Chronic Ulcers: Treatment with Unfocused Extracorporeal Shock Waves

Abstract

The aim of this study was to evaluate the efficacy of the treatment of chronic ulcers with unfocused shock waves. Between March 2009 and February 2012 we studied a group of 124 patients, aged between 28 and 80 years, with serious wounds arisen over three months and who met the inclusion criteria for treatment. The patients were randomly divided into groups A and B, both treated with unfocused ESWT but with an average energy density for each impulse equal to 0.10 mJ/mm2 in group A (total energy equal to 1.7 mJ for each shot) and an average energy density for each impulse equal to 0.04 mJ/mm2 in group B (total energy equal to 3.3 mJ for each shot). The pulses were administered at a frequency of 4 Hz in both groups. Wounds were classified according to: location, width, length, percentage of granulation tissue, necrotic tissue, fibrous tissue, presence of bacterial exudation and pain (assessed by VAS). Their evolution was monitored by photo capture. The patients were treated with a frequency of 1 session every 7 days for 7 weeks. During the treatment period, the possible occurrence of side effects was monitored. Before treatment the wounds in group A had an average area equal to 3.85 cm2 and the average value of the VAS pain scale was equal to 5.8 (range 2–9); the wounds in group B had an average area equal to 3.4 cm2 and the average value of the VAS pain scale was equal to 5.7 (range 3–9). At the end of the treatment protocol the mean area in group A decreased by 80% (final mean area 0.93 cm2), and the average pain on VAS scale dropped by 79%; the mean area in group B decreased by 67% (final mean area 1.2 cm2) and the average score on VAS scale dropped by 48%. None of the treated patients experienced adverse reactions to treatment. None of the treated wounds developed infection during treatment. In conclusion, shock waves can act on difficult wounds, stimulating the reparative physiological process; therefore it represents an effective and safe procedure to accelerate the healing process, reducing the operating costs and avoiding more complex interventions.