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Scott HC, Robinson LS, Brown T. Scar massage as an intervention for post-surgical scars: A practice survey of Australian hand therapists. HAND THERAPY 2024; 29:21-29. [PMID: 38434186 PMCID: PMC10901164 DOI: 10.1177/17589983231205666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/19/2023] [Indexed: 03/05/2024]
Abstract
Introduction Scar massage is a commonly used treatment in hand therapy. The current empirical evidence that supports it is disparate and of variable quality, with no established effective dosage and method proposed. This study aimed to identify the current practice among Australian hand therapists using massage as an intervention for scarring following surgery to the hand and upper limb. Methods A purposely designed self-report online survey was emailed to current members of the Australian Hand Therapy Association (n = 958). Data collected included demographics, intervention techniques, conditions treated and protocols, scar assessment and knowledge and training about scar massage as a clinical intervention. Results A total of 116 completed questionnaires were received (a response rate of 12.1%). All respondents used scar massage as part of their clinical practice with 98% to improve soft tissue glide (n = 114), 92% for hypersensitivity (n = 107), and 84% to increase hand function (n = 97). Only 18% (n = 21) of respondents used standardised outcome measures, and most therapists had learned scar massage from a colleague (81%). Conclusions Commonalities in how respondents implemented scar massage were found. Participants reported relying primarily on clinical experience to inform their practice. Whilst scar massage was widely used, few respondents had received formal skills training or completed outcome measures regularly to formally evaluate its clinical efficacy or impact. Replication of this study with a larger international sample of participants is warranted to determine if these findings reflect general practice.
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Affiliation(s)
- Helen C Scott
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, VIC, Australia
- Department of Occupational Therapy, Alfred Health, Melbourne, VIC, Australia
| | - Luke S Robinson
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, VIC, Australia
| | - Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, VIC, Australia
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Wang Y, Hua Z, Tang L, Song Q, Cui Q, Sun S, Yuan Y, Zhang L. Therapeutic implications of extracorporeal shock waves in burn wound healing. J Tissue Viability 2024; 33:96-103. [PMID: 38155029 DOI: 10.1016/j.jtv.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/24/2023] [Accepted: 12/22/2023] [Indexed: 12/30/2023]
Abstract
Burns are a common type of trauma that seriously affect not only the physical health, but also the mental health and quality of life of the patient. Extracorporeal shock wave therapy (ESWT) is an emerging treatment that has been used in clinical treatment. It has many advantages, including safety, non-invasiveness, efficiency, short treatment duration, fewer complications, and relatively low prices. In clinical settings, ESWT has played an important role in the healing process of burns and the prevention of sequelae. This article reviews the history of ESWT, the mechanism of ESWT to promote burn healing, and the application of ESWT in burns. Current status of ESWT treatment for burns as well as future perspectives for research have been summarized and proposed. However, patients with burns cannot be considered recovered when the wounds have healed, we need some new technology to adjust to the challenges of the future.
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Affiliation(s)
- Yashi Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Zuoyu Hua
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Liang Tang
- Department of Rehabilitation Medicine, Anshan Central Hospotal (6 Th Clinical College of China Medical University), Anshan, Liaoning Province, 114001, China
| | - Qifeng Song
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Qian Cui
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Shi Sun
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Yin Yuan
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China.
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Fang Z, Li J, Wang K, He T, Wang H, Xie S, Yang X, Han J. Autologous Scar-Related Tissue Combined with Skin Grafting for Reconstructing Large Area Burn Scar. J INVEST SURG 2022; 35:1779-1788. [PMID: 35853786 DOI: 10.1080/08941939.2022.2101164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study introduced a novel method to reconstruct large areas of scarring caused by burns via combining autologous scar-related tissue with spit-thickness skin grafting (ASTCS). METHODS 25 patients underwent reconstruction after scar resection surgeries around the joints were analyzed between Jan 2012 and Jan 2018. Patient demographics and clinical parameters were collected, autologous scar-related tissue was modified to meshed structure, and the split-thickness skin was acquired from the scalp. The scar was resected and punched by a meshing machine with a thickness of 0.3-0.5 mm at a ratio of 1:1. The secondary wounds were covered by the epidermis from a donor site. The surgical areas were bandaged for 7-10 days before the first dressing change. RESULTS 25 patients (mean [SD] age, 26.4 [18.8] years; 16 [64%] men) underwent wounds reconstructive operations due to scar resection were reviewed. Wound location of 9 (22%), 8 (19.5%), 9 (22%), 7 (17.1%) and 8 (19.5%) cases were reconstructed in axillary, hand and wrist, popliteal fossa, elbow and neck, respectively. 39 sites of transplanted tissues survived well, and 2 sites were cured after two weeks of dressing changes. Except the analysis of injury causes, nutritional status, wound area and hospital days, patients with scar deformities in joint areas achieved satisfactory function by assessing the Vancouver Burn Skin Score and the Barthel Index Scale Scores after 12-month follow-up. CONCLUSIONS Combining autologous scar-related tissue with skin grafting provided a novel method for treating large areas of burn scars with better functional outcomes.
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Affiliation(s)
- Zhuoqun Fang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, China.,Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jun Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, China
| | - Kejia Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, China
| | - Ting He
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, China
| | - Hongtao Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, China
| | - Songtao Xie
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, China
| | - Xuekang Yang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, China
| | - Juntao Han
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shanxi, China
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Is massage an effective intervention in the management of post-operative scarring? A scoping review. J Hand Ther 2022; 35:186-199. [PMID: 35227556 DOI: 10.1016/j.jht.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/21/2021] [Accepted: 01/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Scar massage is a widely used treatment modality in hand therapy. This intervention is thoroughly discussed in the literature relating to burns rehabilitation, however, the evidence for its use in treating linear scars following surgery is limited. PURPOSE OF STUDY To collate the empirical literature on scar massage for the treatment of postsurgical cutaneous scars. STUDY DESIGN Scoping review. METHODS Medline, EMBASE, CINAHL, AMED, Scopus, ProQuest Dissertations & Theses Global, and the Joanna Briggs Institute were searched from inception to December 2020. Two researchers used a data extraction tool to record key demographic, intervention and outcome data, and to apply the Oxford Levels of Evidence for each study. RESULTS Twenty-five studies met the inclusion criteria, reporting on a combined sample of 1515 participants. Only two papers addressed hand or wrist scars (92 participants). While all studies reported favorable outcomes for scar massage, there were 45 different outcome measures used and a propensity towards non-standardized assessment. Intervention protocols varied from a single session to three treatments daily for 6 months. The results from 13 studies were confounded by the implementation of additional rehabilitation interventions. CONCLUSIONS The overall findings suggest that while there may be benefits to scar massage in reducing pain, increasing movement and improving scar characteristics; there is a lack of consistent research methods, intervention protocols and outcome measures. This scoping review highlights the heterogenous nature of research into scar massage following surgery and supports the need for further research to substantiate its use in the clinical setting.
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Yang Y, Kang J, Jiang T, Schmitz C, Weng C, Zhang L. Safety and efficacy of treating post-burn pathological scars with extracorporeal shock wave therapy: A meta-analysis of randomised controlled trials. Wound Repair Regen 2022; 30:595-607. [PMID: 35691021 DOI: 10.1111/wrr.13037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
The clinical application of shockwave therapy has expanded to the treatment of pathological scars. The objective of this systematic review and meta-analysis is to quantitatively evaluate the efficacy and safety of extracorporeal shockwave therapy combined with comprehensive rehabilitation therapy on post-burn pathological scars compared to comprehensive rehabilitation therapy alone. The randomised controlled trials of extracorporeal shockwave therapy for post-burn pathological scars published in English and Chinese languages before October 2021 were included. The methodological quality and risk of bias of the selected articles were assessed with the Cochrane Collaboration's 'risk of bias' tool. RevMan software was applied for data analysis. This is the first systematic review and meta-analysis considering the effectiveness and safety of extracorporeal shockwave therapy on post-burn pathological scars. And nine randomised controlled trials involving 422 patients were included in this meta-analysis. The meta-analysis results showed that, compared with comprehensive rehabilitation therapy alone, extracorporeal shockwave therapy combined with comprehensive rehabilitation therapy was more effective in relieving pain (standardized mean difference [SMD] = -0.59, 95% confidence interval [CI]: [-0.87 to -0.31], p < 0.0001) and pruritus related to pathological scars (SMD = -0.94; 95% CI: [-1.25 to -0.63], p = 0.004), improving scars' appearance (SMD = -1.78, 95% CI: [-3.37 to -0.19], p = 0.03) and elasticity (SMD = 0.25, 95% CI: [0.29-0.21], p < 0.00001), decreasing scars thickness (SMD = -0.13, 95% CI: [-0.25 to -0.01], p = 0.04) and promoting the maturation status of scars (SMD = -2.86, 95% CI: [-3.96 to -1.76], p < 0.00001). There were no reported serious adverse events during and after extracorporeal shockwave therapy in the included studies. Available data preliminarily suggested that the combination of extracorporeal shockwave therapy and comprehensive rehabilitation therapy had better therapeutic effect on post-burn pathological scars than comprehensive rehabilitation therapy alone, without obvious side effects. However, further clinical well-controlled randomised controlled trials are needed. Systematic review registration ID: PROSPERO CRD42022297573.
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Affiliation(s)
- Yanhui Yang
- Department of Cardiology, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Haidian District, Beijing, China.,Chinese PLA Medical School, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Jingwen Kang
- Department of Rehabilitation Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Tianyu Jiang
- Department of Rehabilitation Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Christoph Schmitz
- Extracorporeal Shock Wave Research Unit, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Changshui Weng
- Department of Rehabilitation Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Li Zhang
- Department of Rehabilitation Medicine, the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Haidian District, Beijing, China
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Kaya Şimşek E, Haberal B, Korkmaz Kasap Y, Yurtcu E. Could radial extracorporeal shock wave therapy have an effect on wound healing in clinical practice by creating genotoxic damage? An in vitro study in mouse fibroblasts. Jt Dis Relat Surg 2021; 32:658-667. [PMID: 34842098 PMCID: PMC8650679 DOI: 10.52312/jdrs.2021.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/04/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: This study aims to evaluate wound healing effects of in vitro radial extracorporeal shock wave (rESW) application on mouse fibroblasts and whether the cytotoxic effect of extracorporeal shock wave (ESW) was due to a possible genotoxic effect. Patients and methods: After creating an in vitro wound healing model in L929 mouse fibroblast culture, fibroblasts were stimulated with a frequency of 3 Hz, and 100, 250, 500, 1,000 and 1,500 pulses shock waves were applied. Energy flux densities ranging from 0.01 to 0.23 mJ/mm2 (14.3 MPa) at a constant pressure level of 0.5 and 1 bar were applied. Wound healing, cell viability, and genotoxicity were evaluated at 24 and 48 h. Results: All shot numbers for both pressures significantly reduced cell viability (p<0.05). For both 0.5 and 1 bar pressures, in both intervals, the rate of wound healing decreased, regardless of the number of shots (p<0.05). In vitro genotoxic damage was detected at both 0.5 and 1 bar pressures, in both time intervals, regardless of the number of shots. The genotoxic damage increased from 24 to 48 h. Conclusion: The study results suggest that, when ESWT is applied in this in vitro experimental setup, cell viability decreases and wound healing is delayed under all conditions. Furthermore, genotoxic damage can be prevented by using shots below 1,000 pulses. Therefore, while investigating the therapeutic effect of ESW therapy in vitro, the upper limit for the number of shots should be 1,000 pulses.
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Affiliation(s)
| | - Bahtiyar Haberal
- Başkent Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 06490 Bahçelievler, Ankara, Türkiye.
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Dellanna L, Hirche F, Capra V. Successful Treatment of Recurrent Dermatitis after Physalia physalis (Portuguese Man O' War) Envenomation with Extracorporeal Shock Wave Therapy. Case Rep Dermatol 2021; 13:202-208. [PMID: 34703428 PMCID: PMC8488417 DOI: 10.1159/000513367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/25/2020] [Indexed: 01/22/2023] Open
Abstract
For more than 3 decades, extracorporeal shock wave therapy (ESWT) has been clinically implemented in urologic and orthopaedic indications. Here, we present the case of a patient with envenomation from a highly toxic jellyfish-like siphonophore (Physalia physalis) with a toxic contact dermatitis resulting in chronic eruptive skin lesions. The skin lesions on the dorsal right hand lasted more than 16 weeks and were refractive to local cortisone treatment. They finally healed after 8 applications of low-energy planar/defocused ESWT over 4 weeks. In detail, the clinical course, ESWT specifications and the possible mechanisms of ESWT in the light of the current literature are discussed. Our case indicates that ESWT is an underestimated, promising non-invasive, non-immunosuppressive treatment for chronic eruptive skin lesions after jellyfish or related toxin envenomations.
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Affiliation(s)
| | | | - Vasile Capra
- Institute for Physical Therapy in Braunsfeld, Cologne, Germany
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Extracorporeal shock wave therapy as a bet for the treatment of burn patients. Burns 2021; 47:1460-1461. [PMID: 33994223 DOI: 10.1016/j.burns.2021.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
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Impact of radial extracorporeal shock wave therapy in post-laminectomy epidural fibrosis in a rat model. Jt Dis Relat Surg 2021; 32:162-169. [PMID: 33463432 PMCID: PMC8073443 DOI: 10.5606/ehc.2021.77870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to investigate the effect of radial extracorporeal shock wave therapy (rESWT) treatment in the prevention of epidural fibrosis after laminectomy in rats. Materials and methods
Eighteen 16-month-old male Sprague-Dawley rats weighing 300 g were used in this experimental study between November 2019 and February 2020. The rats were randomly divided into two groups as the control group (L3-L4 total laminectomy without any treatment) and the study group (L3-L4 total laminectomy plus rESWT). The rats were sacrificed at the postoperative sixth week and the lumbar spine was excised en bloc, fixed, and decalcified. Sections were stained with hematoxylin-eosin to evaluate epidural fibrosis, acute inflammation, chronic inflammation, and vascular proliferation. Results
The median value and standard deviations were obtained based on histological examinations. Accordingly, epidural fibrosis decreased significantly in the study group compared to the control group. There was no statistically significant difference between the groups in terms of acute and chronic inflammation response and vascular proliferation. Conclusion
The rESWT application immediately after surgery is effective in preventing epidural fibrosis after laminectomy in rats.
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Lee SY, Joo SY, Cho YS, Hur GY, Seo CH. Effect of extracorporeal shock wave therapy for burn scar regeneration: A prospective, randomized, double-blinded study. Burns 2020; 47:821-827. [PMID: 32917473 DOI: 10.1016/j.burns.2020.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE This study aimed to investigate the regeneration effect of extracorporeal shock wave therapy (ESWT) on hypertrophic scar regeneration using objective measurements. METHODS This was a double-blinded, randomized, controlled trial of 48 participants who had undergone autologous split-thickness skin grafting (STSG) with same artificial dermis. The ESWT group (n=25) received shock waves with low-energy flux density (0.05-0.30mJ/mm2). The interval between treatments is a 1-week. The ESWT group also received recommended treatment. The control group (n=23) only received standard treatment. We measured skin characteristics before treatment and after 6 weeks for both groups. RESULTS No significant intergroup difference was noted at the initial evaluations (p>0.05). The pre- to post-treatment change in the scar thickness (p=0.03) and erythema (p=0.03), greater reduction was found in the ESWT group than control group. The pre- to post-treatment change in the sebum level (p=0.02), more increase was found in the ESWT group. We found no significant differences in the change measurements between the two groups for melanin levels (p=0.62) and transepidermal water loss (TEWL) (p=0.94). The changes (skin distensibility, biological skin elasticity, gross skin elasticity, and skin viscoelasticity) measured with the Cutometer showed no significant differences between the two groups (p=0.87, p=0.32, p=0.37, and p=0.29, respectively). CONCLUSION This is the first report of ESWT on hypertrophic scar after burn using objective tools (melanin, erythema, sebum, TEWL, elasticity and thickness). ESWT has objective beneficial effects on burn-associated scar characteristics.
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Affiliation(s)
- Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Gi Yeun Hur
- Department of plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea.
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Kim DH, Han SH, Suh HS, Choi YS. Benefits of extracorporeal shock waves for keloid treatment: A pilot study. Dermatol Ther 2020; 33:e13653. [DOI: 10.1111/dth.13653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Dong Hee Kim
- Department of Dermatology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
| | - Seok Hyun Han
- Department of Dermatology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
| | - Ho Seok Suh
- Department of Dermatology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
| | - Yu Sung Choi
- Department of Dermatology Ulsan University Hospital, University of Ulsan College of Medicine Ulsan South Korea
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Clinical Utility of Extracorporeal Shock Wave Therapy on Hypertrophic Scars of the Hand Caused by Burn Injury: A Prospective, Randomized, Double-Blinded Study. J Clin Med 2020; 9:jcm9051376. [PMID: 32392796 PMCID: PMC7290924 DOI: 10.3390/jcm9051376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/29/2023] Open
Abstract
Postburn hypertrophic scarring is a common complication in burn injuries to the hands, often associated with impaired hand function. We evaluated the effects of extracorporeal shock wave therapy (ESWT), compared to a sham stimulation therapy, on hypertrophic scars of the hand caused by burn injury and investigated its effects on hand function. This was a double-blinded, randomized, controlled trial of 48 patients with a burn to their dominant right hand. The parameters of ESWT were as follows: energy flux density, 0.05–0.30 mJ/mm2; frequency, 4 Hz; 1000 to 2000 impulses per treatment; four treatments, once a week for four weeks. The outcomes measured were as follows: a 10-point visual analogue scale pain score; Vancouver scar scale for scar vascularity, height, pliability and pigmentation; ultrasound measurement of scar thickness; Jebsen−Taylor hand function test; grip strength; Perdue pegboard test; and the Michigan hand outcomes questionnaire. The change in the score from baseline to post-treatment was compared between the two groups. ESWT improved the pain score (p = 0.001), scar thickness (p = 0.018), scar vascularity (p = 0.0015), and improved hand function (simulated card-turning, p = 0.02; picking up small objects, p = 0.004). The other measured outcomes were not different between the two groups. ESWT is effective in decreasing pain, suppressing hypertrophic scarring, and improving hand function.
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Chan S. The effectiveness of extracorporeal shockwave therapy on hypertrophic scar appearance and hand mobility in a severe burn patient. BURNS OPEN 2020. [DOI: 10.1016/j.burnso.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Extracorporeal Shock Wave Therapy for Treating Foot Ulcers in Adults With Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Can J Diabetes 2020; 44:196-204.e3. [DOI: 10.1016/j.jcjd.2019.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022]
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Moortgat P, Anthonissen M, Van Daele U, Vanhullebusch T, Maertens K, De Cuyper L, Lafaire C, Meirte J. The effects of shock wave therapy applied on hypertrophic burn scars: a randomised controlled trial. Scars Burn Heal 2020; 6:2059513120975624. [PMID: 33312712 PMCID: PMC7716075 DOI: 10.1177/2059513120975624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION A wide variety of non-invasive treatments has been proposed for the management of hypertrophic burn scars. Unfortunately, the reported efficacy has not been consistent, and especially in the first three months after wound closure, fragility of the scarred skin limits the treatment options. Extracorporeal shock wave therapy (ESWT) is a new non-invasive type of mechanotherapy to treat wounds and scars. The aim of the present study was to examine the objective and subjective scar-related effects of ESWT on burn scars in the early remodelling phase. MATERIAL AND METHODS Evaluations included the Patient and Observer Scar Assessment Scale (POSAS) for scar quality, tri-stimulus colorimetry for redness, tewametry for trans-epidermal water loss (TEWL) and cutometry for elasticity. Patients were randomly assigned to one of two groups, the low-energy intervention group or the placebo control group, and were tested at baseline, after one, three and six months. All patients were treated with pressure garments, silicone and moisturisers. Both groups received the ESWT treatment (real or placebo) once a week for 10 weeks. RESULTS Results for 20 patients in each group after six months are presented. The objective assessments showed a statistically significant effect of ESWT compared with placebo on elasticity (P = 0.011, η2P=0.107) but revealed no significant effects on redness and TEWL. Results of the clinical assessments showed no significant interactions between intervention and time for the POSAS Patient and Observer scores. CONCLUSION ESWT can give added value to the non-invasive treatment of hypertrophic scars, more specifically to improve elasticity when the treatment was already started in the first three months after wound closure. LAY SUMMARY Pathological scarring is a common problem after a burn injury. A wide variety of non-invasive treatments has been proposed for the management of these scars. Unfortunately, the reported efficacy of these interventions has not been consistent, and especially in the first three months after wound closure, fragility of the scarred skin limits the treatment options. Extracorporeal shock wave therapy (ESWT) is a relatively new non-invasive therapy to treat both wounds and scars. The aim of the present study was to examine the scar-related effects of ESWT on burn scars in the early phase of healing.The scars were subjectively assessed for scar quality by the patient and an observer using the Patient and Observer Scar Assessment Scale (POSAS). Objective assessments included measurements to assess redness, water loss and elasticity. Forty patients were randomly assigned to one of two groups, the low-energy intervention group or the placebo control group (the device simulated the sound of an ESWT treatment but no real shocks were applied), and were tested at four timepoints up to six months. All patients were treated with pressure garments, silicone and moisturisers. Both groups received the ESWT treatment (real or placebo) once a week for 10 weeks.The objective assessments showed a significant improvement of elasticity in the intervention group when compared with placebo but revealed no significant effects on redness and water loss. Results of the clinical assessments showed no differences between the groups for the POSAS Patient and Observer scores.ESWT can give added value to the non-invasive treatment of pathological scars more specifically to improve elasticity in the early phase of healing.
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Affiliation(s)
| | - Mieke Anthonissen
- OSCARE, Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ulrike Van Daele
- OSCARE, Antwerp, Belgium
- University of Antwerp, Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
| | - Tine Vanhullebusch
- OSCARE, Antwerp, Belgium
- University of Antwerp, Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium
| | - Koen Maertens
- OSCARE, Antwerp, Belgium
- Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve De Cuyper
- OSCARE, Antwerp, Belgium
- ZNA Stuivenberg, Burns Center, Antwerp, Belgium
| | - Cynthia Lafaire
- OSCARE, Antwerp, Belgium
- ZNA Stuivenberg, Burns Center, Antwerp, Belgium
| | - Jill Meirte
- OSCARE, Antwerp, Belgium
- University of Antwerp, Rehabilitation Sciences and Physiotherapy, REVAKI-MOVANT, Antwerp, Belgium
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17
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Elnaggar RK, Samhan AF, Elshafey MA. Differential Effects of Extracorporeal Shockwave Therapy and Botulinum Toxin-A Injection on Postburn Contractures and Gait Kinematics in Burn Children. J Burn Care Res 2019; 41:612-618. [DOI: 10.1093/jbcr/irz212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Postburn contracture is a complex and multifactorial problem that requires intensive inputs from the burn care staff. This study endeavored to evaluate the effectiveness of extracorporeal shockwave therapy and botulinum toxin-A for treating the postburn plantar flexion contracture and optimizing ankle kinematics in burn children. Thirty-eight children with burns and plantar flexion contracture were randomized to receive the standard physical rehabilitation program (control group; n = 13), unfocused extracorporeal shockwave therapy (0.2 mJ/mm2) once a week over four consecutive weeks in addition to the standard physical rehabilitation (n = 12), or botulinum toxin-A injection (0.5–2 U/kg/muscle group with maximum dose of 12 U/kg/body weight) once at entry besides the standard physical rehabilitation (n = 13). Dorsiflexion active range of motion and ankle kinematics were measured before and immediately after treatment. The posttreatment dorsiflexion active range of motion increased significantly in the extracorporeal shockwave therapy group (P = .025) and botulinum toxin-A group (P = .04) when compared to the control group. Likewise, the initial stance–dorsiflexion, stance-maximum dorsiflexion, and swing-peak dorsiflexion angle improved significantly in the extracorporeal shockwave therapy group (P ˂ .001, P = .005, and P = .002, respectively) and botulinum toxin-A group (P = .004, P = .012, and P ˂ .001, respectively) compared to the control group. No significant differences were observed between the extracorporeal shockwave therapy and botulinum toxin-A groups with respect to any of the measured variables. To conclude, extracorporeal shockwave therapy and botulinum toxin-A injection could be effectively used to treat postburn plantar flexion contracture and to optimize the ankle kinematics during walking in children, without preference for either of them.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed F Samhan
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Egypt
| | - Mohammed A Elshafey
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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18
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Aguilera-Sáez J, Muñoz P, Serracanta J, Monte A, Barret JP. Extracorporeal shock wave therapy role in the treatment of burn patients. A systematic literature review. Burns 2019; 46:1525-1532. [PMID: 31387804 DOI: 10.1016/j.burns.2019.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/25/2019] [Accepted: 07/12/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Extracorporeal shock wave therapy (ESWT), first described in the eighties for the treatment of urolithiasis, has also been applied in other fields such as orthopaedics and chronic wound care. Recently it has also been used in the treatment of burns and its sequelae since several studies suggest it could be an important tool in the conservative management of these conditions. The aim of this article is to review the literature for published evidence on the use of ESWT for the treatment of acute burn patients and its sequelae and to elaborate a brief report on the current state of the matter. MATERIAL AND METHODS We carried on a search on PUBMED database and Cochrane database with the following terms: ('burns' [title/abstract] OR 'burn' [title/abstract]) AND "shock wave" ([title/abstract]). For an optimal reporting of the studies found we followed the PRISMA statement. RESULTS This search found 34 articles from which only 15 were actually related to the use of ESWT in burn patients. From these 15 articles, 7 involved the use of ESWT in the treatment of acute burns, 6 related to its application in post-burn scars, 1 in the treatment of heterotopic ossification and 1 was about the use of ESWT in skin-graft donor site. Except for the latter, all of them were carefully reviewed. CONCLUSION Scientific evidence on the use of ESWT for the treatment of burn patients is weak due to the paucity of studies and their low quality. However, ESWT seems to be a promising tool in this field and therefore more high-quality trials should be conducted.
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Affiliation(s)
- Jorge Aguilera-Sáez
- Department of Plastic Surgery and Burn Center, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Pablo Muñoz
- Department of Plastic Surgery and Burn Center, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jordi Serracanta
- Department of Plastic Surgery and Burn Center, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Alejandra Monte
- Department of Plastic Surgery and Burn Center, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Juan P Barret
- Department of Plastic Surgery and Burn Center, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Antonic V, Hartmann B, Balks P, Schaden W, Ottomann C. Extracorporeal shockwave therapy as supplemental therapy for closure of large full thickness defects—Rat full-thickness skin graft model. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.wndm.2017.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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20
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Zhao JC, Zhang BR, Hong L, Shi K, Wu WW, Yu JA. Extracorporeal shock wave therapy with low-energy flux density inhibits hypertrophic scar formation in an animal model. Int J Mol Med 2018; 41:1931-1938. [PMID: 29393337 PMCID: PMC5810209 DOI: 10.3892/ijmm.2018.3434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/23/2018] [Indexed: 01/08/2023] Open
Abstract
Hypertrophic scar is characterized by excessive deposits of collagen during skin wound healing, which could become a challenge to clinicians. This study assessed the effects of the extracorporeal shock wave therapy (ESWT) on hypertrophic scar formation and the underlying gene regu-lation. A rabbit ear hypertrophic scar model was generated and randomly divided into three groups: L-ESWT group to receive L-ESWT (energy flux density of 0.1 mJ/mm2), H-ESWT (energy flux density of 0.2 mJ/mm2) and sham ESWT group (S-ESWT). Hypertrophic scar tissues were then collected and stained with hematoxylin and eosin (H&E) and Masson's trichrome staining, respectively, to assess scar elevation index (SEI), fibroblast density and collagen fiber arrangement. Expression of cell proliferation marker proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) were assessed using RT-PCR and immunohistochemistry in hypertrophic scar tissues. H&E staining sections showed significant reduction of SEI and fibroblast density in both ESWT treatment groups compared to S-ESWT, but there was no dramatic difference between L-ESWT and H-ESWT groups. Masson's trichrome staining showed that collagen fibers were more slender and broader and oriented in parallel to skin surface after administration of ESWT compared to control tissues. At the gene level, PCNA‑positive fibroblasts and α-SMA-positive myofibroblasts were significantly decreased after L-ESWT or H-ESWT compared to the controls. Furthermore, there was no significant difference in expression of PCNA mRNA between L-ESWT or H-ESWT and S-ESWT, whereas expression of α-SMA mRNA significantly decreased in L-ESWT compared to that of H-ESWT and S-ESWT (P=0.002 and P=0.030, respectively). In conclusion, L-ESWT could be effective on suppression of hypertrophic scar formation by inhibition of scar elevation index and fibroblast density as well as α-SMA expression in hypertrophic scar tissues of the rabbit model.
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Affiliation(s)
- Jing-Chun Zhao
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Bo-Ru Zhang
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Lei Hong
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kai Shi
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wei-Wei Wu
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jia-Ao Yu
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Cui HS, Hong AR, Kim JB, Yu JH, Cho YS, Joo SY, Seo CH. Extracorporeal Shock Wave Therapy Alters the Expression of Fibrosis-Related Molecules in Fibroblast Derived from Human Hypertrophic Scar. Int J Mol Sci 2018; 19:ijms19010124. [PMID: 29301325 PMCID: PMC5796073 DOI: 10.3390/ijms19010124] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 01/13/2023] Open
Abstract
Extracorporeal shock wave therapy (ESWT) considerably improves the appearance and symptoms of post-burn hypertrophic scars (HTS). However, the mechanism underlying the observed beneficial effects is not well understood. The objective of this study was to elucidate the mechanism underlying changes in cellular and molecular biology that is induced by ESWT of fibroblasts derived from scar tissue (HTSFs). We cultured primary dermal fibroblasts derived from human HTS and exposed these cells to 1000 impulses of 0.03, 0.1, and 0.3 mJ/mm2. At 24 h and 72 h after treatment, real-time PCR and western blotting were used to detect mRNA and protein expression, respectively, and cell viability and mobility were assessed. While HTSF viability was not affected, migration was decreased by ESWT. Transforming growth factor beta 1 (TGF-β1) expression was reduced and alpha smooth muscle actin (α-SMA), collagen-I, fibronectin, and twist-1 were reduced significantly after ESWT. Expression of E-cadherin was increased, while that of N-cadherin was reduced. Expression of inhibitor of DNA binding 1 and 2 was increased. In conclusion, suppressed epithelial-mesenchymal transition might be responsible for the anti-scarring effect of ESWT, and has potential as a therapeutic target in the management of post-burn scars.
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Affiliation(s)
- Hui Song Cui
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea.
| | - A Ram Hong
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea.
| | - June-Bum Kim
- Department of Pediatrics, Hallym University Hangang Sacred Heart Hospital, Seoul 07247, Korea.
| | - Joo Hyang Yu
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea.
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea.
| | - So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea.
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 07247, Korea.
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Zhao JC, Zhang BR, Shi K, Wang J, Yu QH, Yu JA. Lower energy radial shock wave therapy improves characteristics of hypertrophic scar in a rabbit ear model. Exp Ther Med 2017; 15:933-939. [PMID: 29434689 PMCID: PMC5772977 DOI: 10.3892/etm.2017.5441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/02/2017] [Indexed: 12/16/2022] Open
Abstract
The aim of the present study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on scar characteristics and transforming growth factor (TGF)-β1/Smad signaling in order to explore a potential modality for the treatment of hypertrophic scars (HS). The HS model was generated in rabbit ears, then rabbits were randomly divided into 3 groups: Lower (L)-ESWT [treated with rESWT with lower energy flux density (EFD) of 0.1 mJ/mm2], higher (H)-ESWT (treated with a higher EFD of 0.18 mJ/mm2) and the sham ESWT group (S-ESWT; no ESWT treatment). Scar characteristics (wrinkles, texture, diameter, area, volume of elevation, hemoglobin and melanin) were assessed using the Antera 3D® system. The protein and mRNA expression of TGF-β1, Smad2, Smad3 and Smad7 was assessed by enzyme-linked immunosorbent assay and reverse transcription-quantitative polymerase chain reaction, respectively. The Antera 3D® results indicated that wrinkles and hemoglobin of the HS were significantly improved in both of the rESWT groups when compared with the S-ESWT group. However, these changes appeared much earlier in the L-ESWT group than the H-ESWT. Scar texture was also improved in the L-ESWT group. However, rESWT did not influence HS diameter, area, volume of elevation or melanin levels. rESWT had no effect on TGF-β1 or Smad7 expression in either of rESWT groups. Although no difference was observed in Smad2 mRNA expression in the L-ESWT group, the Smad3 mRNA and protein expression significantly decreased when compared with the H-ESWT and S-ESWT groups. By contrast, Smad2 and Smad3 mRNA expression were upregulated in the H-ESWT group. These results demonstrated that rESWT with 0.1 mJ/mm2 EFD improved some characteristics of the HS tissue. Downregulation of Smad3 expression may underlie this inhibitory effect. Inhibition of the TGF-β1/Smad signal transduction pathway may be a potential therapeutic target for the management of HS.
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Affiliation(s)
- Jing-Chun Zhao
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Bo-Ru Zhang
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kai Shi
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jian Wang
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Qing-Hua Yu
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jia-Ao Yu
- Burns and Plastic Reconstruction Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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23
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Zhang L, Weng C, Zhao Z, Fu X. Extracorporeal shock wave therapy for chronic wounds: A systematic review and meta-analysis of randomized controlled trials. Wound Repair Regen 2017; 25:697-706. [PMID: 28759136 DOI: 10.1111/wrr.12566] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/29/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Li Zhang
- Department of Rehabilitation Medicine; Nan Lou of Chinese PLA General Hospital; Beijing China
| | - Changshui Weng
- Department of Rehabilitation Medicine; Nan Lou of Chinese PLA General Hospital; Beijing China
| | - Zhanbo Zhao
- School of Software and Microelectronics; Peking University; Beijing China
| | - Xiaobing Fu
- Wound Healing and Cell Biology Laboratory, the First Affiliated Hospital, Chinese PLA General Hospital; Trauma Center of Postgraduate Medical College; Beijing China
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