Evidence Supporting Extracorporeal Shockwave Therapy for Acute and Chronic Soft Tissue Wounds
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Index: WOUNDS 2011;23(7):204–215
Soft tissue wound healing is a complex and well-orchestrated sequence of events on multiple biological levels involving systemic, cellular, and molecular signals. The physiological process of wound healing leads to full tissue repair and regeneration with nearly complete restoration of tissue integrity and functionality.
Wounds, particularly among the elderly population, can show delayed or disturbed healing; however, delayed or disturbed healing is also evident in patients with comorbidities such as diabetes, atherosclerosis, venous/arterial insufficiency, reduced mobility due to chronic infirmity, and hypercholesterolemia.
Chronic wounds consist of a wide range of inflammatory and degenerative conditions of the musculoskeletal system. Management of chronic, difficult to heal, or non-healing soft tissue wounds requires a multidisciplinary approach. Often these treatment options have inconsistent and irregular outcomes. Poor response or failure to conservative treatments places a substantial burden on patients, their families, the healthcare system, and society in general. Therefore, the development of a new, effective method of treatment to improve healing of problematic wounds and reduce treatment-related costs is extremely valuable; ne such therapy is Extracorporeal Shockwave Therapy (ESWT).
ESWT acts through mechanotransduction, which produces therapeutic benefits through complex biological pathways including neovascularization and tissue regeneration in the therapeutic target. Published data thus far suggest that the application of ESWT for soft tissue indications is safe, reliable, cost-effective, and clinically efficacious. The exact biological effects of ESWT on human cells are not completely understood, but are currently undergoing further study.
The aim of this review is to provide a general overview of shockwave therapy and its role in the treatment of acute and chronic soft tissue wounds.
Surgical wounds are the most common wounds in the world. Worldwide, more than 110 million surgical incisions are made every year. In approximately 80% of these cases, some form of closure product is used, such as sutures, staples, and tapes.1 Many promote hemostasis (blood clotting), and of course, the use of fabric bandages and surgical dressings is almost universal. Traumatic wounds occur at a rate of about 1.6 million cases each year, and their complexity requires surgical intervention (multiple debridements, skin grafts, skin flaps), especially in military settings. According to the American Burn Association, approximately 450,000 patients with burn injuries seek help in emergency departments annually with more than 40% of these burns involving the upper extremities. Close to 5% of these injuries are full-thickness, third degree injuries.2
Occasionally, acute wounds fail to advance through normal physiological steps in a timely manner. The inability of the healing process to progress leaves the wound susceptible to infections and deterioration of the underlying tissue, which typically leads to further morbidities3–6 and delayed healing. Chronic wounds are defined as wounds that have not proceeded through orderly and timely phases of tissue repair in order to produce anatomic and functional integrity within 3 months.7
A number of population-based factors including advanced age, obesity, diabetes mellitus, and venous and arterial insufficiency, have led to an increasing number of patients with chronic wounds.