Extracorporeal Shock Wave Enhanced Extended Skin Flap Tissue Survival via Increase of Topical Blood Perfusion and Associated with Suppression of Tissue Pro-Inflammation

Kuo, Yur-Ren; Wu, Wen-Sheng; Hsieh, Yu-Ling; Wang, Feng‐Sheng; Wang, Chunting; Chiang, Yuan‐Cheng; Wang, Ching‐Jen

doi:10.1016/j.jss.2006.12.552

Cited by 76 publications

(83 citation statements)

References 35 publications

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“…Pain reduction obtained in both groups confirmed the effectiveness of ESWT in stimulating analgesia through modulation of pain chemical mediators such as blocking of pain signal transmission induced by substance P (29)(30)(31)(32)(33)(34)(35).…”

Section: Discussionsupporting

confidence: 64%

Chronic Ulcers: Treatment with Unfocused Extracorporeal Shock Waves

et al. 2013

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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

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Section: Discussionsupporting

confidence: 64%

Chronic Ulcers: Treatment with Unfocused Extracorporeal Shock Waves

et al. 2013

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“…in VEGF and PCNA expression in shock wave treated random flaps in rats [13]. In our study, we found an up-regulation of PCNA, which is an early marker for cell proliferation.…”

Section: U N C O R R E C T E D P R O O Fsupporting

confidence: 65%

“…Furthermore ESWA has been shown to exert a significant synergistic growth inhibitory effect on tumour cells when applied in combination with chemotherapeutic agents [9,10], which was explained by CP-induced permeabilization of cellular membranes and intercellular connections [11,12]. Recent investigations revealed decreased leukocytic infiltration and suppression of tumour necrosis factor a (TNF-a) in critically perfused random skin flaps after ESWA [13]. Only few studies report the biological effect of ESWA on the circulatory system.…”

Section: U N C O R R E C T E D P R O O Fmentioning

confidence: 99%

“…In another study of cardiac ESWA, enhanced coronary angiogenesis was associated with reduced angina pectoris in patients with severe coronary artery disease, whereby no adverse effects were noted [18]. Accordingly, improved local perfusion was suggested after ESWA-associated reduction of necrosis using an epigastric skin flap model and a dorsal skin random flap model, respectively [13,[19][20][21]. The exposition of human umbilical vascular endothelial cells (HUVECs) to low dose ESWA revealed a significant upregulation of VEGF m-RNA protein, indicating a direct vascular effect [22].…”

Section: U N C O R R E C T E D P R O O Fmentioning

confidence: 99%

“…These measurements coincided with the clinical improvement of the patient's pain-free walking distance. The effects of shock waves on distal ischemic skin flap necrosis were examined in rats using different skin flap models [13,[19][20][21]. All studies showed a significant increase in mean percentage of the flap survival area after ESWA and can be seen as an indicator of improved local perfusion.…”

Section: U N C O R R E C T E D P R O O Fmentioning

confidence: 99%

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Microvascular Response to Shock Wave Application in Striated Skin Muscle

Calcagni

Chen

Högger

et al. 2011

Journal of Surgical Research

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Background: This study aims to quantify by intravital microscopy the microhemodynamic response after extracorporeal shock wave application (ESWA) to the physiologic microcirculation of the mouse dorsal skinfold chamber.Materials and Methods: ESWA was carried out using an electrohydraulic shock wave source. Two different shock wave doses of 500 and 1000 pulses at an energy flux rate of 0.08 mJ/mm2 and a frequency of 4 Hz were compared with sham-operated animals. Microcirculatory analyses were performed at baseline (BL) and during a 3 d observation period after ESWA. The expression of caspase-3 (casp-3), proliferating cell nuclear antibody (PCNA), von Willebrand factor (vWF), and endothelial nitric oxide synthase (eNOS) were analyzed semiquantitatively by immunohistochemistry.Results: ESWA provoked a significant and persistent increase of functional capillary density (FCD) throughout the observation period, reaching a maximum (140% ± 5% of BL, P < 0.05 versus sham) after 1 d when animals were treated with 1000 pulses. ESWA induced a slight increase of leukocyte rolling (not, vert, similar2-to not, vert, similar3.5-fold, P < 0.05) and leukocyte adherence (not, vert, similar1.5-to not, vert, similar2-fold, P < 0.05) to the endothelial lining of postcapillary venules. One day following ESWA, we observed enhanced expression of casp-3 (not, vert, similar3-to not, vert, similar4-fold), PCNA (not, vert, similar9-to not, vert, similar14-fold), vWF (not, vert, similar11-to not, vert, similar14-fold), and eNOS (not, vert, similar3-fold), all P < 0.05.Conclusion: This study shows that ESWA provokes a favorable persistent increase of patent capillaries, however accompanied by a transient and slight inflammatory response but also by dose-dependant apoptotic cell death. Our data suggest that ESWA might represent a noninvasive biomechanical tool to treat critically perfused and endangered tissues, but certainly warrants further investigation. Background. This study aims to quantify by intravital microscopy the microhemodynamic response after extracorporeal shock wave application (ESWA) to the physiologic microcirculation of the mouse dorsal skinfold chamber. U N C O R R E C T E D P R O O FMaterials and Methods. ESWA was carried out using an electrohydraulic shock wave source. Two different shock wave doses of 500 and 1000 pulses at an energy flux rate of 0.08 mJ/mm 2 and a frequency of 4 Hz were compared with sham-operated animals. Microcirculatory analyses were performed at baseline (BL) and during a 3 d observation period after ESWA. The expression of caspase-3 (casp-3), proliferating cell nuclear antibody (PCNA), von Willebrand factor (vWF), and endothelial nitric oxide synthase (eNOS) were analyzed semiquantitatively by immunohistochemistry.Results. ESWA provoked a significant and persistent increase of functional capillary density (FCD) throughout the observation period, reaching a maximum (140% ± 5% of BL, P < 0.05 versus sham) after 1 d when animals were treated with 1000 pulses. ESWA induced a slight increase of ...

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Extracorporeal Shock Wave Therapy for Acute and Chronic Soft Tissue Wounds

Mittermayr

Schaden

2014

Urgent Interventional Therapies

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Extracorporeal Shock Wave Enhanced Extended Skin Flap Tissue Survival via Increase of Topical Blood Perfusion and Associated with Suppression of Tissue Pro-Inflammation

Cited by 76 publications

References 35 publications

Chronic Ulcers: Treatment with Unfocused Extracorporeal Shock Waves

Chronic Ulcers: Treatment with Unfocused Extracorporeal Shock Waves

Microvascular Response to Shock Wave Application in Striated Skin Muscle

Extracorporeal Shock Wave Therapy for Acute and Chronic Soft Tissue Wounds

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