Extracorporeal shockwave treatment for chronic diabetic foot ulcers.
BACKGROUND
This prospective study compared extracorporeal shockwave treatment (ESWT) with hyperbaric oxygen therapy (HBO) in chronic diabetic foot ulcers.


METHODS
Seventy-two patients with 72 chronic diabetic foot ulcers were randomly divided into two groups of similar demographics with 34 patients with 36 ulcers in the ESWT group and 36 patients with 36 ulcers in the HBO group. Patients in the ESWT group received 300 + 100/cm(2) impulses of shockwave at 0.11 mJ/cm(2) energy flux density every 2 wk for 6 wk, whereas patients in the HBO group received HBO daily for 20 treatments. The evaluations included clinical assessment of the ulcers with photo-documentation, blood flow perfusion scan, bacteriological examination, histological study, and immunohistochemical analysis.


RESULTS
The overall results showed completely healed in 31%, improved in 58%, and unchanged in 11% for the ESWT group and 22% completely healed, 50% improved, and 28% unchanged for the HBO group. The ESWT group showed significantly better clinical results and local blood flow perfusion, higher cell concentration, and activity than the HBO group. On immunohistochemical analysis, the ESWT group demonstrated significant increases in endothelial nitric oxide synthase, vessel endothelial growth factor, and proliferation cell nuclear antigen expressions and a decrease in transference-mediated digoxigenin-deoxy-UTP nick end-labeling expression than the HBO group.


CONCLUSIONS
ESWT appears to be more effective than HBO in chronic diabetic foot ulcers.
Wang
Ching-Jen
CJ
Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan. w281211@cgmh.org.tw
Kuo
Yur-Ren
YR
Wu
Re-Wen
RW
Liu
Rue-Tsuan
RT
Hsu
Chi-Shiung
CS
Wang
Feng-Sheng
FS
Yang
Kuender D
KD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000473:pathology / Q000628:therapy*; D005528:Foot / Q000098:blood supply / Q000473:pathology; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007150:Immunohistochemistry; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D014464:Ultrasonic Therapy