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We greatly appreciate Dr McCulloch's thoughtful commentary. We agree that controlling for all variables threatening internal validity in clinical trials is a formidable task, made even more difficult when sample sizes are small. As we stated in our discussion, we randomly assigned patients to high voltage pulsed direct current (HVPC) and placebo HVPC groups after controlling for factors known from the literature to affect healing (ie, ulcer grade and patient smoking status). To our knowledge, no controlled studies have compared healing rates of pressure ulcers in gluteal/ischial versus sacral/coccygeal locations. Knowledge concerning expected healing rates of chronic ulcers of various etiologies and anatomical locations in patients is certainly lacking, and greater clinical research is needed in this area.
Dr McCulloch's comments regarding the relative merit of wound surface area (WSA) measurements from slide versus transparency tracings are interesting and relevant to both clinical practice and research.…
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