Improvement of Blood Flow, Expression of Nitric Oxide, and Vascular Endothelial Growth Factor by Low-Energy Shockwave Therapy in Random-Pattern Skin Flap Model

Abstract

Extracorporeal shock wave therapy (ESWT) can improve flap survival, but its mechanism remains unclear. In this study, we aim to investigate whether ESWT can improve blood flow in ischemic skin flaps and the possible mechanism. Cranially based random-pattern flap (3 x 10 cm) model was established, and its ischemic portion was treated with or without ESWT at 0.09 mJ/mm2 with 750 impulses (1.5 Hz), immediately after operation. Survival area, blood flow, vessel distribution, microvessel density, and expression of nitric oxide and vascular endothelial growth factor were evaluated at 1, 3, and 10 days postoperatively. The results showed that blood perfusion, expression of nitric oxide and vascular endothelial growth factor, vasodilatation of pre-existing vessels at early postoperative stage, neovascularization at late stage, and flap survival were all significantly promoted in treatment group. In conclusion, ESWT can improve skin flap surviving rate through enhanced vasodilatation at early postoperative stage and neovascularization at late stage via modulation of angio-active factors expression.

Microvascular Response to Shock Wave Application in Striated Skin Muscle

“…In our study, eNOS was significantly up-regulated 1 d after ESWA. The observation of increased eNOS levels after ESWA is in line with findings of other researchers [41][42][43]. In addition, we observed a significantly increased expression of vWF within the endothelial lining.…”

Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study

“…Therefore induction of NO 9 synthesis has been suggested to be one of the most important mechanism implicated in the anti-inflammatory effect of ESWT, while increased expression of VEGF and the consequent mobilization of endothelial progenitor cells can explain the proangiogenic action [6][7][8]17]. It has been recently demonstrated that, in addition to angiogenesis due to migration and proliferation of endothelial cells in situ, EPCs contribute to neovascularization in ischemic tissue through a vasculogenetic mechanism and through secretion of a variety of angiogenic factors [18][19]. Finally, recent studies have marked out that ESW are able to recruit stem cells and to stimulate their differentiation in various damaged tissues inducing reparative phenomena [20][21][22].…”

Extracorporeal Shock Wave Therapy as a New and Non-invasive Angiogenic Strategy

“…Recently, several studies are reported that showed the beneficial effects of low-energy SW therapy in other disorders, including skin flap model in rodents (Stojadinovic et al 2008;Yan et al 2008) and patients with refractory chronic skin ulcers (Saggini et al 2008;Moretti et al 2009). Also, low to high energy levels of SW is widely used for the treatment of certain orthopedic conditions, such as nonunions, tendinosis calcarea, epicondylitis and calcaneal spur (Birnbaum et al 2002;Wang et al 2003).…”