Extracorporeal Shockwaves Therapy

For Clinicians

Extrcorporeal Shockwaves Therapy (ESWT) achieves excellent results with Chronic & Acute wounds

Extracorporeal Shock Waves Therapy (ESWT) is a treatment for chronic non-healing and acute wounds which is used in many countries in mainland Europe, North America, and the Far East although is relatively new to the United Kingdom.

Many different types of wounds that can be successfully treated with ESWT including:

• Diabetic ulcers
• Arterial ulcers
• Pressure ulcers
• Vascular ulcers
• Post traumatic ulcers
• Burns 
• Trauma wounds
• Surgical wounds

ESWT is a proven technique with reported efficacy of up to 76%.  Where complete healing is not achieved, clinical studies record that wounds are smaller in size with less exudate, pain, need for antibiotics, and it is used as an effective wound management tool.

It is a quick and effective therapy which is virtually pain free, with a typical treatment taking about five minutes and being administered on average once every two weeks. 

ESWT works through an effect which causes an increase in growth factors within the wound (PNCA, VEGF, ENOS plus others) which leads to angiogenesis )the birth of new blood vessels) and neovascularisation (the growth of new blood vessels).  Many studies have been done demonstrating these effects.

The Advantages of ESWT

• It re-starts the healing process in chronic non healing wounds, giving patients hope that a non healing wound can if fact be healed
• It is quick procedure with the average wound taking 5 to 10 minutes to treat
• It is effective with a proven efficacy of up to 76% in chronic non healing wounds
• It is virtually pain free and well tolerated by patients
• Patients and clinicians start seeing results very quickly, with less swelling, less exudate, less pain, and visible healing
• Where complete healing is not achieved, it is used as a wound management tool; leading to the benefits of wounds which are in greater control with lower infection rates.
• In acute wounds, it reduces the need for antibiotics and / or surgical revision, and increases the rate of healing

Treatment Protocol

The amount of ESWT treatment is dependant on the wound size, with a typical wound taking in the region of 5 minutes treatment time. This would normally be applied about once every two weeks. It is not painful for the patient. Sterile ultrasound gel is applied to the wound, followed by a sterile plastic sheet. The shock wave probe is then applied over this and the wound is treated with a pre-calculated number of pulses dependent on wound size.

Clinical Evidence

Many papers have been written from around the world, and randomised control trials are included in these.  In the UK, The NHS is Aberdeen are pioneering this treatment and have published results at the Royal Society of Medicine, The Charing Cross Symposium, and The Vascular Society Conference.  A selection is listed below: 

Dumfarth – Wound Healing after Vein Harvesting – Randomised Control Trial

This is a randomised study where ESWT was applied immediately after vein harvesting was completed. 

The results are significant showing improved healing times and a large drop in the need for treatment with antibiotics (from 22% to 4%).  There was also a significant decrease in the need for surgical revisions which dropped from 10% to 2%.

Wang – Diabetic Foot Ulcers – Randomised Control Trial

This study comes from Taiwan and is a randomised trial comparing ESWT with Hyperbaric Oxygen Therapy (HBO).  It also looks in detail at the histological effects and measures the increase in growth factors in the ESWT group.  Professor Wang has done many ESWT studies including looking at the histology of wounds and bone. 

This reports that the ESWT group show significantly better clinical results and local blood perfusion, higher cell concentration and activity than the HBO group.  Significant increases in growth factors are also recorded. 

It also demonstrates significantly better results using ESWT over HBO, with the number of ulcers completely healed 50% greater with ESWT over HBO.

Saggini – ESWT in Chronic Ulcers

This is not a randomised trial, and despite this gives very interesting results.  It reports in detail how chronic wounds respond to ESWT; the results gained are excellent. 

50% of the patients treated with ESWT showed complete healing within 6 sessions, and when compared to the control group it shows a statistical significant improvement in the healing process.  The types of wounds were non-responding chronic posttraumatic, venous, or diabetic ulcers.

In the non healed wounds treated with ESWT, reductions in exudates, increased percentage of granulation tissue compared to fibrin / necrotic tissue, and decrease in wounds’ size were statistically significant after 4 to 6 sessions of ESWT.  Significant decrease in pain was also reported.

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