Address correspondence to:

Ultrasound (US) has been employed therapeutically for decades and iscurrently used by clinicians to treat a wide variety of soft tissue dis-orders.1 In the management of cutaneous wounds, US has been found to enhance the healing process in incisional lesions, diabetic ulcers,2 and venous ulcers.3 Ultrasound is sound energy of frequency> 20 kHz, which is above the normal range of human perception. It may produce a number of biophysical effects that are relevant to wound healing.These include alterations in cel-lular protein synthesis and release, blood flow and vascular permeability, angiogenesis, and collagen content and alignment.4 Such effects have been suggested to provide a rationale for the use of therapeutic US at each stage of the wound-healing process.5 However, systematic reviews have generally concluded that there is insufficient robust data to make firm judgements about the efficacy of the modality.6–8 The favorable evidence is strongest in the case of venous ulcers.9–11 Many published studies of US treatment of wounds use protocols that involve insonation of the surrounding tissue, rather than the wound bed itself.12–17 The rationale for this choice is rarely stated, but the intention is probably to avoid causing pain or trauma to the wound, or raising the risk of infection.18 It can also retard the healing process by allowing the wound to cool—wound bed temperatures have been shown to fall by several degrees Celsius during normal dressing changes,19 and there is a concomitant reduc-tion in biochemical processes of healing.20,21 Mitotic and leucocyte activity may not return to normal for several hours after application of a new dress