For almost 30 years, extracorporeal shock wave therapy has been clinically implemented as an effective treatment to disintegrate urinary stones. This technology has also emerged as an effective noninvasive treatment modality for several orthopedic and traumatic indications including problematic soft tissue wounds. Delayed/nonhealing or chronic wounds constitute a burden for each patient affected, significantly impairing quality of life. Intensive wound care is required, and this places an enormous burden on society in terms of lost productivity and healthcare costs. Therefore, cost-effective, noninvasive, and efficacious treatments are imperative to achieve both (accelerated and complete) healing of problematic wounds and reduce treatment-related costs. Several experimental and clinical studies show efficacy for extracorporeal shock wave therapy as means to accelerate tissue repair and regeneration in various wounds. However, the biomolecular mechanism by which this treatment modality exerts its therapeutic effects remains unclear. Potential mechanisms, which are discussed herein, include initial neovascularization with ensuing durable and functional angiogenesis. Furthermore, recruitment of mesenchymal stem cells, stimulated cell proliferation and differentiation, and anti-inflammatory and antimicrobial effects as well as suppression of nociception are considered important facets of the biological responses to therapeutic shock waves. This review aims to provide an overview of shock wave therapy, its history and development as well as its current place in clinical practice. Recent research advances are discussed emphasizing the role of extracorporeal shock wave therapy in soft tissue wound healing.

Significance Inducing the growth of new blood vessels by specific factors is an attractive strategy to restore blood flow in ischemic tissues. Vascular endothelial growth factor (VEGF) is the master regulator of angiogenesis, yet clinical trials of VEGF gene delivery failed. Major challenges include the need to control the tissue distribution of factor dose and the duration of expression. Here, we developed a highly tunable fibrin-based platform to precisely control the dose and duration of VEGF protein delivery in tissues. Optimized delivery of fibrin-bound VEGF ensured normal, stable, and functional angiogenesis and improved perfusion of ischemic tissues, without genetic modification and with limited duration of VEGF delivery. These findings suggest a strategy to improve both safety and efficacy of therapeutic angiogenesis.

Background: Signaling pathways underlying beneficial effects of extracorporeal shock wave treatment (ESWT) remain to be completely elucidated. Results: ESWT enhances cell proliferation in vitro and wound healing in vivo. Conclusion: ESWT-induced ATP release and subsequent extracellular signal-regulated kinase (ERK) activation are prerequisites for enhanced cell proliferation and wound healing. Significance: Deciphering the involved signaling cascades provides the basis for ESWT as clinical wound healing treatment.

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Acute burn wounds often require early excision and adequate coverage to prevent further hypothermia, protein and fluid losses, and the risk of infection. Meshed autologous skin grafts are generally regarded as the standard treatment for extensive full-thickness burns. Graft take and rate of wound healing, however, depend on several endogenous factors. This paper describes a standardized reproducible porcine model of burn and skin grafting which can be used to study the effects of topical treatments on graft take and re-epithelialization.Procedures provide a protocol for successful porcine burn wound experiments with special focus on pre-operative care, anesthesia, burn allocation, excision and grafting, postoperative treatment, dressing application, and specimen collection. Selected outcome measurements include percent area of wound closure by planimetry, wound assessment using a clinical assessment scale, and histological scoring.The use of this standardized model provides burn researchers with a valuable tool for the comparison of different topical drug treatments and dressing materials in a setting that closely mimics clinical reality. KeywordsBurn; Burn excision; Wound healing; Reconstruction; Autograft BackgroundStandard treatment for severe burns currently includes early excision and adequate coverage to prevent hypothermia, protein and fluid loss, and risk of exogenous infection [1]. Autologous meshed split-thickness skin grafts are generally regarded as the standard treatment for extensive full-thickness burns. Early wound healing with concomitant wound closure is a major factor in patient outcome and infection control.To determine new treatment options which enhance and accelerate wound healing, many investigators rely on animal models to closely observe the healing process. Many animal models have been described in the literature, mostly involving rodents and pigs, with different *Corresponding author. Tel.: +1 409 770 6742; fax: +1409 770 6919. E-mail address: majeschk@utmb.edu (M.G. Jeschke). 1 Authors contributed equally to this manuscript. [2][3][4][5][6]. However, there has been no large animal model described which would encompass a burn excision and autografting, for an extended observation of over 2 weeks, to closely monitor the wound healing progress and its mechanisms. This paper presents a porcine model for the assessment of multiple treatments and quantification of differences in burn wound healing. Conflict of interest statement Procedures Basic and study guidelinesPigs have been used as models for wound healing studies due to their structural and functional resemblance to human skin. The thickness of porcine skin differs greatly depending on the location (pig epidermis: 30-140 μm; Human epidermis: 50-120 μm) [7]. Further, the vascularization of human and porcine skin is similar [8], with both human and pig having about 95% collagen and 2% elastic fibers in their extracellular matrix. This composition presents similar elastic components which is paramount in wound contraction [9]....

Shock wave preconditioning and treatment postischemic insult improves skin flap survival through neovascularization and early upregulation of angiogenesis-related growth factors.

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Incisional and inguinal hernia repair are among the most common procedures of general surgery. Mesh fixation by means of staples or sutures may lead to severe complications. The use of fibrin sealant (FS) has been suggested as alternative, but data on biocompatibility and adhesive strength of FS in combination with macroporous meshes is limited. Ventral hernia (n = 8 per group) was treated in rats in onlay technique with two types of meshes, fibrin sealed or stapled. TI-Mesh (TMxl) extralight and VYPROII (VPII) were tested 17 days post op. No failure in mechanical tests (tensile and burst strength) occurred in sealed or stapled meshes. Histology revealed equally good tissue integration and neovascularization in all groups. Fibrin sealant yields excellent fixation in experimental hernia repair. This rat model is suitable for testing meshes and fixation techniques.