Case studies: The use of Non-invasive Pulsed Acoustic Cellular Expression (PACE) System in complex wounds related to Diabetes reduces wound area and speeds wound closure

Background and Aims: Managing complex, chronic wounds involving diabetes and other comorbidities is a challenge in the plastic surgery field. New tools on regenerative medicine may show innovative paths on treatments.

This is a prospective, single site, single-arm pilot case series. The goal of this study aims to determine the effects of weekly PACE (Pulsed Acoustic Cellular Expression) therapy on wound healing.

MethodsFour patients were followed, treatment dates from March 13th to July 14th, 2021Patient 1: 72 years old, diabetes, hypertension, type of injury: ulcer (diabetic foot) Therapies: 5 tpn sessions, use of fibrase, collagenase and herbal bath Patient 2 43 years old, diabetes, hypertension, chronic renal failure type of injury: abscess in the left hand after fistula closure and tendon rupture.

Therapies: use of collagenase and age.Patient 3: 35 years old diabetes, hypertension, cardiopathy, type of injury: diabetic foot - right hallux amputation.

Therapies: tpn, collagenase and age.Patient 4: 50 years old; diabetes, hypertension; type of injury: diabetic foot - right hallux amputation; therapies: tpn, collagenase and age.

A baseline standard assessment was performed with initial wound measurements (length, width and depth in cm) and pictures were taken prior to each weekly PACE therapy (WPT). The device dermaPACE system was used to deliver shockwave therapy from focused eletro-hydraulic acoustic pulses. Standard of care coverage was also used.

Results:

Patient 1: After 7 sessions of WPT, delivering 12,000 pulses, wound area was reduced by 97,4%.

Patient 2: After 10 sessions of WPT, delivering 14,650 pulses, wound was closed.

Patient 3: After 9 sessions of WPT, delivering a total of 18,500 pulses wound area was reduced by 62,5%. Treatment is ongoing.

Patient 4: After 10 sessions of WPT delivering a total of 21,000 pulses, total wound area was reduced by 51,0%. This patient was then referred to graft.

All 4 patients showed also significant reduction on wound depth, improvement of vascularization and epithelization. ConclusionIn the author’s opinion PACE therapy offers good, fast and safe regenerative effect in the management of complex wound standard of care.