Review Efficacy and Theoretical Basis of Low-Intensity Shock Wave Therapy in the Management of Different Forms of Wound Healing: Own Experiences and a Review of the Literature
Main Article Content
Abstract
Objectives: Wound healing is a complex process that involves inflammation, proliferation, and tissue remodeling to restore damaged tissue integrity. Chronic wounds and ulcers, with incomplete healing and a high risk of recurrence, pose significant challenges to conventional treatments. Extracorporeal Shock Wave Therapy (ESWT) has emerged as a promising wound healing therapy.
Material and Methods: In this review, we summarize the current state of ESWT for wound management based on personal experiences and a comprehensive literature review. Among 184 data sources from 1990 to 2022, 19 relevant publications were identified, including systematic reviews, meta-analyses, and clinical studies applying focused and radial ESWT for various wound types.
Results: ESWT's mechanism of action involves generating focused or radial shock waves, stimulating tissue repair through angiogenesis, fibroblast proliferation, and collagen expression. Data extracted from systematic reviews showed positive outcomes for wound healing, healing rate, and wound area reduction for chronic wounds such as diabetic foot ulcers, pressure ulcers, and venous ulcers. Studies on radial ESWT revealed similar positive effects in pain reduction and wound healing, with no serious adverse events reported. ESWT exhibited a well-tolerated safety profile, with minor and transient side effects such as reddening, swelling, and mild pain at the treatment site. Comparatively, Hyperbaric Oxygenation Therapy (HBO), an alternative treatment option, showed unique adverse events not observed with ESWT. Our evaluation confirms ESWT as a safe and effective treatment for wound management, offering hope for patients with chronic wounds or ulcers.
Conclusions: ESWT presents a compelling non-invasive and safe treatment option for various wound healing challenges, improving outcomes for patients with chronic wounds and ulcers. This review highlights the potential of ESWT as an advanced wound healing therapy, complementing conventional approaches. Further studies should explore potential differences between focal and radial ESWT for wound healing.
Keywords:
Extracorporeal shock wave therapy, radial shock waves, focused shock waves, Wound healing, Diabetic foot ulcers, venous leg ulcers, pressure ulcers, Fournier Gangrene, Stem cell activation
Article Details
How to Cite
RASSWEILER, Jens et al.
Review Efficacy and Theoretical Basis of Low-Intensity Shock Wave Therapy in the Management of Different Forms of Wound Healing: Own Experiences and a Review of the Literature.
Medical Research Archives, [S.l.], v. 11, n. 8, aug. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4394>. Date accessed: 04 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i8.4394.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Aldana, P.C. and A. Khachemoune, Diabetic Foot Ulcers: Appraising Standard of Care and Reviewing New Trends in Management. Am J Clin Dermatol, 2020. 21(2): p. 255-264.
2. Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev. 2018 Jun 15;6(6):CD012583. doi: 10.1002/14651858.CD012583.pub2. PMID: 29906322; PMCID: PMC6513558..
3. Westby MJ, Dumville JC, Soares MO, Stubbs N, Norman G. Dressings and topical agents for treating pressure ulcers. Cochrane Database Syst Rev. 2017 Jun 22;6(6):CD011947. doi: 10.1002/14651858.CD011947.pub2. PMID: 28639707; PMCID: PMC6481609.
4. Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015 Jun 24;2015(6):CD004123. doi: 10.1002/14651858.CD004123.pub4. PMID: 26106870; PMCID: PMC7055586.
5. Chaussy C, Brendel W, Schmiedt E: Extracorporeally induced destruction of kidney stones by shock waves. Lancet 1980; 2:1265-1268
6. Fuchs G, Miller K, Rassweiler J, Eisenberger F: Extracorporeal shock wave lithotripsy: One-year experience with the Dornier lithotripter. Eur Urol 1985; 11: 145-149
7. Rompe JD, Hopf C, Nafe B, Burger R. Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study. Arch Orthop Trauma Surg 1996; 115:75-79
8. Haupt G, Haupt A, Ekkernkamp A, Gerety B, Chvapil M. Influence of shock wave healing. Urology 1992; 39: 529-532
9. Schaden W, Thiele R, Kölpl C, Pusch M, Nissan A, Attinger CE, Maniscalco-Theberge ME, Peoples GE, Elster EA, Stojadinovic A. Shock wave therapy for acute and chronic soft tissue wounds: a feasibility study. J Surg Res. 2007;143(1):1-12
10. Mariotto, S.C., E.; Amelio, E.; Ciampa, A. R.; de Prati, A. C.; Marlinghaus, E.; Russo, S., Suzuki, H, Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide (Elsevier), 2005. 12(2): p. 89-96.
11. Kisch T, Wuerfel W, Forstmeier V, Liodaki E, Stang FH, Knobloch K, Mailaender P, Kraemer R. Repetitive shock wave therapy improves muscular microcirculation. J Surg Res. 2016 Apr;201(2):440-445. doi: 10.1016/j.jss.2015.11.049. Epub 2015 Nov
12. Serizawa F, Ito K, Matsubara M, Sato A, Shimokawa H, Satomi S. Extracorporeal shock wave therapy induces therapeutic lymphangiogenesis in a rat model of secondary lymphoedema. Eur J Vasc Endovasc Surg. 2011 Aug;42(2):254-260. doi: 10.1016/j.ejvs.2011.02.029. Epub 2011 Mar 31. PMID: 21454105.
13. Mariotto, S.d.P., A. C.; Cavalieri, E.; Amelio, E.; Marlinghaus, E. & Suzuki, H, Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Current Medicinal Chemistry (Bentham Science Publishers), 2009. 16(19): 2366-2372.
14. Frairia, R. and L. Berta, Biological effects of extracorporeal shock waves on fibroblasts. A review. Muscles Ligaments Tendons J, 2011. 1(4): 138-147.
15. Rassweiler JJ, Scheitlin W, Goezen AS, Rassweiler-Seyfried MC. Low-energy Shockwave Therapy in the Management of Wound Healing Following Fournier's Gangrene. Eur Urol Open Sci. 2022 Sep 13;45:8-11. doi: 10.1016/j.euros.2022.08.019. PMID: 36131850; PMCID: PMC9483798.
16. Rassweiler JJ, Knoll T, Köhrmann KU, McAteer JA, Lingeman JE, Cleveland RO, Bailey MR, Chaussy C: Shock wave technology and application – an update. Eur Urol 2011; 59: 784-796
17. Császár NB, Angstman NB, Milz S, Sprecher CM, Kobel P, Farhat M, Furia JP, Schmitz C. Radial Shock Wave Devices Generate Cavitation. PLoS One. 2015 Oct 28;10(10):e0140541. doi: 10.1371/journal.pone.0140541. PMID: 26509573; PMCID: PMC4625004.
18. Djedovic G, Kamelger FS, Jeschke J, Piza-Katzer H. Effect of extracorporeal shock wave treatment on deep partial-thickness burn injury in rats: a pilot study. Plast Surg Int. 2014;2014: 495967. doi: 10.1155/2014/495967. Epub 2014 Nov 6. PMID: 25431664; PMCID: PMC4241334.
19. Goertz O, Hauser J, Hirsch T, von der Lohe L, Kolbenschlag J, Stricker I, Lehnhardt M, Lauer H. Short-term effects of extracorporeal shock waves on microcirculation. J Surg Res. 2015 Mar;194(1):304-11. doi: 10.1016/j.jss.2014.10.018. Epub 2014 Oct 17. PMID: 25454971.
20. Stojadinovic A, Elster EA, Anam K, Tadaki D, Amare M, Zins S, Davis TA. Angiogenic response to extracorporeal shock wave treatment in murine skin isografts. Angiogenesis. 2008;11(4):369-80. doi: 10.1007/s10456-008-9120-6. Epub 2008 Nov 9. PMID: 18998221.
21. Kuo YR, Wang CT, Wang FS, Chiang YC, Wang CJ. Extracorporeal shock-wave therapy enhanced wound healing via increasing topical blood perfusion and tissue regeneration in a rat model of STZ-induced diabetes. Wound Repair Regen. 2009 Jul-Aug;17(4):522-30. doi: 10.1111/j.1524-475X.2009.00504.x. PMID: 19614917.
22. Hayashi D, Kawakami K, Ito K, Ishii K, Tanno H, Imai Y, Kanno E, Maruyama R, Shimokawa H, Tachi M. Low-energy extracorporeal shock wave therapy enhances skin wound healing in diabetic mice: a critical role of endothelial nitric oxide synthase. Wound Repair Regen. 2012 Nov-Dec;20(6):887-95. doi: 10.1111/j.1524-475X.2012.00851.x. Epub 2012 Oct 30. PMID: 23110611.
23. 23. Kuo YR, Wang CT, Wang FS, Yang KD, Chiang YC, Wang CJ. Extracorporeal shock wave treatment modulates skin fibroblast recruitment and leukocyte infiltration for enhancing extended skin-flap survival. Wound Repair Regen. 2009 Jan-Feb;17(1):80-7. doi: 10.1111/j.1524-475X.2008.00444.x. PMID: 19152654.
24. 24. 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. 2020 Nov;46(7):1525-1532. doi: 10.1016/j.burns.2019.07.023. Epub 2019 Aug 3. PMID: 31387804.
25. 25. 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 Sep;30(5):595-607. doi: 10.1111/wrr.13037. Epub 2022 Jun 23. PMID: 35691021.
26. 26 Omar MT, Gwada RF, Shaheen AA, Saggini R. Extracorporeal shockwave therapy for the treatment of chronic wound of lower extremity: current perspective and systematic review. Int Wound J. 2017 Dec;14(6):898-908. doi: 10.1111/iwj.12723. Epub 2017 Feb 15. PMID: 28198141; PMCID: PMC7950187.
27. Hitchman LH, Totty JP, Raza A, Cai P, Smith GE, Carradice D, Wallace T, Harwood AE, Chetter IC. Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Ann Vasc Surg. 2019 Apr;56:330-339. doi: 10.1016/j.avsg.2018.10.013. Epub 2018 Nov 26. PMID: 30496896.
28. Huang, Q., et al., 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(2): p. 196-204.e3.
29. Hitchman L, Totty J, Smith GE, Carradice D, Twiddy M, Iglesias C, Russell D, Chetter IC. Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review. Int Wound J. 2023 Aug;20(6):2303-2320. doi: 10.1111/iwj.14035. Epub 2022 Dec 3. PMID: 36461894; PMCID: PMC10332991.
30. Butterworth PA, Walsh TP, Pennisi YD, Chesne AD, Schmitz C, Nancarrow SA. The effectiveness of extracorporeal shock wave therapy for the treatment of lower limb ulceration: a systematic review. J Foot Ankle Res. 2015 Feb 5;8:3. doi: 10.1186/s13047-014-0059-0. PMID: 25722746; PMCID: PMC4342213.
31. Dymarek R, Halski T, Ptaszkowski K, Slupska L, Rosinczuk J, Taradaj J. Extracorporeal shock wave therapy as an adjunct wound treatment: a systematic review of the literature. Ostomy Wound Manage. 2014 Jul;60(7):26-39. PMID: 25019247.
32. Dolibog P, Franek A, Brzezińska-Wcisło L, Dolibog P, Wróbel B, Arasiewicz H, Chmielewska D. Shockwave therapy in selected soft tissue diseases: a literature review. J Wound Care. 2018 Sep 2;27(9):573-583. doi: 10.12968/jowc.2018.27.9.573. PMID: 30204576.
33. 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 Aug;25(4):697-706. doi: 10.1111/wrr.12566. Epub 2017 Oct 18. PMID: 28759136.
34. Zhang L, Fu XB, Chen S, Zhao ZB, Schmitz C, Weng CS. Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta-analysis. Int Wound J. 2018 Aug;15(4):590-599. doi: 10.1111/iwj.12902. Epub 2018 Apr 19. PMID: 29675986; PMCID: PMC7949564.
35. Taheri P, Shahbandari M, Parvaresh M, Vahdatpour B. Extracorporeal Shockwave Therapy for Chronic Venous Ulcers: A Randomized Controlled Trial. Galen Med J. 2021 Apr 25;10:e1931. doi: 10.31661/gmj.v10i0.1931. PMID: 35434156; PMCID: PMC8995091..
36. Chen J, Nie J. Effects of Extracorporeal Shock Wave Combined with Vivaphototherapy on Blood Perfusion, Inflammatory Response, and Prognosis in Burn Patients. Comput Math Methods Med. 2022 Mar 25;2022:1386875. doi: 10.1155/2022/1386875. PMID: 35371278; PMCID: PMC8975678.
37. 37. Dymarek R, Kuberka I, Rosińczuk J, Walewicz K, Taradaj J, Sopel M. The Immediate Clinical Effects Following a Single Radial Shock Wave Therapy in Pressure Ulcers: A Preliminary Randomized Controlled Trial of The SHOWN Project. Adv Wound Care (New Rochelle). 2023 Aug;12(8):440-452. doi: 10.1089/wound.2021.0015. Epub 2022 Oct 6. PMID: 35996355.
38. 38. Kang N, Yu X, Ma Y: Radial extracorporeal shock wave therapy in a patient with decubitus ulcer after spinal cord injury: a case report. Am J Transl Res, 2020. 12(5): 2093-2098.
39. ISMST, DIGEST Guidelines for Extracorporeal Shock Wave Therapy, in ESWT on the skin. 2019
40. Ottomann C, Hartmann B, Tyler J, Maier H, Thiele R, Schaden W, Stojadinovic A: Prospective Randomized Trial of Accelerated Re-epithelization of Skin Graft Donor Sites Using Extracorporeal Shock Wave Therapy. j.jamcollsurg.2010.05.012; ISSN 1072-7515/10/; doi:10.1016
41. Lin G, Van Kuiken M, Wang G, Banie L, Tan Y, Zhou F, Wang Z, Chen Y, Zhang Y, Lue TF. Microenergy acoustic pulse therapy restores function and structure of pelvic floor muscles after simulated birth injury. Transl Androl Urol. 2022 May;11(5):595-606. doi: 10.21037/tau-22-30.
42. Shin D, Jeon SH, Tian WJ, Kwon EB, Kim GE, Bae WJ, Cho HJ, Hong SH, Lee JY, Kim SW. Extracorporeal shock wave therapy combined with engineered mesenchymal stem cells expressing stromal cell-derived factor-1 can improve erectile dysfunction in streptozotocin-induced diabetic rats. Transl Androl Urol. 2021 Jun;10(6):2362-2372. doi: 10.21037/tau-21-79. PMID: 34295723; PMCID: PMC8261440.
2. Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev. 2018 Jun 15;6(6):CD012583. doi: 10.1002/14651858.CD012583.pub2. PMID: 29906322; PMCID: PMC6513558..
3. Westby MJ, Dumville JC, Soares MO, Stubbs N, Norman G. Dressings and topical agents for treating pressure ulcers. Cochrane Database Syst Rev. 2017 Jun 22;6(6):CD011947. doi: 10.1002/14651858.CD011947.pub2. PMID: 28639707; PMCID: PMC6481609.
4. Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015 Jun 24;2015(6):CD004123. doi: 10.1002/14651858.CD004123.pub4. PMID: 26106870; PMCID: PMC7055586.
5. Chaussy C, Brendel W, Schmiedt E: Extracorporeally induced destruction of kidney stones by shock waves. Lancet 1980; 2:1265-1268
6. Fuchs G, Miller K, Rassweiler J, Eisenberger F: Extracorporeal shock wave lithotripsy: One-year experience with the Dornier lithotripter. Eur Urol 1985; 11: 145-149
7. Rompe JD, Hopf C, Nafe B, Burger R. Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study. Arch Orthop Trauma Surg 1996; 115:75-79
8. Haupt G, Haupt A, Ekkernkamp A, Gerety B, Chvapil M. Influence of shock wave healing. Urology 1992; 39: 529-532
9. Schaden W, Thiele R, Kölpl C, Pusch M, Nissan A, Attinger CE, Maniscalco-Theberge ME, Peoples GE, Elster EA, Stojadinovic A. Shock wave therapy for acute and chronic soft tissue wounds: a feasibility study. J Surg Res. 2007;143(1):1-12
10. Mariotto, S.C., E.; Amelio, E.; Ciampa, A. R.; de Prati, A. C.; Marlinghaus, E.; Russo, S., Suzuki, H, Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide (Elsevier), 2005. 12(2): p. 89-96.
11. Kisch T, Wuerfel W, Forstmeier V, Liodaki E, Stang FH, Knobloch K, Mailaender P, Kraemer R. Repetitive shock wave therapy improves muscular microcirculation. J Surg Res. 2016 Apr;201(2):440-445. doi: 10.1016/j.jss.2015.11.049. Epub 2015 Nov
12. Serizawa F, Ito K, Matsubara M, Sato A, Shimokawa H, Satomi S. Extracorporeal shock wave therapy induces therapeutic lymphangiogenesis in a rat model of secondary lymphoedema. Eur J Vasc Endovasc Surg. 2011 Aug;42(2):254-260. doi: 10.1016/j.ejvs.2011.02.029. Epub 2011 Mar 31. PMID: 21454105.
13. Mariotto, S.d.P., A. C.; Cavalieri, E.; Amelio, E.; Marlinghaus, E. & Suzuki, H, Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Current Medicinal Chemistry (Bentham Science Publishers), 2009. 16(19): 2366-2372.
14. Frairia, R. and L. Berta, Biological effects of extracorporeal shock waves on fibroblasts. A review. Muscles Ligaments Tendons J, 2011. 1(4): 138-147.
15. Rassweiler JJ, Scheitlin W, Goezen AS, Rassweiler-Seyfried MC. Low-energy Shockwave Therapy in the Management of Wound Healing Following Fournier's Gangrene. Eur Urol Open Sci. 2022 Sep 13;45:8-11. doi: 10.1016/j.euros.2022.08.019. PMID: 36131850; PMCID: PMC9483798.
16. Rassweiler JJ, Knoll T, Köhrmann KU, McAteer JA, Lingeman JE, Cleveland RO, Bailey MR, Chaussy C: Shock wave technology and application – an update. Eur Urol 2011; 59: 784-796
17. Császár NB, Angstman NB, Milz S, Sprecher CM, Kobel P, Farhat M, Furia JP, Schmitz C. Radial Shock Wave Devices Generate Cavitation. PLoS One. 2015 Oct 28;10(10):e0140541. doi: 10.1371/journal.pone.0140541. PMID: 26509573; PMCID: PMC4625004.
18. Djedovic G, Kamelger FS, Jeschke J, Piza-Katzer H. Effect of extracorporeal shock wave treatment on deep partial-thickness burn injury in rats: a pilot study. Plast Surg Int. 2014;2014: 495967. doi: 10.1155/2014/495967. Epub 2014 Nov 6. PMID: 25431664; PMCID: PMC4241334.
19. Goertz O, Hauser J, Hirsch T, von der Lohe L, Kolbenschlag J, Stricker I, Lehnhardt M, Lauer H. Short-term effects of extracorporeal shock waves on microcirculation. J Surg Res. 2015 Mar;194(1):304-11. doi: 10.1016/j.jss.2014.10.018. Epub 2014 Oct 17. PMID: 25454971.
20. Stojadinovic A, Elster EA, Anam K, Tadaki D, Amare M, Zins S, Davis TA. Angiogenic response to extracorporeal shock wave treatment in murine skin isografts. Angiogenesis. 2008;11(4):369-80. doi: 10.1007/s10456-008-9120-6. Epub 2008 Nov 9. PMID: 18998221.
21. Kuo YR, Wang CT, Wang FS, Chiang YC, Wang CJ. Extracorporeal shock-wave therapy enhanced wound healing via increasing topical blood perfusion and tissue regeneration in a rat model of STZ-induced diabetes. Wound Repair Regen. 2009 Jul-Aug;17(4):522-30. doi: 10.1111/j.1524-475X.2009.00504.x. PMID: 19614917.
22. Hayashi D, Kawakami K, Ito K, Ishii K, Tanno H, Imai Y, Kanno E, Maruyama R, Shimokawa H, Tachi M. Low-energy extracorporeal shock wave therapy enhances skin wound healing in diabetic mice: a critical role of endothelial nitric oxide synthase. Wound Repair Regen. 2012 Nov-Dec;20(6):887-95. doi: 10.1111/j.1524-475X.2012.00851.x. Epub 2012 Oct 30. PMID: 23110611.
23. 23. Kuo YR, Wang CT, Wang FS, Yang KD, Chiang YC, Wang CJ. Extracorporeal shock wave treatment modulates skin fibroblast recruitment and leukocyte infiltration for enhancing extended skin-flap survival. Wound Repair Regen. 2009 Jan-Feb;17(1):80-7. doi: 10.1111/j.1524-475X.2008.00444.x. PMID: 19152654.
24. 24. 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. 2020 Nov;46(7):1525-1532. doi: 10.1016/j.burns.2019.07.023. Epub 2019 Aug 3. PMID: 31387804.
25. 25. 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 Sep;30(5):595-607. doi: 10.1111/wrr.13037. Epub 2022 Jun 23. PMID: 35691021.
26. 26 Omar MT, Gwada RF, Shaheen AA, Saggini R. Extracorporeal shockwave therapy for the treatment of chronic wound of lower extremity: current perspective and systematic review. Int Wound J. 2017 Dec;14(6):898-908. doi: 10.1111/iwj.12723. Epub 2017 Feb 15. PMID: 28198141; PMCID: PMC7950187.
27. Hitchman LH, Totty JP, Raza A, Cai P, Smith GE, Carradice D, Wallace T, Harwood AE, Chetter IC. Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Ann Vasc Surg. 2019 Apr;56:330-339. doi: 10.1016/j.avsg.2018.10.013. Epub 2018 Nov 26. PMID: 30496896.
28. Huang, Q., et al., 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(2): p. 196-204.e3.
29. Hitchman L, Totty J, Smith GE, Carradice D, Twiddy M, Iglesias C, Russell D, Chetter IC. Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review. Int Wound J. 2023 Aug;20(6):2303-2320. doi: 10.1111/iwj.14035. Epub 2022 Dec 3. PMID: 36461894; PMCID: PMC10332991.
30. Butterworth PA, Walsh TP, Pennisi YD, Chesne AD, Schmitz C, Nancarrow SA. The effectiveness of extracorporeal shock wave therapy for the treatment of lower limb ulceration: a systematic review. J Foot Ankle Res. 2015 Feb 5;8:3. doi: 10.1186/s13047-014-0059-0. PMID: 25722746; PMCID: PMC4342213.
31. Dymarek R, Halski T, Ptaszkowski K, Slupska L, Rosinczuk J, Taradaj J. Extracorporeal shock wave therapy as an adjunct wound treatment: a systematic review of the literature. Ostomy Wound Manage. 2014 Jul;60(7):26-39. PMID: 25019247.
32. Dolibog P, Franek A, Brzezińska-Wcisło L, Dolibog P, Wróbel B, Arasiewicz H, Chmielewska D. Shockwave therapy in selected soft tissue diseases: a literature review. J Wound Care. 2018 Sep 2;27(9):573-583. doi: 10.12968/jowc.2018.27.9.573. PMID: 30204576.
33. 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 Aug;25(4):697-706. doi: 10.1111/wrr.12566. Epub 2017 Oct 18. PMID: 28759136.
34. Zhang L, Fu XB, Chen S, Zhao ZB, Schmitz C, Weng CS. Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta-analysis. Int Wound J. 2018 Aug;15(4):590-599. doi: 10.1111/iwj.12902. Epub 2018 Apr 19. PMID: 29675986; PMCID: PMC7949564.
35. Taheri P, Shahbandari M, Parvaresh M, Vahdatpour B. Extracorporeal Shockwave Therapy for Chronic Venous Ulcers: A Randomized Controlled Trial. Galen Med J. 2021 Apr 25;10:e1931. doi: 10.31661/gmj.v10i0.1931. PMID: 35434156; PMCID: PMC8995091..
36. Chen J, Nie J. Effects of Extracorporeal Shock Wave Combined with Vivaphototherapy on Blood Perfusion, Inflammatory Response, and Prognosis in Burn Patients. Comput Math Methods Med. 2022 Mar 25;2022:1386875. doi: 10.1155/2022/1386875. PMID: 35371278; PMCID: PMC8975678.
37. 37. Dymarek R, Kuberka I, Rosińczuk J, Walewicz K, Taradaj J, Sopel M. The Immediate Clinical Effects Following a Single Radial Shock Wave Therapy in Pressure Ulcers: A Preliminary Randomized Controlled Trial of The SHOWN Project. Adv Wound Care (New Rochelle). 2023 Aug;12(8):440-452. doi: 10.1089/wound.2021.0015. Epub 2022 Oct 6. PMID: 35996355.
38. 38. Kang N, Yu X, Ma Y: Radial extracorporeal shock wave therapy in a patient with decubitus ulcer after spinal cord injury: a case report. Am J Transl Res, 2020. 12(5): 2093-2098.
39. ISMST, DIGEST Guidelines for Extracorporeal Shock Wave Therapy, in ESWT on the skin. 2019
40. Ottomann C, Hartmann B, Tyler J, Maier H, Thiele R, Schaden W, Stojadinovic A: Prospective Randomized Trial of Accelerated Re-epithelization of Skin Graft Donor Sites Using Extracorporeal Shock Wave Therapy. j.jamcollsurg.2010.05.012; ISSN 1072-7515/10/; doi:10.1016
41. Lin G, Van Kuiken M, Wang G, Banie L, Tan Y, Zhou F, Wang Z, Chen Y, Zhang Y, Lue TF. Microenergy acoustic pulse therapy restores function and structure of pelvic floor muscles after simulated birth injury. Transl Androl Urol. 2022 May;11(5):595-606. doi: 10.21037/tau-22-30.
42. Shin D, Jeon SH, Tian WJ, Kwon EB, Kim GE, Bae WJ, Cho HJ, Hong SH, Lee JY, Kim SW. Extracorporeal shock wave therapy combined with engineered mesenchymal stem cells expressing stromal cell-derived factor-1 can improve erectile dysfunction in streptozotocin-induced diabetic rats. Transl Androl Urol. 2021 Jun;10(6):2362-2372. doi: 10.21037/tau-21-79. PMID: 34295723; PMCID: PMC8261440.