Advanced wound care
For wounds that have stopped answering to conservative care
We specialize in chronic wounds older than 30 days with a vascular or pressure origin — venous and arterial ulcers, diabetes-related foot wounds, and pressure injuries that have plateaued despite appropriate dressings, offloading, and compression.
The threshold
Why 30 days matters
A wound that is healing, even slowly, is doing what it should. A wound that has made no meaningful progress across 30 days of appropriate conservative treatment is a different problem: something is interrupting the healing cascade, and repeating the same dressing change for another month will not find it.
That is the point at which advanced modalities become clinically appropriate — and it is also the threshold payers use. Advanced wound therapies are reserved for wounds that have documented failure of conservative treatment over more than 30 days. We hold to that standard because it protects you from paying for treatment you don’t yet need, and it protects the wound from a delayed escalation you do.
Standard care — dressings, offloading, compressionDay 30 · the escalation point
You may be a candidate if
- The wound is more than 30 days old and has not measurably improved
- The origin is venous, arterial, diabetic, or pressure-related
- Conservative care has been genuinely tried — and documented
- Sharp debridement is too painful, or has already been done and the wound still stalls
- You have a physician willing to write an order for ultrasound therapy
You may not be, if
- The wound is acute, surgical, and healing on schedule
- Untreated arterial insufficiency, active osteomyelitis, or malignancy is driving the wound — these need medical or surgical management first
- You are currently under a home health agency’s plan of care for the same services
Candidacy is determined at evaluation, not over the phone. If we are not the right setting for your wound, we will say so and help you find the one that is.
What to bring
- Photo ID and your insurance cards
- Physician’s order for ultrasound therapy
- Recent wound notes or photographs
- Vascular studies, if you’ve had them
- Current medication list
- Your dressings, compression garments, and offloading devices
- Your completed intake packet
The modality
Low-frequency ultrasound therapy, explained plainly
A handpiece held just above the wound converts sterile saline into a fine mist and drives low-frequency ultrasonic energy through it into the tissue. Nothing touches the wound bed.
Cleans without cutting
The acoustic energy helps lift slough, exudate, and devitalized tissue and disrupts bacterial biofilm in the wound bed — the film that keeps many chronic wounds locked in a low-grade inflammatory state.
Reaches what dressings can’t
Energy is delivered below the wound surface, including undermined and tunneled areas that topical care struggles to affect.
Tolerable when debridement isn’t
Because the applicator is non-contact, treatment is usually comfortable — which matters enormously for painful ulcers and for patients who cannot tolerate sharp debridement.
On our equipment
Coastal Wound Care is finalizing its device selection among the FDA-cleared low-frequency ultrasound systems on the market. Our clinical criteria, documentation standards, and reassessment schedule are identical regardless of which system we deploy, and this page will name the device once it is in service.
The equipment travels. Advanced wound care is available at all three offices and in your home, so you can be seen wherever the drive is shortest.
The evidence
What the research actually shows — and where it’s thin
We think patients deserve the real state of the evidence rather than a brochure. Low-frequency ultrasound for chronic wounds has a genuine body of randomized trials behind it, with meaningful signals on healing rate and wound closure. It also has real methodological criticism, and several commercial payers still classify it as investigational on that basis. Both things are true.
- 2005 · double-blind, multicentre, sham-controlled RCT · n=133
In patients with recalcitrant diabetic foot ulcers, the group receiving active ultrasound therapy reached a substantially higher healing rate at 12 weeks than the sham group. Independent reviewers note real limitations, including protocol deviations at several sites and participant loss — which is why several commercial payers cite this trial while still declining coverage.
- 2006 · clinical effectiveness study of MIST ultrasound therapy
Across chronic wounds treated either with ultrasound alone or combined with moist wound care, healing was achieved in roughly two-thirds of cases, and response was typically evident within the first four weeks of therapy.
PubMed 17008814 - 2007 · 51-patient analysis, Journal of the American Podiatric Medical Association
A feasibility analysis in chronic, recalcitrant lower-leg and foot ulcerations across a medically complex population — diabetes, neuropathy, limb ischemia, renal insufficiency, venous disease. The population most like our own.
PubMed 17369314 - 2008 · retrospective comparative analysis
Chronic wounds treated with ultrasound therapy plus standard care healed significantly more often than those treated with standard care alone, and the rate of area reduction was markedly steeper in the treated group.
PubMed 18769168 - White et al., 2015 · assessor-blinded RCT · International Wound Journal
A single-centre randomised trial comparing non-contact low-frequency ultrasound added to UK standard care against standard care alone in chronic venous leg ulcers.
Full text - Voigt et al., 2011 · systematic review and meta-analysis of 8 RCTs
Pooled results across venous stasis and diabetic foot ulcers favoured low-frequency ultrasound, while the authors themselves flagged significant risk of bias across the included trials.
Independent payer technology assessments — including those published by Aetna, UnitedHealthcare, and several Blue Cross plans — review this same literature and reach differing conclusions, with several still designating the therapy investigational for commercial members. Medicare coverage is governed separately by medical-necessity rules and local contractor guidance. We are happy to share the full citations with you or your physician.
Nothing on this page should be read as a promise of healing. It is a summary of published research on a category of therapy, offered so you can make an informed decision with your physician.
How we decide to continue
Baseline
Wound measured, photographed, staged, and documented alongside vascular and nutritional status.
Early reassessment
Progress reviewed after the first several treatments. No measurable change means the plan changes.
Course review
Formal reassessment against the plan of care, with documented findings sent to your referring physician.
Continue, change, or refer
Therapy continues only while the wound responds. If it stalls, we escalate or refer rather than repeat.
Beyond the modality
The rest of the plan, which is most of the plan
Offloading and pressure redistribution
Positioning, seating, footwear, and equipment recommendations, because a pressure or diabetic wound will not close under the load that made it.
Edema and compression management
Compression selection and technique, plus the mobility and calf-pump work that makes venous return possible in the first place.
Mobility and strength
The reason a physical therapist should be doing this: gait, transfers, and endurance are what determine whether a healed wound stays healed.
Nutrition
Protein and micronutrient status assessed with a licensed clinical dietitian, guided by laboratory work. More on nutrition.
Start with a conversation, not a form
Tell us about the wound or the fall, and we’ll tell you honestly whether we’re the right fit — and what your physician needs to send if we are.