Extracorporeal Shockwave Therapy (ESWT) in an Outpatient Wound Care Clinic: Retrospective analysis of a non-invasive technology in the management of chronic wounds for wound bed preparation.

Introduction: Chronic wounds affect 6.5 million people in the US. [1]. They contribute significantly to lower limb amputations. Every 20 seconds a limb is amputated somewhere in the world due to diabetes.[2] Chronic wounds exert a heavy financial burden on our healthcare system. In the USA, total Medicare spending estimates for all wound types range from $28.1 - $96.8 billion. [3] When wounds fail to achieve significant healing after four weeks of the standard of care, reassessment of underlying pathology and consideration of the need for advanced wound therapies should be undertaken.[4] Wound Bed Preparation is a paradigm to optimize chronic wound treatment[5].ESWT has been shown to reduce wound dimensions and healing time in chronic wounds and should be considered as a valuable tool for wound bed preparation in selected wounds. Methods: Patients with chronic wounds presented to the outpatient wound care clinic. Patients who had wounds that were refractory to the standard of care for greater than 30 days were considered for ESWT. A total of 13 patients were selected and 18 wounds were followed. All patients had baseline wound measurements taken (length, width, and depth in cm). Pictures of the wounds were also taken at the time of the initial visit. Patients selected for ESWT received weekly treatments for a maximum recorded duration of 12 weeks. Prior to each weekly treatment, wound measurements were reassessed and recorded. Wound beds were cleansed according to the standard of care. Pictures of the wounds were taken every two weeks. ESWT in the form of focused electro-hydraulic acoustic pulses was applied. Results: In sum, 13 patients were followed with a total of 18 wounds treated. Out of these wounds, 10 wounds were healed in less than 12 weeks and 8 remaining open wounds continued treatment but did demonstrate significant wound dimension reduction during the first 12 weeks of treatment. Conclusion: Our small retrospective study showed a significant reduction in wound measurements and improvement in wound healing outcomes. ESWT could be a valuable tool in wound bed preparation for chronic wounds. Further research will be needed to validate our findings.