(CS-020) A New Approach to Diabetic Foot Ulcer (DFU) Management with Extracorporeal Shockwave Therapy (ESWT) PACE-Technology: An Adjunctive therapy that improves the outcome of DFU management.

Introduction: The incidence of foot ulcers in patients who present with Diabetes appears to be increasing in South Africa. Prevention and control methods are needed to reduce the incidents of complications and amputations for patients presenting with Diabetic Foot Ulcer (DFU). Any advantage that could be gained using innovative or advanced modalities and technologies should be explored.

Therefore, for the purpose of this case series, we are investigating the use of Extracorporeal Shockwave Therapy (ESWT). The ESWT System is a non-invasive energy technology, that can be safely and easily performed in the outpatient setting as an adjunctive therapy.

Methods: Multiple subjects were selected from the existing practice of a busy advanced wound care center. Patients who were selected had recent post-ray amputations all are known diabetic foot management patients. Post-surgical debridement and amputation were started as adjunctive therapy and included standard wound care practice (SOC).

SOC included offloading, surgical debridement, and application of appropriate advanced wound treatment modalities. Treatment with ESWT was performed at 2 Tx per week for the first week, (1500-2500 shocks/treatment) were administered per Tx session. The target wounds were measured data and pictures were recorded. Study dates were December 2022-present.

Results: Improvement following the first treatment a startling contraction of the wound was observed. The patients revealed better sensations in their feet. ESWT was well tolerated, and the patient was effortlessly compliant. We observed the effect of ESWT on several cases who presented with DFU complications/amputations beyond two months. Results were documented; peri-wound inflammation, cell migration, and cytokine activity as reflected in the reduction of peri-wound edema, accelerated edge effect, and granulation tissue production.

Discussion: Results demonstrated ESWT may have a definitive role in the treatment of DFU management. As this therapy seems to promote increased tissue oxygenation and neovascularization within the wound bed. We anticipate shorter times to healing. ESWT in conjunction with good clinical wound care practice and offloading, may prove a beneficial additional treatment modality for DFU management, chronic lower extremity ulcerations, and other wound types. Hence, the examination of ESWT as a modality has shown that it can accelerate the healing process.