Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
Ann Surg. 2011 May;253(5):1024-32. doi: 10.1097/SLA.0b013e3182121d6e.
To assess the time-dependent treatment effects of extracorporeal shock wave therapy (ESWT) in a standard rodent ischemic epigastric flap model.
ESWT has been shown to accelerate tissue repair in acute and chronic wounds and improve graft survival, but the mechanism remains incompletely understood.
Shock waves at 0.1 mJ/mm and 5 impulses/s (total 300 impulses) were applied to the epigastric flap ischemic region at various times pre-, immediately and 24 hours postischemic insult. Flap survival; vascular perfusion; vessel number; von Willebrand factor and smooth muscle actin protein expression as well as in vivo vascular endothelial growth factor receptor 2 expression were evaluated at 1, 3, and 7 days postoperatively in ESWT-treated and untreated controls.
Flap perfusion, microvessel number, and survival (through reduced flap contraction and necrosis) were significantly enhanced in the treated groups compared with controls, irrespective of timing of shock wave treatment (preischemia vs. postischemia). Vascular endothelial growth factor receptor 2 expression was dynamically upregulated in response to ESWT.
Shock wave preconditioning and treatment postischemic insult improves skin flap survival through neovascularization and early upregulation of angiogenesis-related growth factors.
评估体外冲击波疗法（ESWT）在标准啮齿动物缺血上腹皮瓣模型中的时间依赖性治疗效果。
ESWT 已被证明可加速急性和慢性伤口的组织修复，并提高移植物存活率，但作用机制尚不完全清楚。
在缺血性损伤前、即刻和 24 小时后，将 0.1 mJ/mm 和 5 脉冲/s（总 300 脉冲）的冲击波应用于上腹皮瓣缺血区。在术后 1、3 和 7 天，通过评估皮瓣存活、血管灌注、血管数量、血管性血友病因子和平滑肌肌动蛋白蛋白表达以及血管内皮生长因子受体 2 的体内表达来评估 ESWT 治疗组和未治疗对照组。
与对照组相比，无论冲击波治疗的时间（缺血前与缺血后）如何，治疗组的皮瓣灌注、微血管数量和存活（通过减少皮瓣收缩和坏死）均显著提高。血管内皮生长因子受体 2 的表达也随 ESWT 而动态上调。
缺血前的冲击波预处理和缺血后的治疗可通过新生血管形成和早期上调血管生成相关生长因子来提高皮瓣存活率。
