Clinical Utility of Extracorporeal Shock Wave Therapy on Hypertrophic Scars of the Hand Caused by Burn Injury: A Prospective, Randomized, Double-Blinded Study

Joo, So Young; Lee, Seung Yeol; Cho, Yoon Soo; Seo, Cheong Hoon

doi:10.3390/jcm9051376

Cited by 9 publications

(35 citation statements)

References 37 publications

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“… 2 3 4 5 6 We transformed the effects of ESWT on hypertrophic scars into the clinical results as POSAS scores, and most of the POSAS subscales were significantly improved after treatment. Apart from the previous studies, which included only the hypertrophic scars following burn wounds, 4 8 15 the current study also included the various etiologies of hypertrophic scars to extend the indications of using ESWT in other causes of hypertrophic scars.…”

Section: Discussionmentioning

confidence: 99%

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Extracorporeal Shock Wave Therapy for Hypertrophic Scars

et al. 2022

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Background Hypertrophic scars cause aesthetic concerns and negatively affect the quality of life. A gold standard treatment for hypertrophic scars has not been established due to various responses of modalities. Extracorporeal shock wave therapy (ESWT) is a noninvasive and affects scar remodeling by fibroblast regulation. This study investigated the effectiveness of ESWT for hypertrophic scars. Methods Twenty-nine patients were enrolled. All patients underwent ESWT once a week for 6 consecutive weeks. Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS), erythema index, melanin index, and scar pliability before treatment and again 4 weeks after treatment completion. Results Thirty-four hypertrophic scars in this study had persisted for between 6 months and 30 years. Most scars developed after surgical incision (55.88%). The chest and upper extremities were the predominant areas of occurrence (35.29% each). Most of the POSAS subscales and total scores were significantly improved 4 weeks after treatment (p < 0.05). Furthermore, the pain, itching, and pigmentation subscale were improved. The pliability, melanin index, and erythema index were also improved, but without significance. The patients were satisfied with the results and symptoms alleviation, although subjective score changes were insignificant. No serious adverse events were found. The patients reported pruritus in 62.5% and good pain tolerance in 37.5%. Subgroup analyses found no differences in scar etiologies or properties at different parts of the body. Conclusion The ESWT is a modality for hypertrophic scar treatment with promising results. Most of POSAS subscales were significantly improved.

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Section: Discussionmentioning

confidence: 99%

“…The wide range of applications highlights the versatile benefits and regenerative potential of ESWT. 4 5 6 7 8 9 10 11 ESWT transmits a mechanical force via an acoustic wave to facilitate wound healing. The force stimulates the release of neuropeptides from nerve endings and improves wound healing.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Shock Wave Therapy for Hypertrophic Scars

et al. 2022

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“…In the past two years, a high number of publications on the effects of SWT on burn scars was presented. A double-blinded, randomized, controlled trial of 48 patients with a burn to their dominant right hand revealed beneficial effects on pain, scar thickness, vascularity, and hand function [85]. Another study compared the efficacy of Triamcinolon Acetonide injections (TAI) alone, or in combination with SWT, to treat keloids.…”

Section: Shockwave Therapymentioning

confidence: 99%

Mechanomodulation: Physical Treatment Modalities Employ Mechanotransduction to Improve Scarring

Daele

Meirte

Anthonissen

et al. 2022

EBJ

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Every year, surgical interventions, traumatic wounds, and burn injuries lead to over 80 million scars. These scars often lead to compromised skin function and can result in devastating disfigurement, permanent functional loss, psychosocial problems, and growth retardation. Today, a wide variety of nonsurgical scar management options exist, with only few of them being substantiated by evidence. The working mechanisms of physical anti-scarring modalities remained unclear for many years. Recent evidence underpinned the important role of mechanical forces in scar remodeling, especially the balance between matrix stiffness and cytoskeleton pre-stress. This perspective article aims to translate research findings at the cellular and molecular levels into working mechanisms of physical anti-scarring interventions. Mechanomodulation of scars applied with the right amplitude, frequency, and duration induces ECM remodeling and restores the ‘tensile’ homeostasis. Depending on the scar characteristics, specific (combinations of) non-invasive physical scar treatments are possible. Future studies should be aimed at investigating the dose-dependent effects of physical scar management to define proper guidelines for these interventions.

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“…20,[30][31][32] To summarise, there were nine RCT studies involving 422 patients included in our systematic review and meta-analyses. 20,25,[28][29][30][31][32]34,35 The major subject characteristics of the nine selected articles are outlined in Table 1. All these studies were published within the last 5 years (from 2016 to 2021).…”

Section: T a B L E 1 Study Design And Patient Characteristics Of Incl...mentioning

confidence: 99%

Safety and efficacy of treating post‐burn pathological scars with extracorporeal shock wave therapy: A meta‐analysis of randomised controlled trials

Yang

Kang

Jiang

et al. 2022

Wound Repair Regeneration

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The clinical application of shockwave therapy has expanded to the treatment of pathological scars. The objective of this systematic review and meta‐analysis is to quantitatively evaluate the efficacy and safety of extracorporeal shockwave therapy combined with comprehensive rehabilitation therapy on post‐burn pathological scars compared to comprehensive rehabilitation therapy alone. The randomised controlled trials of extracorporeal shockwave therapy for post‐burn pathological scars published in English and Chinese languages before October 2021 were included. The methodological quality and risk of bias of the selected articles were assessed with the Cochrane Collaboration's ‘risk of bias’ tool. RevMan software was applied for data analysis. This is the first systematic review and meta‐analysis considering the effectiveness and safety of extracorporeal shockwave therapy on post‐burn pathological scars. And nine randomised controlled trials involving 422 patients were included in this meta‐analysis. The meta‐analysis results showed that, compared with comprehensive rehabilitation therapy alone, extracorporeal shockwave therapy combined with comprehensive rehabilitation therapy was more effective in relieving pain (standardized mean difference [SMD] = −0.59, 95% confidence interval [CI]: [−0.87 to −0.31], p < 0.0001) and pruritus related to pathological scars (SMD = −0.94; 95% CI: [−1.25 to −0.63], p = 0.004), improving scars' appearance (SMD = −1.78, 95% CI: [−3.37 to −0.19], p = 0.03) and elasticity (SMD = 0.25, 95% CI: [0.29–0.21], p < 0.00001), decreasing scars thickness (SMD = −0.13, 95% CI: [−0.25 to −0.01], p = 0.04) and promoting the maturation status of scars (SMD = −2.86, 95% CI: [−3.96 to −1.76], p < 0.00001). There were no reported serious adverse events during and after extracorporeal shockwave therapy in the included studies. Available data preliminarily suggested that the combination of extracorporeal shockwave therapy and comprehensive rehabilitation therapy had better therapeutic effect on post‐burn pathological scars than comprehensive rehabilitation therapy alone, without obvious side effects. However, further clinical well‐controlled randomised controlled trials are needed. Systematic review registration ID: PROSPERO CRD42022297573.

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Clinical Utility of Extracorporeal Shock Wave Therapy on Hypertrophic Scars of the Hand Caused by Burn Injury: A Prospective, Randomized, Double-Blinded Study

Cited by 9 publications

References 37 publications

Extracorporeal Shock Wave Therapy for Hypertrophic Scars

Extracorporeal Shock Wave Therapy for Hypertrophic Scars

Mechanomodulation: Physical Treatment Modalities Employ Mechanotransduction to Improve Scarring

Safety and efficacy of treating post‐burn pathological scars with extracorporeal shock wave therapy: A meta‐analysis of randomised controlled trials

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