact Ultrasonic Debridement in Diabetic Foot Ulcer. Diabetic Foot Ulcers – Pathogenesis, Innovative Treatments and AI Applications. IntechOpen. http://dx.doi.org/10.5772/intechopen.1004066