Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Westfalen, Dortmund, Germany.
Department of Health, University of Witten/Herdecke, Witten, Germany.
Eur Surg Res. 2021;62(3):134-143. doi: 10.1159/000515737. Epub 2021 Sep 14.
Extracorporeal shock waves (ESWs) have been shown to have a positive effect on skin wound healing; however, little is known on the regeneration of the microcirculation and angiogenesis as well as the different application modes.
A total of 40 BALB/c mice were provided with dorsal skin fold chambers and were divided into 3 therapy groups (n = 30) and one control group (n = 10). The 3 therapy groups were treated with shock waves at different pulse rates (500-1,000 pulses/min) and application frequencies (day 0 and day 6 or day 0 only). Photographic documentation and intravital microscopy were carried out on day 1, 2, 4, and 6 after wounding.
Using the newly developed Diver Box, shock waves could be applied in vivo without mechanical tissue damage. Shock wave therapy to skin wounds demonstrated to induce faster wound closure rates in the beginning than controls in groups with higher pulse rates and frequencies of the shock waves. Furthermore, the regeneration of microcirculation and perfusion in the healing skin was significantly improved after the application of, in particular, higher pulse rates as given by increased numbers of perfused capillaries and functional vessel density. The study of inflammation showed, especially in high-pulse ESW groups, higher leukocyte counts, and rolling leukocytes over time until day 6 as a response to the induction of inflammatory reaction after ESW application. Angiogenesis showed a marked increase in positive areas as given by sprouts, coils, and recruitments in all ESW groups, especially between days 4 and 6.
The major findings of this trial demonstrate that ESW therapy to skin wounds is effective and safe. This is demonstrated by the initially faster wound closure rate, but later the same wound closure rate in the treatment groups than in controls. Furthermore, during the regeneration of microcirculation and perfusion in the healing skin, a significant improvement was observed after the application of, in particular, higher ESW pulse rates, suggesting an ESW-related increase in nutrient and oxygen supply in the wound tissue.
体外冲击波（ESW）已被证明对皮肤伤口愈合有积极影响；然而，对于微循环和血管生成的再生以及不同的应用模式知之甚少。
共提供 40 只 BALB/c 小鼠背部皮肤折叠室，并将其分为 3 个治疗组（n = 30）和 1 个对照组（n = 10）。3 个治疗组分别采用不同的脉冲率（500-1000 脉冲/分钟）和应用频率（第 0 天和第 6 天或仅第 0 天）进行冲击波治疗。在创伤后第 1、2、4 和 6 天进行摄影记录和活体显微镜检查。
使用新开发的 Diver Box，冲击波可以在体内应用而不会造成机械组织损伤。与对照组相比，在脉冲率和频率较高的组中，冲击波治疗皮肤伤口在开始时表现出更快的伤口闭合率。此外，在应用特别是较高的脉冲率后，愈合皮肤中的微循环和灌注再生得到显著改善，表现为灌注毛细血管和功能血管密度的增加。炎症研究表明，尤其是在高脉冲 ESW 组中，白细胞计数随着时间的推移呈上升趋势，特别是在 ESW 应用后炎症反应诱导期间，滚动白细胞计数也呈上升趋势。在所有 ESW 组中，血管生成表现出明显的阳性区域增加，如芽、线圈和募集，尤其是在第 4 天和第 6 天之间。
本试验的主要发现表明，ESW 治疗皮肤伤口是有效和安全的。这表现为最初更快的伤口闭合率，但在治疗组中，后期与对照组相同的伤口闭合率。此外，在愈合皮肤的微循环和灌注再生过程中，在应用特别是较高的 ESW 脉冲率后观察到显著改善，这表明 ESW 相关的伤口组织营养和氧气供应增加。
