Wound Healing: Current Data Demonstrate Efficacy of Shock Wave Therapy
Shock wave therapy is an acknowledged form of treatment in urology, orthopaedics and cardiology. Wound healing is a relatively new field of application. At a STORZ MEDICAL symposium held in the course of the 17th Annual Congress of the German Wound Healing Society in Bochum, experts presented current data and informed about this promising treatment option.
For almost 20 years extracorporeal shock wave therapy (ESWT) has been an acknowledged form of treatment in orthopaedics where it is applied successfully for the non-invasive treatment of indications such as calcific tendinitis, achillodynia, epicondylitis and trigger points. Originally, shock wave therapy comes from urology where it is used for the disintegration of kidney stones (extracorporeal shock wave lithotripsy, SWL). Today shock wave therapy is also being used in dermatology. In wound management it is applied as a non-invasive method of stimulating wound healing. Poorly healing wounds such as leg ulcers or diabetic gangrenes have already been treated successfully [1,2,3,4]. The treatment is carried out with a modern shock wave therapy system such as the DUOLITH® SD1 »ultra«.
Left: Treating an open wound on the foot with the DUOLITH® SD1 »ultra«
Right: Shock wave treatment of a non-healing wound
Shock waves initiate the healing process
PD Dr med. Jean-Paul Schmid of Spital Netz Bern/Switzerland (Tiefenau Hospital & Bern University) explained in his presentation that a decisive effect of shock waves in wound healing is mainly the release of eNOS (endothelial nitric oxide synthase) and VEGF (endothelial growth factor). Both proteins are responsible for neovascularization and wound closure. A modern shock wave therapy system is of advantage for the shock wave application and, consequently, for the success of the treatment. Easy controllability of the handpiece, for example, is important for the user.
PD Dr med. Georg Daeschlein of Greifswald Medical University emphasized in his paper the great importance of additive non-invasive methods such as ESWT for the treatment of non-healing wounds. In this context he presented current data obtained in the Greifswald skin clinic showing that the use of ESWT clearly supported the healing of chronic wounds. Chronic wounds of 13 patients were treated with shock waves (DUOLITH® SD1). A reduction of the wound surface was achieved in 9 patients (18 wounds) and wound closure was achieved in 6 patients.
Conclusion and outlook
In the past few years the mechanisms of action of ESWT in the field of wound healing were described in numerous scientific studies and publications. Among the described mechanisms there are:
- Stimulation of microcirculation (blood, lymph) and metabolism (nitric oxide, vasodilation, reduction of oxidative stress)
- Mechanotransduction – cell matrix stimulation
- NO release (eNOS)
- Antibacterial and anti-inflammatory effect
- Release of growth factors (e.g. VEGF)
- Stimulation of stem cells, i.e. cell proliferation, transport and differentiation
Currently the effect of shock waves in wound healing is being studied by several international working groups. In order to optimize wound treatment with ESWT further studies will be needed in the future.
Symposium, STORZ MEDICAL AG: Extracorporeal shock wave therapy for wound treatment. 17th Annual Congress of the German Wound Healing Society. Bochum, 27 June 2014.
 Schaden W et al. Shock wave therapy for acute and chronic soft tissue wounds: a feasibility study. J Surg Res 2007;143(1):1-12.
 Moretti B et al. ESWT-induced healing of diabetic foot ulcers. ISMST Congress, Juan les Pins, 2008.
 Jankovic D. Case study: shock waves treatment of diabetic gangrene. Int Wound J 2011;8(2):206-9.
 Stieger M et al. Extrakorporale Stoßwellentherapie eines komplizierten chronischen Ulcus cruris venosum. Hautarzt, 2013.