Extracorporeal Shock Wave Therapy: An Emerging Treatment Modality for Retracting Scars of the Hands

Saggini, Raoul; Saggini, Andrea; Spagnoli, Anna Maria; Dodaj, Ira; Cigna, Emanuele; Maruccia, Michele; Soda, Giuseppe; Fulle, Stefania; Scuderi, Nicolò

doi:10.1016/j.ultrasmedbio.2015.07.028

Cited by 32 publications

(32 citation statements)

References 39 publications

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“…13,[23][24][25] The findings from experimental and clinical studies indicate that ESWT promotes wound healing and tissue regeneration through neovascularization and matrix remodeling, and through its anti-inflammatory effects. 10,[13][14][15][25][26][27][28][29] The findings from molecular studies involving intramuscular silicone injections showed significant declines in TGF-ß1, which is a profibrotic protein, and increases in matrix metalloproteinase-2, which is an antifibrotic protein, both of which are key factors associated with keloid formation and degradation. 5,23,30,31 In addition, the mechanical action of ESWT may cause microscopic injuries that break down collagen fibers in scar tissue, thereby enabling scar remodeling.…”

Section: Discussionmentioning

confidence: 99%

Benefits of extracorporeal shock waves for keloid treatment: A pilot study

Kim

Han

Suh

et al. 2020

Dermatologic Therapy

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Keloids are fibroproliferative skin disorders characterized by the progressive deposition of collagen. Recently, extracorporeal shock wave therapy (ESWT) has been used to treat pathologic scars. Herein, we conducted a study to compare the efficacy of intralesional injections (ILIs) of triamcinolone acetonide (TA) used alone, or in combination with ESWT for keloids. Forty patients were randomized equally into two groups in this 12‐week comparative clinical trial. Group A was treated with TA ILIs and ESWT, and group B was treated with TA ILIs alone. At week 12, both groups showed acceptable improvements in nearly all dimensions evaluated, and these improvements were statistically more significant in group A. Group A showed a higher mean percentage reduction in lesion length, width, and height and in the Vancouver Scar Scale score than group B (all P < .05). More patients in group A than in group B had scores of ≥4, which indicated improvements that were good or excellent, on the patient global assessment and investigator global assessment. No serious adverse events occurred. This study suggests that ESWT could be a new, effective and acceptable adjuvant treatment option for keloids.

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Section: Discussionmentioning

confidence: 99%

Benefits of extracorporeal shock waves for keloid treatment: A pilot study

Kim

Han

Suh

et al. 2020

Dermatologic Therapy

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“…Shock wave treatment is capable of inducing an increase of activated fibroblasts, CD34positive fibrocytes, and fXIIIa-positive dendritic cells; this process is thought to lead to the deposition of new collagen, characterized by thinner collagen fascicles and parallel orientation to the dermoepidermal junction. Additionally, ESWT may play a significant role in the increase in CD31-positive vessel density in the dermis allowing an improved tissue metabolism [60]. In animal models, ESWT modulates expression of angiogenesis pathway-specific genes such as those encoding for ELR motif (glutamic acid-leucine-arginine sequence) positive (ELR + -CXC) chemokines, CC-chemokines, and cytokines [51].…”

Section: Eswt Indirect Effect On Modulation Of Gene Transcription Hasmentioning

confidence: 99%

Extracorporeal Shock Wave Therapy in Chronic Wound Care

Carmignano¹

2020

Physical Therapy Effectiveness

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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.

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“…Cho et al ( 31 ) report that ESWT significantly reduced scar pain in burn patients after wound recovery. Similarly, Saggini et al ( 32 ) evaluated the efficacy of unfocused shock wave treatment on retracting scars of the hands. They observed significant early improvement in modified Vancouver Scar Scale after treatment.…”

Section: Introductionmentioning

confidence: 99%

“…However, few studies were able to elucidate the underlying mechanism of action. Histologic changes in connective tissue appearance, scar vascularization and density of fXIIIa and CD34-positive cells were found following ESWT treatment ( 32 ).…”

Section: Introductionmentioning

confidence: 99%

Lower energy radial shock wave therapy improves characteristics of hypertrophic scar in a rabbit ear model

et al. 2017

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The aim of the present study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on scar characteristics and transforming growth factor (TGF)-β1/Smad signaling in order to explore a potential modality for the treatment of hypertrophic scars (HS). The HS model was generated in rabbit ears, then rabbits were randomly divided into 3 groups: Lower (L)-ESWT [treated with rESWT with lower energy flux density (EFD) of 0.1 mJ/mm2], higher (H)-ESWT (treated with a higher EFD of 0.18 mJ/mm2) and the sham ESWT group (S-ESWT; no ESWT treatment). Scar characteristics (wrinkles, texture, diameter, area, volume of elevation, hemoglobin and melanin) were assessed using the Antera 3D® system. The protein and mRNA expression of TGF-β1, Smad2, Smad3 and Smad7 was assessed by enzyme-linked immunosorbent assay and reverse transcription-quantitative polymerase chain reaction, respectively. The Antera 3D® results indicated that wrinkles and hemoglobin of the HS were significantly improved in both of the rESWT groups when compared with the S-ESWT group. However, these changes appeared much earlier in the L-ESWT group than the H-ESWT. Scar texture was also improved in the L-ESWT group. However, rESWT did not influence HS diameter, area, volume of elevation or melanin levels. rESWT had no effect on TGF-β1 or Smad7 expression in either of rESWT groups. Although no difference was observed in Smad2 mRNA expression in the L-ESWT group, the Smad3 mRNA and protein expression significantly decreased when compared with the H-ESWT and S-ESWT groups. By contrast, Smad2 and Smad3 mRNA expression were upregulated in the H-ESWT group. These results demonstrated that rESWT with 0.1 mJ/mm2 EFD improved some characteristics of the HS tissue. Downregulation of Smad3 expression may underlie this inhibitory effect. Inhibition of the TGF-β1/Smad signal transduction pathway may be a potential therapeutic target for the management of HS.

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Extracorporeal Shock Wave Therapy: An Emerging Treatment Modality for Retracting Scars of the Hands

Cited by 32 publications

References 39 publications

Benefits of extracorporeal shock waves for keloid treatment: A pilot study

Benefits of extracorporeal shock waves for keloid treatment: A pilot study

Extracorporeal Shock Wave Therapy in Chronic Wound Care

Lower energy radial shock wave therapy improves characteristics of hypertrophic scar in a rabbit ear model

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