Expanding the Role of Ultrasonography in Non-invasive Wound Assessment

I am writing in response to the article “Non-invasive Techniques for Wound Assessment: A Comprehensive Review,” which provides a thorough examination of advanced imaging techniques, particularly high-frequency ultrasound (HFU), for wound assessment [1]. While the article offers valuable insights, I believe there is a key knowledge gap regarding the broader utility of ultrasonography in wound care, especially in chronic diabetic foot ulcers (DFUs) and their associated complications.

While HFU offers unique advantages in visualising tissue characteristics during wound healing, standard ultrasonography has significant value in identifying both acute and long-term complications associated with DFUs, including subcutaneous fibrosis and osteomyelitis. In my case study, “Persistent Edema Leading to Subcutaneous Scarring in Healed Diabetic Foot Ulcer: A Case Study of Ultrasonographic Findings,” I demonstrated how ultrasonography can effectively detect subcutaneous fibrosis, a complication resulting from persistent edema during the wound healing process [2]. This fibrosis can lead to functional impairments and recurrent ulceration if not detected early. The case highlights how ultrasonography, a non-invasive, cost-effective, and accessible modality, can be employed to assess such complications and guide timely interventions.

Additionally, in “Ultrasonographic Features of Diabetic Foot Osteomyelitis: A Case Series,” I demonstrated how ultrasonography can be used to detect osteomyelitis in DFUs—another complication that may not always be obvious through clinical examination [3]. The study highlighted features such as periosteal reaction and cortical erosions, which were later confirmed by x-ray, showing that ultrasonography can complement other imaging methods like CT and MRI, particularly in resource-limited settings where these advanced techniques may not be available.

Furthermore, the “Diagnostic Performance of Ultrasonography for Diabetic Foot Osteomyelitis” study validates the use of ultrasonography for diagnosing osteomyelitis, showing excellent sensitivity and specificity compared to bone cultures [4]. This study reinforces ultrasonography's potential as a more accessible, cost-effective, and reliable alternative to more expensive imaging techniques like CT and MRI for diagnosing this serious complication.

While HFU is undeniably a powerful tool in assessing tissue changes, I believe standard ultrasonography—due to its broad applicability, reproducibility, and lower cost—should be recognised as an essential tool in wound care, especially in the management of DFUs. By combining ultrasonography with other imaging techniques, clinicians could achieve more comprehensive wound assessments, leading to earlier detection of complications such as subcutaneous fibrosis and osteomyelitis, and ultimately improving patient outcomes.

Thank you for your attention to these points. I look forward to continued advancements in the use of imaging technologies for wound care.

The authors declare no conflicts of interest.