SLR - February 2012 - Erik Kissel
Reference: Qureshi AA, Ross KM, Ogawa R, and Orgill DP, Plast Reconstr Surg 128(6):721e-7e, 2011.
Scientific Literature Review
Reviewed by: Erik Kissel, DPM
Residency Program: Detroit Medical Center
Podiatric Relevance:
Lower extremity wound care is a large part of many podiatric practices, and podiatrists are often faced with non-healing wounds in comprised hosts. Any innovation that could potentially speed up the healing process or otherwise improve outcomes would be welcomed by physicians treating lower extremity wounds.
Methods:
Medline and other databases of peer-reviewed literature were searched for articles from the last ten years pertaining to wounds, soft tissue injuries, and ultrasonic therapy. Both clinical and preclinical investigations involving shock wave treatment of wounds, flaps, or burns were included. Because of the small pool of articles on this topic, non-randomized trials were not excluded.
Results:
Two preclinical studies looked at the effect of shock wave therapy on diabetic wounds in rodent models; one study found significantly reduced wound size, and one no apparent benefit. A level IIb study comparing focused shock wave therapy with hyperbaric oxygen therapy in diabetic foot ulcers found shock wave therapy to be superior. A level IIb study of 30 diabetic patients with neuropathic foot ulcers found that their treatment group had a healing rate of 53 percent versus 33 percent in the control group. A study with 28 patients requiring skin grafts treated the skin graft donor site immediately after harvesting; a significantly decreased time for re-epithelialization was noted in the shock wave therapy group versus the control group. Multiple animal-based studies using a random flap model found increased expression of VEGF and nitric oxide in the flaps of treatment groups. Several studies looked at shock wave therapy in burns, and noted decreased levels of pro-inflammatory mediators and a reduction in neutrophil migration to the wound site were associated with shock wave therapy.
Conclusions:
While shock wave therapy appears to be beneficial in the treatment of wounds, flaps, and burns, there are a number of issues that still need to be addressed. Perhaps most importantly, there is no agreement on the actual administration of shock wave therapy. Further studies are necessary to determine the optimal type of shock waves (i.e. focused vs. unfocused), total number of impulses, energy flux density, and frequency of therapy. More investigations are needed to determine the effects of shock wave therapy in specific types of wounds and the subsets of patients who could most benefit from the therapy.