title: Short-term effects of extracorporeal shock waves on microcirculation.
abstract: BACKGROUND
  Extracorporeal shock wave application (ESWA) has the potential to qualify as an adjuvant therapy option for soft tissue disorders such as chronic wounds. As of today, little is known about its exact mechanism of action. For a better understanding of the pathophysiology, we investigated the effect of ESWA on microcirculation and leukocyte-endothelial interaction.
  
  
  METHODS
  Intravital fluorescent microscopy was used to quantify microcirculatory parameters in the ears of hairless mice (n = 30). Values were obtained just before and 10 min after the ESWA (500 shots, 1 Hz, duration 500 s). Mice were randomly divided into three groups undergoing different shock wave intensities (energy flux density: control: 0.00 mJ/mm(2); low level: 0.015 mJ/mm(2); and higher level (hl): 0.04 mJ/mm(2); n = 10 mice per group). Histologic evaluations were taken after completion of the experiments.
  
  
  RESULTS
  A significant increase in the venular diameter was observed in both the groups that underwent ESWA compared with the control group (hl: 118%, low level: 117%, and control: 96%; P < 0.004). Edema formation increased significantly in group I (P = 0.002). ESWA provoked an arteriolar constriction (hl: 93% versus control: 104%; P = 0.019) 10 min after treatment. The highest value of venular blood flow was found in group hl. Moreover, shock waves increased significantly the number of sticking leukocytes immediately after application (hl: 274%, P = 0.003).
  
  
  CONCLUSIONS
  ESWA has a significant and immediate impact on microcirculation with endothelial integrity loss and increase of adherent leukocytes as part of a proinflammatory process. Although a dilation of venules was caused, arterioles primarily show a constriction. The study shows alterations in microcirculation that could help understand the mechanism of action in the future.
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany. Electronic address: olegoertz@rub.de.
authors.forename: Ole
authors.initials: O
authors.lastname: Goertz
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Hauser
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Hirsch
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Leon
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, Bochum, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Kolbenschlag
authors.affiliation: Institute of Pathology, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Stricker
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lehnhardt
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Lauer
mesh_terms: D000818:Animals; D002450:Cell Communication; D042783:Endothelial Cells / Q000502:physiology; D019220:High-Energy Shock Waves; D007962:Leukocytes / Q000502:physiology; D008297:Male; D051379:Mice; D008812:Mice, Hairless; D008833:Microcirculation
keywords: ESWA; Extracorporeal shock wave application; Intravital fluorescent microscopy; Leukocyte–endothelium interaction; Microcirculation