Extracorporeal Shock Wave Therapy in Chronic Wound Care

Abstract

Chronic wounds are wounds, which failed healing and timely reparative process to produce anatomic and functional integrity over a period of 3 months. New physical therapy for chronic wounds is extracorporeal shock wave therapy (ESWT). ESWT generators can be focused, defocused, and radial. ESWT is non-invasiveness, low-associated complication rates, efficacy for indications refractory to other standards of practice, and cost-effectiveness.ESWT determines mechanotransduction that is possible as most of the cells of the body, thank to surface receptors and other transmission signals. In the specific field of ESWT, different biochemical substances are able to influence the processes of different cell lineages, besides to induce the formation of new small blood vessels. So, ESWT enhanced cell proliferation at the local wound tissue level, stimulated extracellular matrix metabolism, decreased apoptosis, and downregulated oxygen-mediated burst of leukocytes, probably stimulating homing and differentiation of stem cells with high tissue regenerating potential. From numerous experimental and clinical data, it is possible to conclude that ESWT would improve not only the wounds healing process but also the regeneration events.

Efek Terapi Adjuvan Extracorporal Shockwave terhadap Penyembuhan Ulkus Kaki Diabetik Penyandang Diabetes Melitus Tipe 2 dengan Penanda Vascular Endothelial Growth Factor

“…5 Penyebab terjadinya UKD melibatkan banyak faktor; umumnya disebabkan oleh mikroangiopati dan berhubungan dengan neuropati perifer dan juga infeksi 5 sehingga memerlukan waktu penyembuhan lama dan penanganan multidisiplin yang komprehensif, berawal dari kontrol kadar gula darah, penggunaan antibiotik, debrideman ulkus, perawatan luka, serta off loading dan revaskularisasi pada ulkus diabetik iskemik. 6 Terdapat beberapa terapi yang digunakan untuk memicu penyembuhan UKD di antaranya terapi oksigen hiperbarik, teknik vakum, dan terapi laser tegangan rendah, namun sampai saat ini belum disepakati terapi yang memuaskan 7 Hal ini mendorong pencarian metode untuk memicu percepatan penyembuhan UKD yang mudah digunakan, non-invasif, tanpa efek samping, dan biaya lebih murah; terapi yang dapat menjadi pilihan ialah extracorporeal shockwave therapy (ESWT). 8 Sebagai terapi adjuvan pada UKD, ESWT bekerja dengan pemberian stimuli fisik secara mekanotransduksi pada luka yang direspon oleh tubuh dengan mengeluarkan sinyal kimiawi berupa peningkatan kadar vascular endotelial growth factor (VEGF) yang memicu proses angiogenesis, dan meningkatkan perfusi darah ke jaringan sehingga luka lebih cepat membaik.…”

Autologous Adipose-Derived Mesenchymal Stem Cells Combined with Shockwave Therapy Synergistically Ameliorates the Osteoarthritic Pathological Factors in Knee Joint

“…SW therapy is a physical, non-invasive, and safe method by which to repair the pathological damage that occurs in the musculoskeletal disorders [ 20 ]. The effects of SW therapy on tissue regeneration act as a mechanical stimulus, which triggers angiogenesis, immunomodulation, chondroprotection, bone remodeling, and stem cell homing [ 20 , 21 , 22 ]. All the detailed biological effects of SW are exerted through mechanotransduction to interact directly with cells in tissue and regulate the expressions of growth factors, signaling factors, transcription factors, cytokines, and chemokines [ 20 , 23 ].…”