Chronic Ulcers: Treatment with Unfocused Extracorporeal Shock Waves

Abstract

The aim of this study was to evaluate the efficacy of the treatment of chronic ulcers with unfocused shock waves. Between March 2009 and February 2012 we studied a group of 124 patients, aged between 28 and 80 years, with serious wounds arisen over three months and who met the inclusion criteria for treatment. The patients were randomly divided into groups A and B, both treated with unfocused ESWT but with an average energy density for each impulse equal to 0.10 m.l/mm' in group A (total energy equal to 1.7 mJ for each shot) and an average energy density for each impulse equal to 0.04 m.I/mm-in group B (total energy equal to 3.3 mJ for each shot). The pulses were administered at a frequency of 4 Hz in both groups. Wounds were classified according to: location, width, length, percentage of granulation tissue, necrotic tissue, fibrous tissue, presence of bacterial exudation and pain (assessed by VAS). Their evolution was monitored by photo capture. The patients were treated with a frequency of 1 session every 7 days for 7 weeks. During the treatment period, the possible occurrence of side effects was monitored. Before treatment the wounds in group A had an average area equal to 3.85 em-and the average value of the VAS pain scale was equal to 5.8 (range 2-9); the wounds in group B had an average area equal to 3.4 ern" and the average value ofthe VAS pain scale was equal to 5.7 (range 3-9). At the end of the treatment protocol the mean area in group A decreased by 80% (final mean area 0.93 em"), and the average pain on VAS scale dropped by 79%; the mean area in group B decreased by 67% (final mean area 1.2 ern") and the average score on VAS scale dropped by 48%. None of the treated patients experienced adverse reactions to treatment. None of the treated wounds developed infection during treatment. In conclusion, shock waves can act on difficult wounds, stimulating the reparative physiological process; therefore it represents an effective and safe procedure to accelerate the healing process, reducing the operating costs and avoiding more complex interventions.Chronic ulcers are complex wounds that do not heal spontaneously and are usually associated with local and systemic predisposing factors (1).Wound healing is a dynamic process influenced by homeostatic balance, inflammatory and matrixsynthesis process, and by an appropriate process

Extracorporeal shockwave therapy for the treatment of chronic wound of lower extremity: current perspective and systematic review

“…Saggini et al . reported significant reduction in WSA of 80% in the ESWT group treated with energy flux density of 0·1 mJ/cm 2 compared with 67% in the ESWT group treated with energy flux density of 0·04 mJ/cm 2 . A series case study reported mean reduction of WSA of 1·21 ± 0·82 cm 2 from initial wound area in four out of five patients treated with ESWT .…”

“…In the same year, Saggini et al . reported complete wound healing in 71% and partial healing in 29% of cases in the unfocused ESWT‐treated group ( n = 63), with an energy flux density of 0·01 mJ/mm 2 , compared with 40% completely healed, 37·5% improved and 22·5% unchanged in the unfocused ESWT group ( n = 40), with energy density 0·04 mJ/mm 2 .…”

“…Overall, five studies were conducted in Europe (30,31,(35)(36)(37), five studies in Asia (26)(27)(28)32,34) and one study in Africa (29). These studies included seven RCTs (27)(28)(29)(30)32,34,35), one clinical controlled trial (CCT) (36) and three case series studies (CSS) (26,31,37). The studies were critically evaluated.…”

“…ESWT is considered feasible for healing of the chronic wound in humans (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). However, the findings of studies conducted so far are still inconclusive, and the clinical use for wound healing is under investigation.…”

“…Despite the increasing use of ESWT, substantial uncertainty continues to exist because of insufficient and inconsistent supporting evidence. The limited scientific information available has been obtained from animal studies (38)(39)(40), case series studies (26,31,36,37), single case reports (41,42) and a few clinical trials (27)(28)(29)(30)32,33).…”