Patent Publication Number: US-7896855-B2

Title: Method of treating wounds by creating a therapeutic combination with ultrasonic waves

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation-in-part of U.S. patent application Ser. No. 11/777,986 filed Jul. 13, 2007, the teachings of which are hereby incorporated by reference. 
     This application is also related to U.S. patent application Ser. No. 11/777,990, filed Jul. 13, 2007, the teachings of which are hereby incorporated by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to a method of treating a wound by creating a therapeutic combination of materials with ultrasonic waves, spraying the combination onto the wound to be treated, and inducing cavitations within the combination. 
     2. Background of the Related Art 
     When confronted with infected and wounded tissue, physicians and similar practitioners of medical arts have numerous devices and methods at their disposal. For instance, exposing an infected wound to oxygen may bring about a therapeutic effect. Methods of delivering oxygen to wounds have been developed and are implemented by various devices and compounds. The methods include placing the wound within an oxygen rich environment as to facilitate the diffusion of oxygen from the environment into the wound. Oxygen releasing compounds have also been placed over wounds as to allow for the diffusion of oxygen from the compound into wound. 
     Administering pharmaceuticals to a wound may also be utilized to treat an infection. Specifically, treating an infected wound may be accomplished by administering various anti-microbial agents such as, but not limited to, antiseptics, antibiotics, antiviral agents, antifungal agents, or any combination thereof. 
     In extreme situations, the practitioner may have to resort to the surgical removal of infected tissue to treat an infected wounded. Subsequently grafting transplanted and/or bioengineered tissue onto the wounded may be necessary with severe wounds. 
     More experimental treatments, such as exposing an infected wound to ultraviolet light, electricity, and/or ultrasound, are also available to the practitioner. For example, U.S. Pat. Nos. 6,478,754, 6,761,729, 6,533,803, 6,569,099, 6,663,554, and 6,960,173 teach methods and devices utilizing an ultrasound generated spray to treat wounds. Methods and devices utilizing indirect contact with wounds via a liquid aerosol are disclosed in U.S. Pat. Nos. 7,025,735 and 6,916,296. 
     SUMMARY OF THE INVENTION 
     Treating infections within severe and/or chronic wounds can be especially difficult. Such wounds are often seen in diabetics, the elderly, individuals with compromised immune systems, and other at risk patient populations. The pain produced by such wounds may disable the patient, thereby reducing the patient&#39;s quality of life. Placing the patient in an environment abundant in drug resistant infectious agents, such as hospital or institutional settings, further increases the patient&#39;s morbidity and mortality by allowing secondary infections to develop. 
     A method of treating infected wounds utilizing ultrasonic vibrations to mix different materials together, as to create a therapeutic combination, and to induce cavitations over the wound is disclosed. The materials are mixed by passing them through an ultrasound horn, vibrated in resonance, comprising an internal chamber including a back wall, a front wall, and at least one side wall, at least one channel opening into the chamber, and a channel originating in the front wall of the internal chamber and exiting the horn. As the materials pass through the internal chamber, ultrasonic vibrations emanating from and/or echoing off the various walls of the chamber mix the materials into a potentially therapeutic combination. After being created within the horn, the combination is delivered to the wound to be treated. Cavitations are then induced over the wound by administering to the combination delivered to the wound ultrasound energy. 
     Delivering the therapeutic combination to the wound may be accomplished in several manners readily apparent to those skilled in that art. For example, the combination could be washed over the wound. It may be beneficial to deliver the combination in such a manner as to allow for an irrigation wash of the wound with the combination. In combination or in the alternative the combination could be sprayed onto the wound. The combination may be sprayed onto the wound in several manners. For instance, a flowing carrier gas may be utilized to spray the combination onto the wound. The combination may also be sprayed onto the wound by pressurizing the combination and then expelling it towards the wound to be treated, thereby jet lavaging the wound. The combination may also be sprayed onto the wound by using ultrasonic vibrations emanating from an ultrasound horn as to ultrasonically lavage the wound. The horn used to spray the combination onto the wound may be the same horn used to create the combination. The enumerated manners of spraying the combination onto the wound may be used in combination or in the alternative. For instance, the combination may be pressurized and expelled towards the wound through an orifice within an ultrasound horn, as to create a jet lavage coupled with ultrasound energy. Furthermore, other manners of spraying the combination onto or otherwise delivering the combination to the wound, readily recognizable to persons of ordinary skill in the art, may be used in addition to and/or in combination with the manners enumerated. 
     After and/or concurrently with delivering the therapeutic combination to the wound, cavitations should be induced in the combination in and/or over the wound. Inducing cavitations in the combination can be accomplished by emitting into and/or otherwise exposing the combination to ultrasound energy. Exposing the combination in and/or over the wound to ultrasound energy results in the formation of tiny bubbles, i.e. cavitations, within the combination. Conceptually, this phenomenon is similar to inducing water to boil by applying heat. However, the induction of cavitations within the combination by ultrasound energy is not dependant upon heating the combination to its boiling point. As such, the induction of cavitations is not dependent upon the transfer of thermal energy to the combination. 
     After spontaneously forming within the therapeutic combination in and/or over the wound, the cavitations randomly explode and/or collapse. An exploding and/or collapsing cavitation releases energy into the combination surrounding it. Furthermore, the explosion and/or collapse of a cavitation induces a pressure change within the volume of the combination surrounding the cavitation. The pressure change and/or energy released may inactivate, kill, weaken, and/or otherwise compromise infectious agents within the vicinity of the exploding cavitation. Thus, the cavitations induced within the combination in and/or over the wound by ultrasound energy emitted into the combination may act as anti-infection bombs. 
     The ultrasound energy responsible for inducing cavitations within the therapeutic combination may be released from any source. If the horn used to create the combination includes a radiation surface, it may be used to emit ultrasound energy into the combination in and/or over the wound. In such a scenario, the ultrasonic vibrations emanating from the radiation surface and directed towards the combination carries the ultrasonic energy into the combination. As previously stated, ultrasonic vibrations emanating from the horn used to create the combination may be utilized to spray the combination onto the wound. Consequently, utilizing a horn including a radiation surface may allow for the simultaneous delivery of the therapeutic combination to the wound and induction cavitations in the combination. 
     After and/or concurrently with delivering the therapeutic combination to the wound, it may be desirable to remove the combination from the wound. Numerous manners of removing the combination readily recognizable to those skilled in the art may be utilized. For example, the combination may be removed by dabbing the combination wound with a sterile gauze or towel. In combination or in the alternative, the combination may be removed by aspirating the wound. Aspiration of the wound, or otherwise removing the combination from the wound, may occur after and/or concurrently with the induction of cavitations in the combination in and/or over the wound. 
     Of course, simultaneously delivering the combination to the wound and inducing cavitations in the combination may be accomplished without the use of a mixing horn containing a radiation surface. All that is required to simultaneously deliver the combination to the wound and induce cavitations within the combination is to concurrently deliver the combination to the wound and emit ultrasound energy, of a sufficient level, into the combination. 
     The materials mixed together to create the therapeutic combination may include liquids, solids, and/or gases. As the materials pass through chamber they may be mixed by dissolving, suspending, and/or disbursing one material within another material utilized. In the alternative or in combination, the materials may also be mixed in other ways as they pass through the chamber. At least one of the materials may, but need not, be a solvent for at least one of the other materials utilized. Acceptable solvents may include, but are not limited to, water, a saline solution, and/or alcohol. At least one of the materials may, but need not, be a pharmaceutical. Preferably, at least one of the materials should be capable of eliciting a positive therapeutic effect, such as, but not limited to oxygen. 
     Oxygen is essential for many important aspects of the healing process. For example, oxygen is required for cellular respiration, the process by which cells produce the energy needed to repair the wound. Oxygen is generally supplied to tissues of the body through the body&#39;s circulation system. Unfortunately, the blood supply to wounded tissue is often diminished or compromised. Consequently, the amount of oxygen reaching wounded tissue is often reduced. Not only can reduced oxygen levels inhibit the ability of cells to produce energy and/or heal a wound, reduced oxygen levels can lead to the production of an anaerobic environment within the wound favoring the development of certain infections. When treating wounded tissue, infected or otherwise, oxygen may be indirectly delivered to the tissue via diffusion by placing the wound in an oxygen rich environment or placing an oxygen releasing compound over the wound. However, the epidermis and/or dermis of most animals are not adapted to allow large amounts of oxygen to diffuse into the body. As such, the epidermis and/or dermis may reduce and/or limit the efficacy oxygen rich environments and oxygen releasing compounds in treating wounds. 
     Ultrasonic vibrations emanating from an ultrasonically vibrating horn may be utilized to spray onto a wound a therapeutic combination created by mixing oxygen and saline. Utilizing ultrasonic waves to deliver the solution to wound may allow for the penetration of the solution into and/or across the dermis and/or epidermis. As such, the oxygen within the solution may enter the body, the cells of the dermis and/or epidermis, and/or otherwise become available to wounded tissues. This may increase the ability of the cells within and/or around the wound to carry out cellular respiration, as to produce energy needed in the healing process, which may involve fighting off an infection. 
     The amount of mixing that occurs within the chamber of the horn may be adjusted by changing the locations of the chamber&#39;s surfaces with respect to ultrasonic vibrations passing through the horn. When the horn is vibrated in resonance by a transducer attached to its proximal end, vibrations travel from the proximal end to the distal end of the horn. The vibrations can be conceptualized as ultrasonic waves traveling down the length of the horn. As the ultrasonic vibrations travel down the length of the horn, the horn contracts and expands. However, the entire length of the horn is not expanding and contracting. Instead, the segments of the horn between the nodes of the ultrasonic vibrations (points of minimum deflection or amplitude) are expanding and contracting. The portions of the horn lying exactly on the nodes of the ultrasonic vibrations are not expanding and contracting. Therefore, only the segments of the horn between the nodes are expanding and contracting, while the portions of the horn lying exactly on nodes are not moving. It is as if the ultrasound horn has been physically cut into separate pieces. The pieces of the horn corresponding to nodes of the ultrasonic vibrations are held stationary, while the pieces of the horn corresponding to the regions between nodes are expanding and contracting. If the pieces of the horn corresponding to the regions between nodes were cut up into even smaller pieces, the pieces expanding and contracting the most would be the pieces corresponding to the antinodes of the ultrasonic vibrations (points of maximum deflection or amplitude). 
     Moving forwards and backwards, the back wall of the chamber induces ultrasonic vibrations in at least one of the materials within the chamber. As the back wall moves forward it hits the material. Striking the material, like a mallet hitting a gong, the back wall induces ultrasonic vibrations that travel through the material. The vibrations traveling through the material possess the same frequency as the ultrasonic vibrations traveling through horn. The farther forwards and backwards the back wall of the chamber moves, the more forcefully the back wall strikes the material within the chamber and the higher the amplitude of the ultrasonic vibrations within the material. 
     When the ultrasonic vibrations traveling through the material within the chamber strike the front wall of the chamber, the front wall compresses forwards. The front wall then rebounds backwards, striking the material within the chamber, and thereby creates an echo of the ultrasonic vibrations that struck the front wall within the material. If the front wall of the chamber is struck by an antinode of the ultrasonic vibrations traveling through chamber, then the front wall will move as far forward and backward as is possible. Consequently, the front wall will strike the material within the chamber more forcefully and thus generate an echo with the largest possible amplitude. If, however, the ultrasonic vibrations passing through the chamber strike the front wall of the chamber at a node, then the front wall will be minimally forced forward, if at all. Consequently, an ultrasonic vibration striking the front wall at a node will produce a minimal echo, or no echo. 
     Positioning the front and back walls of the chamber such that at least one point on both, preferably their centers, lie approximately on antinodes of the ultrasonic vibrations passing through the chamber maximizes the amount of mixing occurring within the chamber. Moving the back wall of the chamber away from an antinode and towards a node decreases the amount of mixing induced by ultrasonic vibrations emanating from the back wall. Likewise, moving the front wall of the chamber away from an antinode and towards a node decreases the amount of mixing induced by ultrasonic vibrations echoing off the front wall. Therefore, positioning the front and back walls of the chamber such that center of both the front and back wall lie approximately on nodes of the ultrasonic vibrations passing through the chamber minimizes the amount of mixing within the chamber. 
     The amount of mixing that occurs within the chamber can also be adjusted by controlling the volume and/or pressure of the materials within the chamber, especially when one of the materials is a fluid. Ultrasonic vibrations within the chamber may cause atomization of the fluid. As the fluid atomizes, its volume increases which may cause the fluid to separate from the other material within the chamber. However, if the materials completely fill the chamber, then there is no room in the chamber to accommodate an increase in the volume of the fluid. Likewise, increasing the pressure of the materials within the chamber may prevent the atomization of a fluid within the chamber. If the pressure of the materials within the chamber is sufficiently high, it will push back on the fluid preventing and/or hindering it from increasing in volume. Constricting the fluid&#39;s increase in volume, the pressure of the materials within the chamber limits the atomization of the fluid. Consequently, the amount of atomization occurring within the chamber will be decreased and the amount of mixing increased when the chamber is completely filled and/or when the pressure of the materials within the chamber increases. 
     The mixing occurring within the chamber may also be enhanced by including an ultrasonic lens within the front wall of the chamber. Ultrasonic vibrations striking the lens within the front wall of the chamber are directed to reflect back into the chamber in a specific manner depending upon the configuration of the lens. For instance, a lens within the front wall of the chamber may contain a concave portion. Ultrasonic vibrations striking the concave portion of the lens would be reflected towards the side walls. Upon impacting the side walls, the reflected ultrasonic vibrations would be reflected again, and would thus echo throughout the chamber. If the concaved portion or portions within a lens form an overall parabolic configuration in at least two dimensions, then the ultrasonic vibrations echoing off the lens and/or the energy they carry may be focused towards the focus of the parabola. 
     In combination or in the alternative, the lens within the front wall of the chamber may also contain a convex portion. Again, ultrasonic vibrations emitted from the chamber&#39;s back wall striking the lens within the front wall would be directed to reflect back into and echo throughout the chamber in a specific manner. However, instead of being directed towards a focal point as with a concave portion, the ultrasonic vibrations echoing off the convex portion are reflected in a dispersed manner towards the side walls of the chamber. Upon reaching the chamber&#39;s side walls, the ultrasonic vibrations reflect off the side walls. If the angle of deflection off the side wall of the chamber is sufficiently great, the ultrasonic vibrations may travel towards and reflect off a different side wall of the chamber. Thus, the inclusion of an ultrasonic lens within the front wall of the chamber containing a convex portion increases the amount of echoing within the chamber. Increasing the amount of echoing, in turn, increases the amount of ultrasonic vibrations agitating, cavitating, and/or colliding against the fluids within the chamber, thereby enhancing the mixing of the fluids within the chamber. 
     In combination or in the alternative, the back wall of the chamber may also contain an ultrasonic lens possessing concave and/or convex portions. Such portions within the back wall lens of the chamber function similarly to their front wall lens equivalents, except that in addition to directing and/or focusing echoing ultrasonic vibrations, they also direct and/or focus the ultrasonic vibrations as they are emitted into the chamber. 
     In combination or in the alternative, the mixing occurring within the chamber may also be enhanced by incorporating protrusions on the side walls of the chamber. The protrusions may be formed in a variety of shapes such as, but not limited to, convex, spherical, triangular, rectangular, polygonal, and/or any combination thereof. Emitting ultrasonic vibrations into the chamber from their distal facing edges, the protrusions within the inner chamber may enhance mixing of the materials within the chamber by increasing the amount of ultrasonic vibrations within the chamber. Increasing the surface area of the chamber&#39;s side wall, the protrusions may enhance echoing by providing more surfaces from which ultrasonic vibrations can echo. 
     The protrusions may be discrete elements. Alternatively, the protrusions may be discrete bands encircling the internal chamber. The protrusions may also spiral down the chamber similar to the threading within a nut. 
     In combination or in the alternative, the mixing occurring within the chamber may be enhanced by placing at least one free member within the chamber. The ultrasonic vibrations within the chamber induce the free member to move about the chamber. The motion of the free member may further mix the materials passing through the chamber. The ultrasonic vibrations within the chamber may push the free member in the direction the ultrasonic vibrations are traveling. As such, the conformation of the lenses within the front and/or back walls of the chamber may influence the motion of the free member about the chamber. If the front or back wall contains an ultrasonic lens with a concave portion or portions that form an overall parabolic configuration in at least two dimensions, the ultrasonic vibrations may converge at the parabola&#39;s focus and then diverge as the vibrations travel from one wall towards the opposite wall. As such, the ultrasonic vibrations may induce the free member to travel towards the focus as it moves from one wall towards the opposite wall. If the front and back walls each contain a lens that forms an overall parabolic configuration in at least two dimensions with different foci, then the free member may travel primarily about the foci, consistently moving towards one focus and away from the other. If the parabolas share a common focus, then the free member may travel primarily about the single focus, consistently moving towards and away from it. 
     If the front or back wall contains a lens with a convex portion, the ultrasonic vibrations may be dispersed throughout the internal chamber. As such, the ultrasonic vibration may induce the free member to travel randomly about the chamber as it moves from one wall towards the opposite wall. Thus, if the front and/or back walls of the chamber contain a lens with a convex portion, then the free member may travel randomly about the chamber as it moves back-and-forth between the front and back wall. 
     The amount of mixing occurring within the internal chamber may also be controlled by adjusting the amplitude of the ultrasonic vibrations traveling down the length of the horn. Increasing the amplitude of the ultrasonic vibrations may increase the degree to which the materials within the chamber are mixed. If the horn is ultrasonically vibrated in resonance by a piezoelectric transducer driven by an electrical signal supplied by a generator, then increasing the voltage of the electrical signal will increase the amplitude of the ultrasonic vibrations traveling down the horn. 
     If the combination is sprayed onto a wound to be treated by utilizing ultrasonic vibrations emanating from a radiation surface of an ultrasound horn, then adjusting the amplitude of the ultrasonic waves traveling down the length of the horn may focus the spray produced at the radiation surface. Creating a focused spray may be accomplished by utilizing the ultrasonic vibrations emanating from the radiation surface to focus and direct the spray pattern. Ultrasonic vibrations emanating from the radiation surface may direct and focus the vast majority of the spray produced within the outer boundaries of the radiation surface. The amount of focusing obtained by the ultrasonic vibrations emanating from the radiation surface depends upon the amplitude of the ultrasonic vibrations traveling down the horn. As such, increasing the amplitude of the ultrasonic vibrations passing through the horn may narrow the width of the spray pattern produced; thereby focusing the spray. For instance, if the spray is fanning too wide, increasing the amplitude of the ultrasonic vibrations may narrow the spray pattern. Conversely, if the spray is too narrow, then decreasing the amplitude of the ultrasonic vibrations may widen the spray pattern. 
     Changing the geometric conformation of the radiation surface may also alter the shape of the spray pattern. Producing a roughly column-like spray pattern may be accomplished by utilizing a radiation surface with a planar face. Generating a spray pattern with a width smaller than the width of the horn may be accomplished by utilizing a tapered radiation surface. Further focusing of the spray may be accomplished by utilizing a concave radiation surface. In such a configuration, ultrasonic waves emanating from the concave radiation surface may focus the spray through the focus of the radiation surface. If it is desirable to focus, or concentrate, the spray produced towards the inner boundaries of the radiation surface, but not towards a specific point, then utilizing a radiation surface with slanted portions facing the central axis of the horn may be desirable. Ultrasonic waves emanating from the slanted portions of the radiation surface may direct the spray inwards, towards the central axis. There may, of course, be instances where a focused spray is not desirable. For instance, it may be desirable to quickly apply the combination to a large wound. In such instances, utilizing a convex radiation surface may produce a spray pattern with a width wider than that of the horn. The radiation surface utilized may possess any combination of the above mentioned configurations such as, but not limited to, an outer concave portion encircling an inner convex portion and/or an outer planar portion encompassing an inner conical portion. Inducing resonating vibrations within the horn facilitates the production of the spray patterns described above, but may not be necessary. 
     It should be noted and appreciated that other benefits, mechanisms of action, and/or mechanisms of operation, in addition to those listed, may be elicited by methods in accordance with the present invention. The mechanisms of action and mechanisms of operation presented herein are strictly theoretical and are not meant in any way to limit the scope this disclosure and/or the accompanying claims. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention will be shown and described with reference to the drawings of preferred embodiments and clearly understood in details. Like elements of the various embodiments depicted within the figures are equivalently numbered. 
         FIG. 1  depicts a flow chart illustrating a sequential embodiment of the method of treating wounds utilizing ultrasonic vibrations to create a therapeutic combination by mixing different materials together. 
         FIG. 2  illustrates an apparatus comprising a horn with an internal chamber that may be utilized to create the therapeutic combination and/or spray it onto a wound to be treated. 
         FIG. 3  illustrates an alternative ultrasound horn comprising an internal chamber that may be used to create the therapeutic combination and/or spray it onto a wound characterized by ultrasonic vibrations emanating from a lens within the back wall of the chamber echoing off a lens within the front wall of the chamber, and thus being reflected back into chamber. 
         FIG. 4  illustrates an alternative ultrasound horn comprising an internal chamber that may be used to create the therapeutic combination and/or spray it onto a wound characterized by at least one free member within the chamber. 
         FIG. 5  illustrates an alternative ultrasound horn comprising an internal chamber that may be used to create the therapeutic combination and/or spray it onto a wound characterized by at least one protrusion on a side wall of the chamber. 
         FIG. 6  illustrates an alternative ultrasound horn comprising an internal chamber that may be used to create the therapeutic combination and/or spray it onto a wound characterized by at least one protrusion on a side wall and extending into chamber comprising a back facing edge and a front facing edge less streamlined than the back facing edge. 
         FIG. 7  illustrates alternative embodiments of the radiation surface. 
     
    
    
     DETAILED DESCRIPTION OF THE DRAWING 
     Preferred embodiments of the method of treating areas of the body utilizing ultrasonic vibrations to create a therapeutic combination by mixing different materials together are illustrated throughout the figures and described in detail below. Those skilled in the art will understand the advantages provided by the treatment method upon review. 
       FIG. 1  depicts an embodiment of the method of treating infected wounds. For the sake of simplicity, a sequential method is depicted in  FIG. 1 . However, it should be noted that various actions depicted in  FIG. 1  may be performed concurrently, that not all of the actions depicted in  FIG. 1  are necessary for the performing the disclosed method treating wounds, and that the actions depicted in  FIG. 1  need not necessarily be performed in the sequence illustrated in  FIG. 1 . As such,  FIG. 1  is meant to facilitate discussion. It is by no means meant to constrain and/or limit the scope of the accompanying claims or the method of treating wounds disclosed herein. 
     The method begins, as depicted by Diamond  1  of  FIG. 1 , by first selecting the materials to be mixed together to create the therapeutic combination. The materials selected may include liquids, solids, and/or gases. At least one of the materials may, but need not, be a pharmaceutical. Preferably, at least one of the materials should be capable of eliciting a positive therapeutic effect. At least one of the materials may, but need not, be a solvent for at least one of the other materials utilized. Any solvent not unnecessarily toxic to the wounded area of the body to be treated may be used such as, but not limited to, saline, alcohol, water, or any combination thereof. For example, the combination may be composed of a solvent of 0.9% sterile saline combined filtered oxygen. Other combinations of solvents and therapeutic agents may be utilized and may be more appropriate depending on the wound and/or infection to be treated. Those skilled in the medical arts will be able to recognize the appropriate materials to be combined to create the therapeutic combination upon examination and/or diagnosis of the area to be treated. 
     The selected materials are then mixed by passing them through an ultrasound horn, vibrating, preferably in resonance, at a frequency of approximately 16 kHz or greater, as depicted by Box  2 . Preferably, the horn through which the materials pass comprises an internal chamber including a back wall, a front wall, and at least one side wall, a radiation surface at the horn&#39;s distal end, at least one channel opening into the chamber, and a channel originating in the front wall of the internal chamber and exiting the horn. Acceptable horns are described in U.S. patent application Ser. No. 11/777,934, filed Jul. 13, 2007, and Ser. No. 11/777,955, filed Jul. 13, 2007, the teachings of which are hereby incorporated by reference and briefly reiterated in part below. The horn utilized may be constructed from any material capable of conducting ultrasound vibrations such as, but not limited to, aluminum, stainless steel, titanium, and any combination thereof. Preferably, the horn is constructed from titanium alloy Ti 6Al-4V. 
     As the materials pass through the internal chamber of the horn, they are mixed by ultrasonic vibrations emanating from and/or echoing off the various surfaces of the chamber, as to create a therapeutic combination, as depicted by Box  4 . The mixing of the materials within the chamber can be enhanced by placing at least one free member within the chamber before passing the materials through the chamber, as depicted by Box  3  of  FIG. 1 . Ultrasonic vibrations within the chamber strike the free member causing it to move about chamber and physically mix the materials. In combination or in the alternative to physically mixing the materials, the free member may also reflect ultrasonic vibrations striking it. Thus, as the free member moves about the chamber it may reflect the ultrasonic vibrations striking it in random directions. The free members, therefore, may create random echoing of the ultrasonic vibrations within the chamber that may further increase the mixing of the materials. 
     In keeping with  FIG. 1 , the material passing through the chamber may be simultaneously mixed and atomized by the ultrasonic vibrations within the chamber, as to create an atomized therapeutic combination. The simultaneous mixing and atomization of the material, if desired, can be accomplished by leaving a gas filled space within the chamber, as depicted by Box  5 . The amount of atomization occurring within the chamber during the creation of the therapeutic combination can be adjusted by controlling the volume of solid and/or liquid materials within the chamber. Atomization of at least one of materials passing through the chamber, especially liquids, causes the volume of the combination to increase, by necessity. However, if liquid and/or solid materials completely fill the chamber, then there is no room in the chamber to accommodate an increase in the volume of the combination. Consequently, the amount of atomization occurring within the chamber when the chamber is completely filled with liquid and/or solid materials will be significantly decreased and the amount of mixing may be significantly increased. 
     In keeping with  FIG. 1 , if an atomized combination is desired, and the therapeutic combination is not sufficiently atomized during its creation, then it should be further atomized, as depicted by Box  6 . The combination may be atomized by its passage through the channel originating in the front wall of the internal chamber and exiting the horn. If the horn utilized to mix the materials includes a radiations surface, then the combination of materials exiting the horn may be atomized by ultrasonic vibrations emanating from the radiation surface. The enumerated manners of atomizing the combination may be used in combination or in the alternative. Furthermore, other manners of atomizing the combination, which are readily recognizable to those of ordinary skill in the art, may be utilized in addition to and/or in combination with the enumerated manners. 
     After mixing the materials passing through the chamber and, if desired, atomizing the combination created, the therapeutic combination should then be delivered to the wound to be treated, as depicted by Box  7 . The combination may be delivered in several manners. For instance, the combination may be washed over the wound. In combination or in the alternative, the combination may be sprayed onto the wound. The combination may be sprayed onto the wound in several manners. For instance, a flowing carrier gas may be utilized to spray the combination. The combination may also be sprayed by pressurizing it, as depicted in Box  8 , and then expelling it towards the wound. The combination may also be sprayed onto the wound by using ultrasonic vibrations emanating from an ultrasound horn. The enumerated manners of spraying the combination onto or otherwise delivering the combination to the wound to be treated may be used in combination or in the alternative. Furthermore, other manners of delivering the combination to the wound, which are readily recognizable to those of ordinary skill in the art, may be utilized in addition to and/or in combination with the enumerated manners. 
     If the combination is sprayed onto the wound, it may be sprayed onto the wound using any motion and/or pattern of movement comfortable to the individual treating the wound and/or the individual being treated. For instance, the combination may be sprayed onto the wound using a side-to-side, up-down, and/or crisscross motion. In the alternative or in combination, the spray may be initially directed at the edge of the wound and then translated into the wound. It is also possible to spray the combination initially at the inside of the wound and translate outwards to the wound&#39;s peripheral edge. The enumerated spraying motions and/or patterns may be used in the alternative and/or in combination. Furthermore, other motions and/or patterns, which are readily recognizable by those skilled in the art, may be utilized in the alternative to or in combination with those enumerated. 
     If a therapeutic combination comprising oxygen mixed with saline is sprayed directly from the horn onto the wound, it may be preferable it may be preferable to have a saline flow rate of 9-15 liters per minute and an oxygen feed of 4-12 pounds per square inch. 
     The combination preferably should be sprayed onto the wound for approximately five seconds or longer, at least once daily until healed. However, more severely infected wounds may require more frequent treatments and/or longer treatment sessions. 
     After and/or concurrently with delivering the therapeutic combination to the wound, cavitations are induced in the combination in and/or over the wound by emitting ultrasound energy into the combination, as depicted by Box  9 . The ultrasound energy emitted into the combination is preferably carried by ultrasonic vibrations having a frequency of approximately 16 kHz or greater and an amplitude of approximately 1 micron and greater. It is preferred that the vibrations carrying the ultrasound energy into the combination have a frequency between approximately 20 kHz and approximately 200 kHz. If the horn utilized to create the combination includes a radiation surface, it may be utilized to emit the ultrasound energy into the combination. 
     After and/or concurrently with the induction of cavitations in the therapeutic combination and/or the delivery of the combination to the wound, the combination should be removed from the wound, as depicted in Box  10 . Numerous manner of removing the combination, readily recognizable by those skilled in the art, may be utilized. For example, the combination may be removed by dabbing the wound with a sterile gauze and/or towel. In combination or in the alternative, the combination may be removed by aspirating the wound. 
       FIG. 2  illustrates an apparatus that may be utilized to create the therapeutic combination and/or spray it onto a wound to be treated. The apparatus comprises a horn  101  and an ultrasound transducer  102  attached to the proximal surface  117  of horn  101  powered by generator  116 . As ultrasound transducers and generators are well known in the art they need not and will not, for the sake of brevity, be described in detail herein. Ultrasound horn  101  comprises a proximal surface  117 , a radiation surface  111  opposite proximal end  117 , and at least one radial surface  118  extending between proximal surface  117  and radiation surface  111 . Within horn  101  is an internal chamber  103  containing a back wall  104 , a front wall  105 , at least one side wall  113  extending between back wall  104  and front wall  105 , and an ultrasonic lens  122  within back wall  104 . As to induce vibrations within horn  101 , ultrasound transducer  102  may be mechanically coupled to proximal surface  117 . Mechanically coupling horn  101  to transducer  102  may be achieved by mechanically attaching (for example, securing with a threaded connection), adhesively attaching, and/or welding horn  101  to transducer  102 . Other means of mechanically coupling horn  101  and transducer  102 , readily recognizable to persons of ordinary skill in the art, may be used in combination with or in the alternative to the previously enumerated means. Alternatively, horn  101  and transducer  102  may be a single piece. When transducer  102  is mechanically coupled to horn  101 , driving transducer  102  with an electrical signal supplied from generator  116  induces ultrasonic vibrations  114  within horn  101 . If transducer  102  is a piezoelectric transducer, then the amplitude of the ultrasonic vibrations  114  traveling down the length of horn  101  may be increased by increasing the voltage of the electrical signal driving transducer  102 . 
     As the ultrasonic vibrations  114  travel down the length of horn  101 , back wall  104  oscillates back-and-forth. The back-and-forth movement of back wall  104  induces the release ultrasonic vibrations from lens  122  into the materials inside chamber  103 . Positioning back wall  104  such that at least one point on lens  122  lies approximately on an antinode of the ultrasonic vibrations  114  passing through horn  101  may maximize the amount and/or amplitude of the ultrasonic vibrations emitted into the materials in chamber  103 . Preferably, the center of lens  122  lies approximately on an antinode of the ultrasonic vibrations  114 . The ultrasonic vibrations emanating from lens  122 , represented by arrows  119 , travel towards the front of chamber  103 . As to minimize the oscillations and/or vibrations of front wall  105 , it may be desirable to position front wall  105  such that at least one point on front wall  105  lies on a node of the ultrasonic vibrations  114 . Preferably, the center of front wall  105  lies approximately on a node of the ultrasonic vibrations  114 . 
     The specific lens illustrated in  FIG. 2A  contains a concave portion  123 . If concave portion  123  forms an overall parabolic configuration in at least two dimensions, then the ultrasonic vibrations, depicted by arrows  119 , emanating from concave portion  123  of lens  122  travel in an undisturbed pattern of convergence towards the parabola&#39;s focus  124 . As the ultrasonic vibrations  119  converge at focus  124 , the ultrasonic energy carried by vibrations  119  may become focused at focus  124 . The materials passing through chamber  103  are therefore exposed to the greatest concentration of ultrasonic energy at focus  124 . Consequently, the ultrasonically induced mixing of the materials may be greatest at focus  124 . Positioning focus  124  at or near the opening of channel  110 , as to be in close proximity to the opening of channel  110  in front wall  105  may, therefore, yield the maximum mixing of the materials as the materials enters channel  110 . 
     The materials to be atomized and/or mixed enter chamber  103  of the embodiment depicted in  FIG. 1  through at least one channel  109  originating in radial surface  118  and opening into chamber  103 . Preferably, channel  109  encompasses a node of the ultrasonic vibrations  114  traveling down the length of the horn  101  and/or emanating from lens  122 . In the alternative or in combination, channel  109  may originate in radial surface  118  and open at back wall  104  into chamber  103 . Upon exiting channel  109 , the materials pass through chamber  103 . The combined materials then exit chamber  103  through channel  110 , originating within front wall  105  and terminating within radiation surface  111 . If the combination is primarily a fluid, the pressure of the combination decreases while its velocity increases as it passes through channel  110 . Thus, as the combination flows through channel  110 , the pressure acting on the combination may be converted to kinetic energy. If the combinations gains sufficient kinetic energy as it passes through channel  110 , then the attractive forces between the molecules of the combination may be broken, causing the combination to atomize as it exits channel  110  at radiation surface  111 . If the combination exiting horn  101  is to be atomized by the kinetic energy gained from its passage through channel  110 , then the maximum height (h) of chamber  103  should be larger than maximum width (w) of channel  110 . Preferably, the maximum height of chamber  103  should be approximately 200 times larger than the maximum width of channel  110  or greater. 
     It is preferable if at least one point on radiation surface  111  lies approximately on an antinode of the ultrasonic vibrations  114  passing through horn  101 . 
     As to simplify manufacturing, ultrasound horn  101  may further comprise cap  112  attached to its distal end. Cap  112  may be mechanically attached (for example, secured with a threaded connector), adhesively attached, and/or welded to the distal end of horn  101 . Comprising front wall  105 , channel  110 , and radiation surface  111 , a removable cap  112  permits the level of atomization and/or the spray pattern produced to be adjusted depending on need and/or circumstances. For instance, the width of channel  110  may need to be adjusted to produce the desired level of atomization with different combinations. The geometrical configuration of the radiation surface may also need to be changed as to create the appropriate spray pattern for different applications. Attaching cap  112  to the present invention at approximately a nodal point of the ultrasonic vibrations  114  passing through horn  101  may help prevent the separation of cap  112  from horn  101  during operation. 
     Alternative embodiments of an ultrasound horn  101  that may be utilized to create the therapeutic combination and/or spray it onto the body may possess a single channel  109  opening within side wall  113  of chamber  103 . If multiple channels  109  are utilized, they may be aligned along the central axis  120  of horn  101 , as depicted in  FIG. 2A . Alternatively or in combination, channels  109  may be located on different platans, as depicted in  FIG. 2A , and/or the same platan, as depicted in  FIG. 2B . 
     Alternatively or in combination, the materials to be combined may enter chamber  103  through a channel  121  originating in proximal surface  117  and opening within back wall  104 , as depicted in  FIG. 2 . If the combination is to be atomized by its passage through the horn, then the maximum width (w′) of channel  121  should be smaller than the maximum height of chamber  103 . Preferably, the maximum height of chamber  103  should be approximately twenty times larger than the maximum width of channel  121 . 
     A single channel may be used to deliver the materials to be combined into chamber  103 . 
       FIG. 3  illustrates an alternative ultrasound horn  101  that may be used to create the therapeutic combination and/or spray it onto a wound characterized by ultrasonic vibrations  119  emanating from lens  122  echoing off lens  126  within front wall  105 , and thus being reflected back into chamber  103 . After striking the concave portion  125  of lens  126  within front wall  105 , ultrasonic vibrations  119  are reflected back into chamber  103 . If concave portion  125  forms an overall parabolic configuration in at least two dimensions, the ultrasonic vibrations  119  echoing backing into chamber  103  may travel in an undisturbed pattern of convergence towards the parabola&#39;s focus. The ultrasonic energy carried by the echoing vibrations may become focused at the focus of the parabola formed by the concave portion  125 . Converging as they travel towards front wall  105  and then again as they echo back towards back wall  104 , ultrasonic vibrations  119  travel back and forth through chamber  103  in an undisturbed, converging echoing pattern. 
     In the embodiment illustrated in  FIG. 3  the parabolas formed by concave portions  123  and  125  have a common focus  124 . In the alternative, the parabolas may have a different focus. However, by sharing a common focus  124 , the ultrasonic vibrations  119  emanating and/or echoing off the parabolas and/or the energy the vibrations carry may become focused at focus  124 . The materials passing through chamber  103  are therefore exposed to the greatest concentration of the ultrasonic agitation, cavitation, and/or energy at focus  124 . Consequently, the ultrasonically induced mixing of the materials is greatest at focus  124 . Positioning focus  124 , or any other focus of a parabola formed by the concave portions  123  and/or  125 , at point downstream of the entry of at least two materials into chamber  103  may maximize the mixing of the materials entering chamber  103  upstream of the focus. 
     The lens within the front and/or back wall of the chamber may contain convex portions. Ultrasonic vibrations emanating from convex portions of the lens within the back wall chamber may travel in an undisturbed dispersed reflecting pattern towards the front wall in the following manner: The ultrasonic vibrations would first be directed towards a side wall of the chamber at varying angles of trajectory. The ultrasonic vibrations would then reflect off the side wall. Depending upon the angle at which the ultrasonic vibrations strike the side wall, they may be reflected through the central axis of the chamber and travel in an undisturbed reflecting pattern towards the front wall. However, if the vibrations emanating from the lens within the back wall strike a side wall at a sufficiently shallow angle, they may be reflected directly towards the front wall, without passing through the central axis. Likewise, when the ultrasonic vibrations strike the convex portions of the lens within the front wall, they may echo back into chamber in an undisturbed dispersed reflecting pattern towards the back wall. As such, some of the ultrasonic vibrations echoing off the lens within the front wall may pass through the central axis after striking a side wall. Some of the echoing ultrasonic vibrations may travel directly towards the back wall after striking a side wall without passing through the central axis. Failing to converge at a single point, or along a single axis, as they travel towards the front wall and then again as they echo back towards the back wall, the ultrasonic vibrations would travel back and forth through the chamber in an undisturbed, dispersed echoing pattern. Consequently, the ultrasonically induced mixing of the materials passing through the chamber may be dispersed throughout the chamber. 
     It should be appreciated that the configuration of the chamber&#39;s front wall lens need not match the configuration of the chamber&#39;s back wall lens. Furthermore, the lenses within the front and/or back wall of the chamber may comprise any combination of the above mentioned configurations such as, but not limited to, an outer concave portion encircling an inner convex portion. 
       FIG. 4  illustrates an alternative ultrasound horn  101  that may be used to create the therapeutic combination and/or spray it onto a wound characterized by at least one free member  401  within chamber  103 . Ultrasonic vibrations  119  emanating from lens  122  within back wall  104  and/or echoing off lens  126  within front wall  105  may induce free members  401  to move about chamber  103 . Traveling through chamber  103 , ultrasonic vibrations  119  strike free members  401  and push them in the direction of vibrations  119 . As free members  401  move about chamber  103  they mechanically agitate the materials within chamber causing the materials to mix. 
     In the embodiment illustrated in  FIG. 4  the parabolas formed by concave portions of lens  122  and  126  have a common focus  124 . In the alternative, the parabolas may have different foci. However, by sharing a common focus  124 , the ultrasonic vibrations  119  emanating and/or echoing off the parabolas and/or the energy the vibrations carry may become focused at focus  124 . The materials passing through chamber  103  are therefore exposed to the greatest concentration of the ultrasonic agitation, cavitation, and/or energy at focus  124 . Furthermore because the parabolas share a common focus, free members  401  may travel primarily about focus  124 , consistently moving towards and away from it. Consequently, the ultrasonic induced mixing of the materials is greatest at and/or about focus  124 . Positioning focus  124 , or any other focus of a parabola formed by the concave portions  123  and/or  125 , at point downstream of the entry of at least two materials into chamber  103  may maximize the mixing of the fluids entering chamber  103  upstream of the focus. 
     Though the specific embodiment of the free members depicted in  FIG. 4  are spherical, other geometric configurations are equally possible such as, but not limited to, cylindrical, pyramidal, rectangular, polygonal, or any combination thereof. Furthermore, instead of using three free members as depicted, any number of mixing members may be used. As to prevent the free members from exiting the internal chamber of the horn, it may be desirable to use free members incapable of passing through the channels leading into and/or out of the internal chamber. In the alternative or in combination, screens, meshes, gates, and/or similar structures may be used to prevent the passage of the free members into and/or through the channels within the horn. Preferably, the free members are constructed from a material that is not completely transparent to ultrasonic vibrations. 
     If the lenses within the front and/or back wall of the chamber contain a convex portion the free members may travel randomly about the chamber as they move back-and-forth between front wall and back wall. Consequently, the overall mixing of the materials passing through the chamber may be dispersed throughout the chamber. 
       FIG. 5  illustrates an alternative ultrasound horn  101  that may be used to create the therapeutic combination and/or spray it onto a wound characterized by at least one protrusion  501  on the side wall  113  and extending into chamber  103 . The incorporation of protrusions  501  may enhance ultrasonic echoing within chamber  103  by increasing the amount of ultrasonic vibrations emitted into chamber  103  and/or by providing a larger surface area from which ultrasonic vibrations echo. The distal, or front facing, edges of protrusions  501  may emit ultrasonic waves into the chamber when horn  101  is vibrated. The proximal, or rear facing, and front facing edges of protrusions  501  reflect ultrasonic waves striking the protrusions  501 . Emitting and/or reflecting ultrasonic vibrations into chamber  103 , protrusions  501  increase the complexity of the echoing pattern of the ultrasonic vibrations within chamber  103 . The specific protrusions  501  depicted in  FIG. 5  comprise a triangular shape and encircle the cavity. The protrusions may be formed in a variety of shapes such as, but not limited to, convex, spherical, triangular, rectangular, polygonal, and/or any combination thereof. In the alternative or in combination to being a band encircling the chamber, the protrusion may spiral down the chamber similar to the threading within a nut. In combination or in the alternative, the protrusions may be discrete elements secured to a side wall of chamber that do not encircle the chamber. In the alternative or in combination, the protrusions may be integral with side wall or walls of the chamber. Furthermore, protrusions  501  may be utilized to increase mixing within chambers containing convex and/or concave ultrasonic lenses within their front and/or back walls. In the alternative or in combination, protrusions  501  may be utilized to increase mixing within chambers lacking ultrasonic lenses within their front and/or back walls. 
       FIG. 6  illustrates an alternative ultrasound horn  101  that may be used to create the therapeutic combination and/or spray it onto a wound characterized by at least one protrusion  603  on the side wall  113  and extending into chamber  103  comprising a back facing edge  601  and a front facing edge  602  less streamlined than the back facing edge. As with the embodiment depicted in  FIG. 5 , the incorporation of protrusions  603  may enhance ultrasonic echoing within chamber  103  by increasing the amount of ultrasonic vibrations emitted into chamber  103  and/or by providing a larger surface area from which ultrasonic vibrations echo. In combination or in the alternative, protrusions  603  may generate a pumping action when horn  101  is vibrated in resonance. As previously stated, vibrating horn  101  in resonance induces segments of the horn to expand and contract as ultrasonic vibrations  114  travel down the length of the horn. As horn  101  expands, the less streamlined front facing edges  602  move forward. As the front facing edges  602  move forward, they push the materials within chamber  103  towards channel  110 . Likewise, when the horn contracts, the more streamlined rear facing edges  601  push the material away from channel  110 . However, because the rear facing edges  601  are more streamlined then edges  602 , more fluid is pushed forwards then backwards. Consequently, an overall forward pumping action is produced by the expansion and contraction of protrusions  603 . 
     As to maximize the movement of front facing edges  602  and pumping action generated, it may be desirable to position front facing edge  602  such that at least one point on the edge lies approximately on an antinode of the ultrasonic vibrations  114  passing through horn  101 . Positioning edges  602  on the antinodes of the ultrasonic vibrations passing through horn  101  may also enable the pumping action to be controlled by the frequency of the ultrasonic vibrations. Reducing the frequency of the ultrasonic vibrations passing through horn  101  by one-half, as depicted by vibration  604 , may result in half of the edges  602  lying on nodes of the vibration  604 . Because there is no movement at a node, the edges  602  lying on the nodes no longer move forward when horn  101  is vibrated. Consequently the edges  602  falling on the nodes no longer contribute to the pumping action produced by the expansion and contraction of horn  101 . Reducing the number of edges  602  contributing to the pumping produced, reduces the overall force pushing the material within chamber  103  towards channel  110 . Consequently, the material passing through the horn  101  may be expelled from channel  110  less forcefully when frequency of the ultrasonic vibrations passing through horn  101  is reduced. 
     The pumping action may also be controlled by adjusting the amplitude of the ultrasonic vibrations traveling through horn  101 . Increasing the amplitude of the vibrations increases the forward movement of edges  602  and the volume of fluid moved forwards. This may result in an increase in the overall force pushing the material within chamber  103  towards channel  110 . Consequently, the material passing through the horn  101  may be expelled from channel  110  more forcefully when the amplitude of the ultrasonic vibrations passing through horn  101  is increased. 
     Regardless of the specific horn utilized, ultrasonic vibrations emanating from the horn&#39;s radiation surface may atomize the combination exiting the horn into a spray. The ultrasonic vibrations may also direct and/or confine the spray. The manner in which ultrasonic vibrations emanating from the radiation surface direct the spray ejected from the horn utilized depends largely upon the conformation of radiation surface  111 .  FIG. 7  illustrates alternative embodiments of the radiation surface.  FIGS. 7A and 7B  depict radiation surfaces  111  comprising a planar face producing a roughly column-like spray pattern. Radiation surface  111  may be tapered such that it is narrower than the width of the horn in at least one dimension oriented orthogonal to the central axis  120  of the horn, as depicted  FIG. 7B . Ultrasonic vibrations emanating from the radiation surfaces  111  depicted in  FIGS. 7A and 7B  may direct and confine the vast majority of spray  701  ejected from channel  110  to the outer boundaries of the radiation surfaces  111 . Consequently, the majority of spray  701  emitted from channel  110  in  FIGS. 7A and 7B  is initially confined to the geometric boundaries of the respective radiation surfaces. 
     The ultrasonic vibrations emitted from the convex portion  703  of the radiation surface  111  depicted in  FIG. 7C  directs spray  701  radially and longitudinally away from radiation surface  111 . Conversely, the ultrasonic vibrations emanating from the concave portion  704  of the radiation surface  111  depicted in  FIG. 7E  focuses spray  701  through focus  702 . Maximizing the focusing of spray  701  towards focus  702  may be accomplished by constructing radiation surface  111  such that focus  702  is the focus of an overall parabolic configuration formed in at least two dimensions by concave portion  704 . The radiation surface  111  may also possess a conical portion  705  as depicted in  FIG. 7D . Ultrasonic vibrations emanating from the conical portion  705  direct the atomized spray  701  inwards. The radiation surface may possess any combination of the above mentioned configurations such as, but not limited to, an outer concave portion encircling an inner convex portion and/or an outer planar portion encompassing an inner conical portion. 
     Regardless of the configuration of the radiation surface, adjusting the amplitude of the ultrasonic vibrations traveling down the length of the horn utilized may be useful in focusing the spray exiting the horn. The amount of focusing obtained by the ultrasonic vibrations emanating from the radiation surface and/or the ultrasonic energy the vibrations carry depends upon the amplitude of the ultrasonic vibrations traveling down horn. As such, increasing the amplitude of the ultrasonic vibrations may narrow the width of the spray pattern produced; thereby focusing the spray produced. For instance, if the spray exceeds the geometric bounds of the radiation surface, i.e. is fanning too wide, increasing the amplitude of the ultrasonic vibrations may narrow the spray. Conversely, if the spray is too narrow, then decreasing the amplitude of the ultrasonic vibrations may widen the spray. If the horn is vibrated in resonance frequency by a piezoelectric transducer attached to its proximal end, increasing the amplitude of the ultrasonic vibrations traveling down the length of the horn may be accomplished by increasing the voltage of the electrical signal driving the transducer. 
     The horn(s) utilized to create the therapeutic combination, spray it onto the wound to be treated, and/or emit ultrasound energy into the combination in and/or over the wound may be capable of vibrating in resonance at a frequency of approximately 16 kHz or greater. The ultrasonic vibrations traveling down the horn(s) may have an amplitude of approximately 1 micron or greater. It is preferred that the horn(s) utilized be capable of vibrating in resonance at a frequency between approximately 20 kHz and approximately 200 kHz. It is recommended that the horn(s) be capable of vibrating in resonance at a frequency of approximately 30 kHz. 
     The signal driving the ultrasound transducer may be a sinusoidal wave, square wave, triangular wave, trapezoidal wave, or any combination thereof. 
     It should be appreciated that elements described with singular articles such as “a”, “an”, and/or “the” and/or otherwise described singularly may be used in plurality. It should also be appreciated that elements described in plurality may be used singularly. 
     Although specific embodiments of apparatuses and methods have been illustrated and described herein, it will be appreciated by those of ordinary skill in the art that any arrangement, combination, and/or sequence that is calculated to achieve the same purpose may be substituted for the specific embodiments shown. It is to be understood that the above description is intended to be illustrative and not restrictive. Combinations of the above embodiments and other embodiments as well as combinations and sequences of the above methods and other methods of use will be apparent to individuals possessing skill in the art upon review of the present disclosure. 
     The scope of the claimed apparatus and methods should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.