Extracorporeal shock waves, a new non-surgical method to treat severe burns

Arno, Anna; García, Olga; Hernán, I.; Sancho, Juan José Alegre; Acosta, Andrés; Barret, Juan P.

doi:10.1016/j.burns.2009.11.012

Cited by 63 publications

(47 citation statements)

References 22 publications

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“…As the research on the effects of shock waves on the healing of skin ulcers has begun recently, the present study also included those studies with low methodological quality, such as the case series by Arnó et al 18 and Schaden et al 15 for the description and discussion of their results. Only Wang et al performed sampling calculation.…”

Section: Discussionmentioning

confidence: 99%

“…In one study, patients reported an increase of local pain during the application of therapy, although this increase was mild and tolerated. 18 In the literature, the adverse effects most commonly found are pain, local hyperemia, and the appearance of petechiae and small hematomas. Other more unusual adverse effects include migraines and vasovagal syncopes.…”

Section: Discussionmentioning

confidence: 99%

“…The other studies included compared ESWT with hyperbaric oxygen therapy, 16 with a standard treatment, 13,19,20,21 or were case series with ESWT. 15,17,18 The studies showed a variety of different intervention standards. There was heterogeneity in the intervention time, number of pulses, and in the frequency of sessions, as well as in the number of sessions, the energy density applied, and also in the type of shock waves used in the therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Arnó et al 18 conducted a prospective pilot study on 15 patients with burns on less than 5% of the body surface, and applied 2 ESWT sessions to them, on the 3rd and 5th days after the lesions occurred. The shock waves were applied with 100 impulses/cm 2 and energy of 0.15 mJ/mm 2 .…”

Section: Description Of Individual Studiesmentioning

confidence: 99%

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Benefits of extracorporeal shockwave in the treatment of skin ulcers: a literature review

Pai

Toma²,

Rampim³

et al. 2016

Acta Fisiátrica

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Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolution and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small studies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs. Objective: To review the literature and evaluate the efficacy of ESWT in caring for skin ulcers of various etiologies: diabetic ulcers, pressure ulcers, burns, post-traumatic ulcers, venous and arterial ulcers. Method: A literature review was made, with only human trials included. Results: 9 articles were selected that fulfilled the eligibility criteria. The studies included evaluations of 788 patients. The manuscripts demonstrated a large variability regarding the interventions made. There was heterogeneity regarding intervention time, number of pulses, frequency of sessions, and also the number of sessions, energy density used, and the type of shock wave used in therapies. Some of the included trials found a higher rate of complete wound healing and faster epithelization in patients with chronic lesions, unresponsive to the traditional measures. However, there were few studies in the literature with proper methodological quality. Conclusion: ESWT is a promising alternative for the treatment of patients unresponsive to conventional measures. The results are promising, although the evidence regarding wound healing and acceleration of wound healing is still limited. The studies selected did not report any significant side effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Description Of Individual Studiesmentioning

confidence: 99%

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Benefits of extracorporeal shockwave in the treatment of skin ulcers: a literature review

Pai

Toma²,

Rampim³

et al. 2016

Acta Fisiátrica

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“…Shockwaves are sonic pulses characterized by a high peak pressure (500mbar) short life cycle (10ms), fast pressure rise (<10ns), broad frequency spectrum (Hz) and the generation of stress forces upon interaction with interface [14]. Energy Flux Density (EFD [mJ/ clinics, ESWT was applied in animal models of soft tissue injuries, burns [16][17][18], ischemic isografts [19,20], incisional wounds, and models of compromised wound healing such as diabetic wounds [21]. Investigations of mechanisms of action for the beneficial effects of ESWT led to reports of application of ESWT in vitro [22][23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Effects of Extracorporeal Shockwave Therapy (ESWT) on Proliferation and Metabolic Activity of Adult Human Keratinocytes

Ottomann¹,

Antonic²

2015

J Bioengineer & Biomedical Sci

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Background: The objective of the presented study is to investigate in vitro effects of low energy extracorporeal shockwave therapy (ESWT) on the keratinocytes and their metabolic and proliferative properties for their therapeutic applications.Materials: Primary culture of keratinocytes was isolated from clinical samples and after passaging into 12 flasks exposed to the various number of ESWT impulses (n=25, 50 and100impulses) in combination with several frequencies (1, 3 or 5Hz) and distances from the applicator head (5, 6 or 7cm with corresponding energy flux densities (EFD)=0.04, 0.025 and 0.015 mJ/mm 2 , respectively) using modified water bath at constant temperature 37°C. Flasks were assigned to receive one combination of treatment parameters. The individually tested distances/EFD with the various impulse numbers and frequencies were summarised to experimental series. Cell viability was measured using trypan blue, cell cytotoxicity was measured using lactate dehydrogenase assay, and cell metabolic activity was measured by level of glucose metabolism. Results:Our results indicate that low energy ESWT has both cytotoxic and stimulating effects on the keratinocytes. These effects depend on number of impulses, distance from the applicator head, and frequency. A proliferationstimulating effect and a higher viable cell count could be observed for a distance of 5 cm with 100 impulses at 1 Hz and EFD=0.04 mJ/mm2. Conclusion:Our results indicate that ESWT (EFD=0.04 mJ/mm2, 100 impulses, 1Hz at 5 cm) augmented proliferative capacity of keratinocytes in vitro. These promising results grant further investigation and have practical potential in keratinocyte research and production. In Vitro Effects of Extracorporeal Shockwave Therapy (ESWT) on Proliferation and Metabolic Activity of Adult Human Keratinocytes IntroductionModern wound dressings engineered to promote wound healing often contain living cells [1,2]. Various cell types such as adipocytes, fibroblasts, mesenchymal stem cells, and keratinocytes have been successfully used in wound healing. Keratinocytes have been used in the form of spray in preclinical animal study as well as in clinical trial for severe burns [3][4][5]. In the animal study directly comparing cryopreserved allogenic keratinocytes and cadaver full thickness skin grafts, authors reported faster epithelialisation in the keratinocytetreated group, with no difference in comparison with full thickness grafts by the end of the study [6,7]. These reports provide a rationale for the further investigation of keratinocytes in wound healing, as well as need for development of cultivating protocols that will decrease culturing time. Augmenting proliferation capacity of the isolated, allogenic keratinocytes will allow clinicians and researchers to produce a sufficient number of viable keratinocytesin a short period of time for their use in wounded patients [7]. Mechanotransduction is a wellknown phenomenon of cellular responses to the physical forces such as sheer stress or stretching both in vivo a...

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Extracorporeal shock wave therapy for the healing and management of venous leg ulcers

Cooper

Bachoo

Brittenden

2015

Cochrane Database of Systematic Reviews

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Extracorporeal shock waves, a new non-surgical method to treat severe burns

Cited by 63 publications

References 22 publications

Benefits of extracorporeal shockwave in the treatment of skin ulcers: a literature review

Benefits of extracorporeal shockwave in the treatment of skin ulcers: a literature review

In Vitro Effects of Extracorporeal Shockwave Therapy (ESWT) on Proliferation and Metabolic Activity of Adult Human Keratinocytes

Extracorporeal shock wave therapy for the healing and management of venous leg ulcers

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