Evidence Supporting Extracorporeal Shockwave Therapy for Acute and Chronic Soft Tissue Wounds
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The focal point (F2) of these plane waves is, by definition, “unfocused” or “radial.” The parabolic reflector allows the plane waves to be nearly parallel. The energy density realized by this reflector configuration is higher than with an exact parabolic reflector, and the acoustical field stimulates a larger area.
Over the last 15 years, ESWT has emerged as a non-invasive, safe, clinically efficacious, and cost-effective treatment option. ESWT has been approved, is commonly used, or has been in various phases of experimental testing for more than 25 indications (Table 2).
An overview of recently published literature of common empirically tested clinical uses of ESWT for soft tissue indications is shown in Table 3.
Studies of ESWT for Acute Soft Tissue
The safety and feasibility of defocused, low-energy ESWT for soft tissue indications was reported in 2007.35 More than 200 patients were prospectively enrolled into a feasibility trial consisting of complicated, non-healing, acute and chronic soft tissue wounds. According to wound size, every 1 to 2 weeks (over mean 3 shockwave treatments) 100 shocks/cm2 at 0.1 mJ/mm2 were applied as an adjunct to standard practice consisting of debridement and moist dressings, which patients tolerated well in an outpatient treatment setting. Of 208 patients, 75% reached 100% epithelialization, and during 44 days of follow up showed no treatment-related toxicity, infection, or wound deterioration in any ESWT-treated wound.
In 2008, a group from Vienna36 evaluated the prophylactic potential of ESWT in patients undergoing coronary artery bypass graft surgery. One hundred patients were randomly assigned to one of two groups: control (received institutional standard of care; n = 50) and ESWT group that received a total of 25 impulses (energy flux density of 0.1 mJ/mm2; 5 Hz) per centimeter of saphenous vein graft donor site wound length, after surgical wound closure under sterile conditions. There were no ESWT-associated adverse events. ASEPSIS score (Additional treatment, presence of Serous discharge, Erythema, Purulent exudate, Separation of the deep tissue, Isolation of bacteria, and duration of inpatient Stay) was significantly higher (P = 0.0001) in the control group suggesting significant improvement in the ESWT-treated group (4.4 ± 5.3 versus 11.6 ± 8.3). In this study, a higher incidence of wound healing disorders necessitating antibiotic treatment was observed in the control group (22%) compared to the ESWT group (4%; P = 0.015). This finding is consistent with reported bactericidal/bacteriostatic effect of ESWT37–40 and supports the utility of ESWT as a preventive treatment option for saphenous vein harvest wound sites in the setting of coronary graft surgery.
In 2010, Ottoman et al41 suggested that a single application of ESWT immediately after split-thickness skin graft harvest accelerates donor site epithelialization. They evaluated the effects of ESWT on donor site healing in 28 patients with traumatic wounds and burns that required skin grafting.