The Effects of Shock Wave Therapy Applied on Hypertrophic Burn Scars: a Randomised Controlled Trial

Overview

Journal Scars Burn Heal

Publisher Sage Publications

Date 2020 Dec 14

PMID 33312712

Citations 7

Authors

Peter Moortgat

Mieke Anthonissen

Ulrike Van Daele

Tine Vanhullebusch

Koen Maertens

Lieve De Cuyper

Cynthia Lafaire

Jill Meirte

Affiliations

Soon will be listed here.

Abstract

Introduction: A wide variety of non-invasive treatments has been proposed for the management of hypertrophic burn scars. Unfortunately, the reported efficacy has not been consistent, and especially in the first three months after wound closure, fragility of the scarred skin limits the treatment options. Extracorporeal shock wave therapy (ESWT) is a new non-invasive type of mechanotherapy to treat wounds and scars. The aim of the present study was to examine the objective and subjective scar-related effects of ESWT on burn scars in the early remodelling phase.

Material And Methods: Evaluations included the Patient and Observer Scar Assessment Scale (POSAS) for scar quality, tri-stimulus colorimetry for redness, tewametry for trans-epidermal water loss (TEWL) and cutometry for elasticity. Patients were randomly assigned to one of two groups, the low-energy intervention group or the placebo control group, and were tested at baseline, after one, three and six months. All patients were treated with pressure garments, silicone and moisturisers. Both groups received the ESWT treatment (real or placebo) once a week for 10 weeks.

Results: Results for 20 patients in each group after six months are presented. The objective assessments showed a statistically significant effect of ESWT compared with placebo on elasticity ( = 0.011, η2=0.107) but revealed no significant effects on redness and TEWL. Results of the clinical assessments showed no significant interactions between intervention and time for the POSAS Patient and Observer scores.

Conclusion: ESWT can give added value to the non-invasive treatment of hypertrophic scars, more specifically to improve elasticity when the treatment was already started in the first three months after wound closure.

Lay Summary: Pathological scarring is a common problem after a burn injury. A wide variety of non-invasive treatments has been proposed for the management of these scars. Unfortunately, the reported efficacy of these interventions has not been consistent, and especially in the first three months after wound closure, fragility of the scarred skin limits the treatment options. Extracorporeal shock wave therapy (ESWT) is a relatively new non-invasive therapy to treat both wounds and scars. The aim of the present study was to examine the scar-related effects of ESWT on burn scars in the early phase of healing.The scars were subjectively assessed for scar quality by the patient and an observer using the Patient and Observer Scar Assessment Scale (POSAS). Objective assessments included measurements to assess redness, water loss and elasticity. Forty patients were randomly assigned to one of two groups, the low-energy intervention group or the placebo control group (the device simulated the sound of an ESWT treatment but no real shocks were applied), and were tested at four timepoints up to six months. All patients were treated with pressure garments, silicone and moisturisers. Both groups received the ESWT treatment (real or placebo) once a week for 10 weeks.The objective assessments showed a significant improvement of elasticity in the intervention group when compared with placebo but revealed no significant effects on redness and water loss. Results of the clinical assessments showed no differences between the groups for the POSAS Patient and Observer scores.ESWT can give added value to the non-invasive treatment of pathological scars more specifically to improve elasticity in the early phase of healing.

Citing Articles

Mechanomodulation: Physical Treatment Modalities Employ Mechanotransduction to Improve Scarring.

Daele U, Meirte J, Anthonissen M, Vanhullebusch T, Maertens K, Demuynck L Eur Burn J. 2024; 3(2):241-255.

PMID: 39599996 PMC: 11575364. DOI: 10.3390/ebj3020021.

The Role of Extracorporeal Shock Wave Therapy in Keloids and Hypertrophic Scars: A Systematic Review.

Gili N, Micallef Stafrace K, Laybats F, Mifsud T Cureus. 2024; 16(10):e71869.

PMID: 39463916 PMC: 11513171. DOI: 10.7759/cureus.71869.

Needle-Free Jet Injection of Poly-(Lactic Acid) for Atrophic Acne Scars: Literature Review and Report of Clinical Cases.

Rho N, Kim H, Kim H, Lee W J Clin Med. 2024; 13(2).

PMID: 38256575 PMC: 10815974. DOI: 10.3390/jcm13020440.

Congress Report on the Second World Congress of Global Scar Society with Scar Academy and Japan Scar Workshop.

Abdelhakim M, Dohi T, Ogawa R Plast Reconstr Surg Glob Open. 2023; 11(4):e4921.

PMID: 37073255 PMC: 10106224. DOI: 10.1097/GOX.0000000000004921.

Vacuum and Electromagnetic Fields Treatment to Regenerate a Diffuse Mature Facial Scar Caused by Sulfuric Acid Assault.

Veronese S, Brunetti B, Minichino A, Sbarbati A Bioengineering (Basel). 2022; 9(12).

PMID: 36551005 PMC: 9774184. DOI: 10.3390/bioengineering9120799.

References

Cai Z, Falkensammer F, Andrukhov O, Chen J, Mittermayr R, Rausch-Fan X . Effects of Shock Waves on Expression of IL-6, IL-8, MCP-1, and TNF-α Expression by Human Periodontal Ligament Fibroblasts: An In Vitro Study. Med Sci Monit. 2016; 22:914-21. PMC: 4805137. DOI: 10.12659/msm.897507. View

Kolmus A, Holland A, Byrne M, Cleland H . The effects of splinting on shoulder function in adult burns. Burns. 2012; 38(5):638-44. DOI: 10.1016/j.burns.2012.01.010. View

Jang K, Choi J, Mun J, Jeon J, Seo C, Kim J . Multi-axis shoulder abduction splint in acute burn rehabilitation: a randomized controlled pilot trial. Clin Rehabil. 2014; 29(5):439-46. DOI: 10.1177/0269215514547653. View

Fathy Samhan A, Abdelhalim N . Impacts of low-energy extracorporeal shockwave therapy on pain, pruritus, and health-related quality of life in patients with burn: A randomized placebo-controlled study. Burns. 2019; 45(5):1094-1101. DOI: 10.1016/j.burns.2019.02.007. View

Draaijers L, Botman Y, Tempelman F, Kreis R, Middelkoop E, van Zuijlen P . Skin elasticity meter or subjective evaluation in scars: a reliability assessment. Burns. 2004; 30(2):109-14. DOI: 10.1016/j.burns.2003.09.003. View

Knobloch K, Joest B, Kramer R, Vogt P . Cellulite and focused extracorporeal shockwave therapy for non-invasive body contouring: a randomized trial. Dermatol Ther (Heidelb). 2013; 3(2):143-55. PMC: 3889306. DOI: 10.1007/s13555-013-0039-5. View

Anthonissen M, Daly D, Fieuws S, Massage P, Van Brussel M, Vranckx J . Measurement of elasticity and transepidermal water loss rate of burn scars with the Dermalab(®). Burns. 2012; 39(3):420-8. DOI: 10.1016/j.burns.2012.07.026. View

Berta L, Fazzari A, Ficco A, Enrica P, Catalano M, Frairia R . Extracorporeal shock waves enhance normal fibroblast proliferation in vitro and activate mRNA expression for TGF-beta1 and for collagen types I and III. Acta Orthop. 2009; 80(5):612-7. PMC: 2823334. DOI: 10.3109/17453670903316793. View

DAgostino M, Craig K, Tibalt E, Respizzi S . Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg. 2015; 24(Pt B):147-53. DOI: 10.1016/j.ijsu.2015.11.030. View

10.

Clark J, Cheng J, Leung K . Mechanical properties of normal skin and hypertrophic scars. Burns. 1996; 22(6):443-6. DOI: 10.1016/0305-4179(96)00038-1. View

11.

Saggini R, Saggini A, Spagnoli A, Dodaj I, Cigna E, Maruccia M . Extracorporeal Shock Wave Therapy: An Emerging Treatment Modality for Retracting Scars of the Hands. Ultrasound Med Biol. 2015; 42(1):185-95. DOI: 10.1016/j.ultrasmedbio.2015.07.028. View

12.

Fioramonti P, Cigna E, Onesti M, Fino P, Fallico N, Scuderi N . Extracorporeal shock wave therapy for the management of burn scars. Dermatol Surg. 2012; 38(5):778-82. DOI: 10.1111/j.1524-4725.2012.02355.x. View

13.

Cho Y, Jeon J, Hong A, Yang H, Yim H, Cho Y . The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial. Burns. 2014; 40(8):1513-20. DOI: 10.1016/j.burns.2014.02.005. View

14.

Moortgat P, Anthonissen M, Daele U, Vanhullebusch T, Maertens K, De Cuyper L . The effects of shock wave therapy applied on hypertrophic burn scars: a randomised controlled trial. Scars Burn Heal. 2020; 6:2059513120975624. PMC: 7716075. DOI: 10.1177/2059513120975624. View

15.

Mittermayr R, Antonic V, Hartinger J, Kaufmann H, Redl H, Teot L . Extracorporeal shock wave therapy (ESWT) for wound healing: technology, mechanisms, and clinical efficacy. Wound Repair Regen. 2012; 20(4):456-65. DOI: 10.1111/j.1524-475X.2012.00796.x. View

16.

Anthonissen M, Daly D, Janssens T, Van den Kerckhove E . The effects of conservative treatments on burn scars: A systematic review. Burns. 2016; 42(3):508-18. DOI: 10.1016/j.burns.2015.12.006. View

17.

Schouten H, Nieuwenhuis M, van Zuijlen P . A review on static splinting therapy to prevent burn scar contracture: do clinical and experimental data warrant its clinical application?. Burns. 2011; 38(1):19-25. DOI: 10.1016/j.burns.2011.06.003. View

18.

Esselman P . Burn rehabilitation: an overview. Arch Phys Med Rehabil. 2007; 88(12 Suppl 2):S3-6. DOI: 10.1016/j.apmr.2007.09.020. View

19.

Van den Kerckhove E, Stappaerts K, Fieuws S, Laperre J, Massage P, Flour M . The assessment of erythema and thickness on burn related scars during pressure garment therapy as a preventive measure for hypertrophic scarring. Burns. 2005; 31(6):696-702. DOI: 10.1016/j.burns.2005.04.014. View

20.

Draaijers L, Tempelman F, Botman Y, Tuinebreijer W, Middelkoop E, Kreis R . The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004; 113(7):1960-5. DOI: 10.1097/01.prs.0000122207.28773.56. View