(DLS-004) Extracorporeal Shockwave Therapy (ESWT): A Novel way to speed up healing installed, diabetic wounds.

Introduction: It has been suggested that ESWT may be able to change the course of chronic, stalled diabetic wounds by altering the wound environment, both physically and physiologically. Acceleration of the healing process is thought to occur by manipulating the microcirculation causing a fluid shift away from the peri-wound, augmented by accelerated cytokine and growth hormone expression and finally by angioneogenisis.

Although ESWT has been in use for over a decade, this approach on wound healing has, only relatively recently, been documented in detail. In this small case series, we propose to add to the growing body of evidence that illustrates these effects.

Methods: Between April and November of 2022, 6 patients who were receiving advanced diabetic wound care at an outpatient, ambulatory diabetic wound center and had wounds that were in a stalled state, were selected to receive additional therapy in the form of extracorporeal shockwave therapy. These patients received 2000 shock ESWT treatments on a weekly basis for 12 consecutive weeks. Wounds were assessed using digital photography and planimetry.

Results: ESWT was well tolerated by all patients. We observed the effect of ESWT on a small group of patients who had chronic diabetic wounds that had been treated with advanced wound treatment modalities but were stalled. All patients responded positively to the treatment and their wounds all contracted at variable rates, but did so consistently, despite their stalled state. Their healing trajectory moved upwards after a significant period flattened or down turning.

Discussion: These results add to the growing body of evidence supporting the use of ESWT in the treatment of diabetic wounds in a variety of physiological states, but most importantly for those wounds that are not moving and are therefore the most dangerous for our diabetic patients. We believe that the novel effects of ESWT are as a result of its known, powerful anti-inflammatory action on the edge cells combined with cytokine and growth hormone expression, which is lacking in these chronic wounds, whose healing velocities have ground to a halt. More research is obviously needed to delineate the wound-reawakening effect of ESWT.