Efficacy Study of Ultrasound-Assisted Debridement to Influence Wound Healing

Inclusion Criteria: * Persons with lower extremity wound referred to vascular surgery service. * Full thickness wound below the knee with surface area of at least 1cm2. * Age \>18 years * English speaking * Ulcer of known etiology including diabetic foot wounds, and arterial or venous leg ulcers * Willing and able to adhere to 12 week study protocol that includes attending weekly clinic appointments, and wearing prescribed footwear or compression therapy Exclusion Criteria: * Leg wounds due to inflammatory conditions (e.g. pyoderma gangrenosum, vasculitis), malignancy, or other unknown etiologies. * Severe arterial insufficiency: Absence of pedal pulses combined with Ankle Brachial Index ≤ 0.3, Toe Pressure ≤20, or Trans Cutaneous Oxygen Measure ≤20 * Presence of acute limb threatening infection * Vascular surgery planned within next 3 months * Exposed vascular graft or blood vessel, bone or tendon in the base of the wound. * Currently receiving advanced wound therapy treatments: Hyperbaric therapy, biological dressings \[collagen or extracellular matrix dressings\]. * Increased likelihood of an adverse reaction to ultrasonic debridement due to: * Excessive wound pain (\>5 VAS scale) or patient described intolerable * Allergy to topical anesthetic (lidocaine) * Individuals who have factors/circumstances that are known to limit their ability to demonstrate healing in 4 weeks. For example: * medically unstable or palliative medical status * poor nutritional status (low serum albumin \< 15), * anemia (Hb \< 75 mg/dl), * taking immunosuppressant medication (prednisone, chemotherapy; transplant anti-rejection medication), * Individuals with medical conditions that contraindicate the use of ultrasound energy * Cardiac pacemaker or defibrillator * Excessive bleeding tendency (\> 5 mins post debridement) or identified coagulopathic disorders * Exposed bone in the wound base * Untreated osteomyelitis