Extracorporeal shock wave therapy (ESWT) for wound healing: Technology, mechanisms, and clinical efficacy

Abstract

For almost 30 years, extracorporeal shock wave therapy has been clinically implemented as an effective treatment to disintegrate urinary stones. This technology has also emerged as an effective noninvasive treatment modality for several orthopedic and traumatic indications including problematic soft tissue wounds. Delayed/nonhealing or chronic wounds constitute a burden for each patient affected, significantly impairing quality of life. Intensive wound care is required, and this places an enormous burden on society in terms of lost productivity and healthcare costs. Therefore, cost-effective, noninvasive, and efficacious treatments are imperative to achieve both (accelerated and complete) healing of problematic wounds and reduce treatment-related costs. Several experimental and clinical studies show efficacy for extracorporeal shock wave therapy as means to accelerate tissue repair and regeneration in various wounds. However, the biomolecular mechanism by which this treatment modality exerts its therapeutic effects remains unclear. Potential mechanisms, which are discussed herein, include initial neovascularization with ensuing durable and functional angiogenesis. Furthermore, recruitment of mesenchymal stem cells, stimulated cell proliferation and differentiation, and anti-inflammatory and antimicrobial effects as well as suppression of nociception are considered important facets of the biological responses to therapeutic shock waves. This review aims to provide an overview of shock wave therapy, its history and development as well as its current place in clinical practice. Recent research advances are discussed emphasizing the role of extracorporeal shock wave therapy in soft tissue wound healing.

Shock Wave Treatment Protects From Neuronal Degeneration via a Toll‐Like Receptor 3 Dependent Mechanism: Implications of a First‐Ever Causal Treatment for Ischemic Spinal Cord Injury

“…Accordingly, the angiogenic factors VEGF and HIF‐1α were significantly increased. This proangiogenic effect was accompanied by a proinflammatory response to shock wave treatment, as described previously in the literature 21, 24. Inflammation is an integral part of angiogenesis and was mediated by an early increase of IL‐6 and transforming growth factor β mRNA expression that resulted in amplified macrophage recruitment.…”

“…This new treatment option was developed as an alternative to or as standard of care for nonhealing bone fractures, wound healing disturbances, and tendinopathies 20, 21, 22. Moreover, our group developed low‐energy SWT for open‐heart direct epicardial application after myocardial infarction 23…”

Shock Wave Treatment Enhances Cell Proliferation and Improves Wound Healing by ATP Release-coupled Extracellular Signal-regulated Kinase (ERK) Activation

“…The cell cycle profiles revealed more cells in the S phase in the samples treated with shock waves compared with control cells without shock waves. This effect increased with energy and was particularly clear 21 h after treatment with 100 pulses at 0.19 mJ/mm 2 , revealing a significant increase in proliferating cells in the S phase (Fig. 1D).…”

“…of ESWT, namely its ability to induce the healing of chronic ulcers and non-healing wounds (1)(2)(3)(4)(5).…”

“…The application of extracorporeal shock wave treatment (ESWT) 3 is a novel and effective therapeutic strategy to treat musculoskeletal disorders as well as chronic soft tissue wounds including bedsores, burn wounds, and diabetic and vascular ulcers (1,2). In addition to the accelerated healing rates in patients treated with ESWT, this therapeutic approach is noninvasive and cost-effective.…”