The Role of Extracorporeal Shock Wave Therapy and Manual Lymphatic Drainage in Chronic Ulcers Treatment

Abstract

Introduction: Chronic wounds are a major, functionally-limiting medical problem impairing quality of life for millions of people each year. Extracorporeal shock wave therapy (ESWT) may accelerate and improve wound repair. Some authors investigated the optimal session number of ESWT in rat models. Aim: Purpose of this study was to verify the effectiveness of two temporal modalities of ESWT administration in chronic ulcers. Materials and methods: 84 subjects with chronic ulcers were enrolled. They were divided into 2 groups according to the absence or presence of associated lymphedema. Each group was divided with a stratified randomization into two subgroups receiving the same total energy of ESWT (2640 Mj) but with different temporal modality during the week. Results: Our results show, at the end of the 5 weeks treatment, a statistically significant reductionof wounds area and pain in the groups which received the ESWT fractioned in 2 weekly steps (2 x 1320 Mj) and reduction of limb circumference in subjects with lymphedema. Discussion: By fractioning energy in 2 weekly steps probably there is greater regenerative activation. This type of application cannot be generalized, it could be a best choice in diabetic ulcers, even in the presence of lymphedema. The kwnoledge relative to the efficacy of ESWT in treatment of chronic wounds has had over the years a consolidation process, instead the modulation of time treatment can be considered as a new borders for clinical studies.