“Difficult-to treat” ulcers management: use of pulse dose radiofrequency aheadofprint 5 November 2012 - Ann. Ital. Chir. 1 Pervenuto in Redazione Settembre 2012. Accettato per la pubblicazione Ottobre 2012 Correspondence to: Gennaro Quarto MD, Department of General, Oncological, Geriatric Surgery and Advanced Technologies. University of Naples “Federico II”, Via Oasi Sacro Cuore 79/18, Giugliano In Campania, Naples, Italy (e-mail: gquarto@unina.it) Gennaro Quarto*, G. Solimeno*, E. Furino*, Luigi Sivero, Luigi Bucci*, Salvatore Massa*, Giacomo Benassai*, M. Apperti** *Department of General, Oncological, Geriatric Surgery and Advanced Technologie. University of Naples “Federico II”, Naples, Italy **C.I.R.F.F (Centro Interuniversitario di Ricerca e Formazione in Flebologia), Perugia, Italy “Difficult-to treat” ulcers management: use of pulse dose radiofrequency AIM: In this paper we wanted to evaluate the impact of pain reduction on the evolution of “difficult-to treat” ulcers, using Radiofrequency analgesia in pulse-dose modality. MATERIALS AND METHODS: We have performed a randomized trial to evaluate the efficacy of the RF in PD mode to reduce the healing time of ulcers of difficult management as outpatient for spontaneous and provoked pain. We enrolled 23 patients, including 7 males (30%) and 16 females (70%), aged between 53 and 79 years (mean age = 67.2) sort- ed according to the first letter of the last name in ascending order and assigned alternately to one or another group. RESULTS: In Group A healing was obtained in 33% of patients (4/12), with an average healing time of 6 months while in Group B healing has been obtained in 81% of patients (9/11) with an average time of 3 months (range 1-5 months) Student’s T was performed to compare the average recovery time among the two groups; moreover we have analyzed the proportions of healed patients in the group A and B. DISCUSSION: Healing time significantly decreased in group B (p = 0,013079). Even the cure rate has changed favor- ably, in a statistically significant way. CONCLUSIONS: According to the literature related to the use of the RF pulse dose, there is a greater effectiveness of this technique in respect of the classical PRF, in terms of immediate and long-term reduction of pain and this impacts pos- itively on the course of ulcer healing. KEY WORDS: Ulcer, Radiofrequency. Introduction The RF is a technique used for decades in the man- agement of chronic pain of different origin. The types of pain that are best suited to the use of radio frequency are: trigeminal neuralgia, neck pain, occipital neuralgia, post-surgical and oncological pain. The rationale of this technique is linked to the principle that the heat which causes in target tissues and, therefore, in the nervous structures, determines an irreversible damage that pre- vents the conduct of the painful impulse. In fact, when applied to tissues, this current determines the oscillation of molecules with electric charge (espe- cially proteins) which collide against each other, gener- ating heat. If the temperature produced reaches a spec- ified value, it generates a thermal damage. To develop the thermal damage by radiofrequency, it is necessary a circuit composed of a current generator and two terminals 3 . A terminal is connected with an elec- trode, whose end is positioned in close contact with the target tissue; the other end is connected to a large sur- face plate, positioned on the patient’s skin, in proximi- ty to the tissue to be treated. The current flows, in this way, from the electrode to the plate. In this way, in the tissues in direct contact with the electrode tip, it gener- ates a temperature that, in some cases, can reach 90°C, sufficient to ensure an irreversible thermal damage; in the tissues in contact with the plate, instead , thanks to the difference in surface between the latter and the elec- trode, does not create any type of damage. Ann. Ital. Chir. aheadofprint 5 November 2012 pii: S0003469X12020507 www.annitalchir .com