title: Repetitive extracorporeal shock wave applications are superior in inducing angiogenesis after full thickness burn compared to single application.
abstract: OBJECTIVE
  Burn wounds remain a challenge due to subsequent wound infection and septicemia, which can be prevented by acceleration of wound healing. The aim of the study was to analyze microcirculation and leukocyte endothelium interaction with particular focus on angiogenesis after full-thickness burn using three different repetitions of low energy shock waves.
  
  
  METHODS
  Full-thickness burns were inflicted to the ears of hairless mice (n=44; area: 1.6±0.05 mm2 (mean±SEM)). Mice were randomized into four groups: the control group received a burn injury but no shock waves; group A received ESWA (0.03 mJ/mm2) on day one after burn injury; group B received shock waves on day one and day three after burn injury; group C ESWA on day one, three and seven after burn injury. Intravital fluorescent microscopy was used to assess microcirculatory parameters, angiogenesis and leukocyte interaction. Values were obtained before burn (baseline value) immediately after and on days 1, 3, 7 and 12 after burn.
  
  
  RESULTS
  Shock-wave treated groups showed significantly accelerated angiogenesis compared to the control group. The non-perfused area (NPA) is regarded as a parameter for angiogenesis and showed the following data on day 12 2.7±0.4% (group A, p=0.001), 1.4±0.5% (group B, p<0.001), 1.0±0.3% (group C, p<0.001), 6.1±0.9% (control group). Edema formation is positively correlated with the number of shock wave applications: day 12: group A: 173.2±9.8%, group B: 184.2±6.6%, group C: 201.1±6.9%, p=0.009 vs. control: 162.3±8.7% (all data: mean±SEM).
  
  
  CONCLUSIONS
  According to our data shock waves positively impact the wound healing process following burn injury. Angiogenesis showed significantly improved activity after shock wave application. In all three treatment groups angiogenesis was higher compared to the control group. Within the ESWA groups, double applications showed better results than single application and three applications showed better results than single or double applications.
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. Electronic address: ole.goertz@rub.de.
authors.forename: O
authors.initials: O
authors.lastname: Goertz
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.
authors.forename: L
authors.initials: L
authors.lastname: von der Lohe
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.
authors.forename: H
authors.initials: H
authors.lastname: Lauer
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.
authors.forename: T
authors.initials: T
authors.lastname: Khosrawipour
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.
authors.forename: A
authors.initials: A
authors.lastname: Ring
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.
authors.forename: A
authors.initials: A
authors.lastname: Daigeler
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.
authors.forename: M
authors.initials: M
authors.lastname: Lehnhardt
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.
authors.forename: J
authors.initials: J
authors.lastname: Kolbenschlag
mesh_terms: D000818:Animals; D002056:Burns / Q000628:therapy*; D004195:Disease Models, Animal; D004423:Ear / Q000098:blood supply* / Q000293:injuries; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D007962:Leukocytes; D051379:Mice; D008833:Microcirculation; D008856:Microscopy, Fluorescence; D018919:Neovascularization, Physiologic; D012867:Skin / Q000098:blood supply* / Q000293:injuries; D014945:Wound Healing
keywords: Angiogenesis; Intravital fluorescent microscopy; Microcirculation; Wound healing