Mittermayr et al. 2012
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Mittermayr R, Antonic V, Hartinger J, Kaufmann H, Redl H, Téot L, Stojadinovic A, Schaden W. Extracorporeal shock wave therapy (ESWT) for wound healing: technology, mechanisms, and clinical efficacy. Wound Repair Regen. 2012 Jul-Aug;20(4):456-65.
• Shock waves used in treating problematic wounds were not determined to be destructive, rather they have been shown to induce/normalize biological responses, which stimulate and support tissue repair and regeneration. • Although the mechanism of action is still under investigation, it was shown that the physical properties of shock waves are translated to complex biological responses including release of factors, cytokine, and chemokines involved in enhanced tissue perfusion and angiogenesis, both essential for the wound healing cascade. • Increase in platelet-cell adhesion molecule 1 (PECAM-1) expression – critically involved in trans- endothelial migration processes at inflammatory sites, endothelial cell migration and the formation of new blood vessels. • Single ESWT treatment turned on/augmented, for a prolonged period, 25 – 30 key pro-angiogenic genes that were previously silent in both a diabetic model and in normal healing wound • Chronic inflammation and bacterial burden also negatively affect wound healing and, therefore, the suppression of pro-inflammatory status as well as the antimicrobial effect of shock waves could further lead to improved wound healing: • In vivo studies have displayed enhanced early local inflammatory responses (high levels of macrophage-derived inflammatory protein [MIP]-1a and MIP-1b) in sham-treated animals when compared with ESWT-treated grafts. • Shockwaves significantly reduced leukocyte and macrophage infiltration into the isograft; these are pivotal cells in the inflammatory response. • A study showed that the bacterial burden in wounds was statistically reduced in a patient population receiving ESWT treatment. • The application of shock waves to wounds is technically easy to perform, allows treatment in an outpatient setting (well tolerated without the need for analgesia), saves time, and does not require anaesthetics.
Key message: Potential mechanisms by which shock wave treatment exerts its therapeutic effects 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.
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