title: Extracorporeal shock waves improve angiogenesis after full thickness burn.
abstract: OBJECTIVE
  Extensive wounds of burn patients remain a challenge due to wound infection and subsequent septicemia. We wondered whether extracorporeal shock wave application (ESWA) accelerates the healing process. The aim of the study was to analyze microcirculation, angiogenesis and leukocyte endothelium interaction after burns by using ESWA with two types of low intensity.
  
  
  METHODS
  Full-thickness burns were inflicted to the ears of hairless mice (n=51; area: 1.3 mm(2)). The mice were randomized into five groups: (A) low-energy shock waves after burn injury (0.04 mJ/mm(2)); (B) very low-energy shock waves after burn injury (0.015 mJ/mm(2)); (C) mice received burns but no ESWA (control group); (D) mice without burn were exposed to low-energy shock waves; (E) mice without burns and with no shock wave application. Intravital fluorescent microscopy was used to assess microcirculatory parameters, angiogenesis and leukocyte behavior. ESWA was performed on day 1, 3 and 7 (500 shoots, 1 Hz). Values were obtained straight after and on days 1, 3, 7 and 12 post burn.
  
  
  RESULTS
  Group A showed accelerated angiogenesis (non-perfused area at day 12: 5.3% vs. 9.1% (group B) and 12.6% (group C), p=0.005). Both shock wave groups showed improved blood flow after burn compared to group C. Shock waves significantly increased the number of rolling leukocytes compared to the non-ESWA-treated animals (group D: 210.8% vs. group E: 83.3%, p=0.017 on day 7 and 172.3 vs. 90.9%, p=0.01 on day 12).
  
  
  CONCLUSIONS
  Shock waves have a positive effect on several parameters of wound healing after burns, especially with regard to angiogenesis and leukocyte behaviour. In both ESWA groups, angiogenesis and blood flow outmatched the control group. Within the ESWA groups the higher intensity (0.04 mJ/mm(2)) showed better results than the lower intensity group. Moreover, shock waves increased the number of rolling and sticking leukocytes as a part of an improved metabolism.
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Buerkle-de-la-Camp Platz 1, 44789 Bochum, Germany. olegoertz@gmx.de
authors.forename: O
authors.initials: O
authors.lastname: Goertz
authors.forename: H
authors.initials: H
authors.lastname: Lauer
authors.forename: T
authors.initials: T
authors.lastname: Hirsch
authors.forename: A
authors.initials: A
authors.lastname: Ring
authors.forename: M
authors.initials: M
authors.lastname: Lehnhardt
authors.forename: S
authors.initials: S
authors.lastname: Langer
authors.forename: H U
authors.initials: HU
authors.lastname: Steinau
authors.forename: J
authors.initials: J
authors.lastname: Hauser
mesh_terms: D000818:Animals; D002056:Burns / Q000628:therapy*; D002448:Cell Adhesion; D002465:Cell Movement; D004727:Endothelium; D007962:Leukocytes; D051379:Mice; D008812:Mice, Hairless; D008833:Microcirculation; D018919:Neovascularization, Physiologic; D012867:Skin / Q000098:blood supply*; D013016:Sound; D014945:Wound Healing