Dear Sir, We read with great interest the recent article entitled “Extracorporeal shock wave therapy role in the treatment of burn patients. A systematic literature review” by Aguilera et al. [1]. Extracorporeal shock wave therapy (ESWT) is a new challenging option used in many different areas of medicine, in particular to relieve after injuries. Inspired by the authors, we would like to express some comments and highlight our idea of what should be correct application of ESWT in burn patients, in order to get real benefits. At the state of the art, a real protocol for using ESWT in burns injuries is a bit premature. This is due to the fact that there are not enough studies which demonstrate concrete advantages. All groups use ESWT exploiting the mechano-transduction concept so that mechanical acoustic waves could influence the inflammatory process helping wound healing [2]. Because of lack of consistent studies, we do not prefer using ESWT in acute burns setting. Selective enzymatic escharolysis or, when necessary, surgical debridement represent the standard of care for the treatment of acute burns in our institution [3]. Nevertheless, we strongly believe that ESWT could have a role for chronic burns and their outcomes. Indeed, as stated by Saggini et al., ESWT has the effect to produce more nitric oxide (NO) that brings to angiogenesis and reduces the inflammatory microenvironment. Actually, someone could object that inflammation is present in both situation: acute and chronic. Still, ESWT has a local effect whilst the inflammation in acute burns is systemic. For this reason, how big the inflammation reduction given by ESWT should be to have an effect? In a retracting scar, that could be the worst result observed after deep burns, the inflammatory microenvironment is a local concern, and EWST could find application. We started to use this new challenging option on hand injury scars; we observed our results were reasonable considering that shock wave treatment is capable of inducing an increase in the number of activated fibroblasts, CD34- positive fibrocytes and f XIIIa-positive dendritic cells; this process is thought to lead to the deposition of new collagen, characterized by thinner collagen fascicles and parallel orientation to the dermo-epidermal junction [4]. Then, we extended ESWT treatment in chronic burns setting, confirm- ing what reported by other authors like Fioramonti et al. who have demonstrated that ESWT use in burns outcomes brings to great improvements in scars, in terms of range of motion of the joint involved and also when touched, the perception of both the physician and patient was softer than it was few days after discharge. Also, its appearance in terms of color and pigmentation, becomes more similar to the surrounding skin not involved in the injury [5]. In conclusion, because of the current evidence and the necessity of the perfect combination of ESWT therapy, massage therapy and rehabilitation to give the patient the best outcome for his daily life, we are carrying on a prospective study comparing the application of different treatment techniques and dressings for chronic burns.
Extracorporeal shock wave therapy as a bet for the treatment of burn patients
De Cosmo A.
;Tedeschi P.;Elia R.
2021-01-01
Abstract
Dear Sir, We read with great interest the recent article entitled “Extracorporeal shock wave therapy role in the treatment of burn patients. A systematic literature review” by Aguilera et al. [1]. Extracorporeal shock wave therapy (ESWT) is a new challenging option used in many different areas of medicine, in particular to relieve after injuries. Inspired by the authors, we would like to express some comments and highlight our idea of what should be correct application of ESWT in burn patients, in order to get real benefits. At the state of the art, a real protocol for using ESWT in burns injuries is a bit premature. This is due to the fact that there are not enough studies which demonstrate concrete advantages. All groups use ESWT exploiting the mechano-transduction concept so that mechanical acoustic waves could influence the inflammatory process helping wound healing [2]. Because of lack of consistent studies, we do not prefer using ESWT in acute burns setting. Selective enzymatic escharolysis or, when necessary, surgical debridement represent the standard of care for the treatment of acute burns in our institution [3]. Nevertheless, we strongly believe that ESWT could have a role for chronic burns and their outcomes. Indeed, as stated by Saggini et al., ESWT has the effect to produce more nitric oxide (NO) that brings to angiogenesis and reduces the inflammatory microenvironment. Actually, someone could object that inflammation is present in both situation: acute and chronic. Still, ESWT has a local effect whilst the inflammation in acute burns is systemic. For this reason, how big the inflammation reduction given by ESWT should be to have an effect? In a retracting scar, that could be the worst result observed after deep burns, the inflammatory microenvironment is a local concern, and EWST could find application. We started to use this new challenging option on hand injury scars; we observed our results were reasonable considering that shock wave treatment is capable of inducing an increase in the number of activated fibroblasts, CD34- positive fibrocytes and f XIIIa-positive dendritic cells; this process is thought to lead to the deposition of new collagen, characterized by thinner collagen fascicles and parallel orientation to the dermo-epidermal junction [4]. Then, we extended ESWT treatment in chronic burns setting, confirm- ing what reported by other authors like Fioramonti et al. who have demonstrated that ESWT use in burns outcomes brings to great improvements in scars, in terms of range of motion of the joint involved and also when touched, the perception of both the physician and patient was softer than it was few days after discharge. Also, its appearance in terms of color and pigmentation, becomes more similar to the surrounding skin not involved in the injury [5]. In conclusion, because of the current evidence and the necessity of the perfect combination of ESWT therapy, massage therapy and rehabilitation to give the patient the best outcome for his daily life, we are carrying on a prospective study comparing the application of different treatment techniques and dressings for chronic burns.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
