Extracorporeal ShockWave Therapy (ESWT) in Wound Care: State of the Art in Italy

Background: The contribution of technology and bioengineering in wound care is very high, especially in terms of physical therapies to reactivate “recalcitrant wounds”. Shockwaves (Extracorporeal ShockWave Therapy, ESWT) are among the most effective treatments for chronic ulcers.

Purpose: To demonstrate ESWT effectiveness in the treatment of any etiological type of “non responder” chronic wound especially in terms of tissue repair reactivation and healing time quickness.

Materials and methods: We evaluated 50 patients with chronic skin lesions divided into 4 groups (pressure ulcers, venous leg ulcers, diabetic foot lesions, inflammatory ulcers), not responding to ongoing treatments for at least 4 weeks. We used an electrohydraulic shock wave generator* (360 shocks/minute); 1000/2000 shocks,  once a week for 4 weeks. Post-treatment follow-up of 12 weeks. We evaluated if and when should begin the Tissue Repair Recovery (TRR), the Healing Rate (HR), the Wound Area Reduction (WAR) after 4 and 16 weeks and the Healing Time (HT).

Results: All wounds have been reactivated after the treatment: 80% after the first ESWT application. The mean WAR was more than 25% after the treatment and about 90% at the end of the follow-up with an HR of more than 0.110 cm/week. About 70% healed within the follow-up period (HT less than 100 days). 90% of the wounds with surgical indication (Dermis/Epidermis implant) completely healed without surgery.

Conclusions: ESWT showed to be truly effective in the treatment of chronic ulcers, regardless of the etiology of the lesions. The application lasts few minutes, doesn’t induce pain and promotes granulating tissue and epithelialization also in recalcitrant wounds from the first week of treatment. This therapy  allows an interesting cost-saving because the management costs are very cheap in comparison with the ones we usually have, due to the reduced Healing Time that ESWT can achieve.