Abstract
Aim
This study investigated the molecular changes of extracorporeal shockwave therapy
(ESWT) and hyperbaric oxygen therapy (HBOT) in chronic diabetic foot ulcers.
Methods
A cohort study consisted of 39 patients (44 ulcers) in the ESWT group and 38 patients
(40 ulcers) in the HBOT group with similar demographic characteristics. The ESWT group
received shockwave therapy twice per week for total six treatments. The HBOT group
received hyperbaric oxygen therapy daily for total 20 treatments. Biopsy was performed
from the periphery of the ulcer before and after treatment. The specimens were immuno-stained,
and the positive immuno-activities of vWF, VEGF, eNOS, PCNA, EGF and TUNEL expressions
were examined and quantified microscopically.
Results
Significant increases in vWF, VEGF, eNOS, PCNA and EGF expressions and a decrease
in TUNEL expression were noted after ESWT (P < 0.05), whereas the changes after HBOT were statistically not significant (P > 0.05). The differences of vWF, VEGF, eNOS, PCNA, EGF and TUNEL expressions between
the two groups were comparable before treatment (P > 0.05), however, the differences became statistically significant after treatment (P < 0.05) favoring the ESWT group.
Conclusion
ESWT showed significant increases in angiogenesis and tissue regeneration over HBOT
in diabetic foot ulcers.
Keywords
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References
- The international consensus and practical guidelines on the management and prevention of the diabetic foot.Curr Diab Rep. 2003; 3 ([PMID: 14611743]): 475-479
- Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation.Diabetes Care. 1998; 21 ([PMID: 9589255]): 855-859
- The description and classification of diabetic foot lesions.Diabet Med. 1993; 10 ([PMID: 8403832]): 676-679
- Diabetic foot ulcers.Lancet. 2003; 361 ([PMID: 12737879]): 1545-1551
- Factors contributing to presentation of diabetic foot ulcers.Diabet Med. 1997; 14 ([PMID: 9371480]): 867-870
- Validation of a system of foot ulcer classification in diabetes mellitus.Diabet Med. 2004; 21 ([PMID: 15317603]): 987-991
- Long-term assessment of chronic leg ulcer treatment by autologous skin grafts.Dermatology. 1997; 195 ([PMID: 9267750]): 77-80
- Topical hyperbaric oxygen and low energy laser for the treatment of diabetic foot ulcers.Arch Orthop Trauma Surg. 1998; 117 ([PMID: 9521521]): 156-158
- Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study.Ostomy Wound Manage. 2005; 51 ([PMID: 16234574]): 24-39
- Effectiveness of recombinant human platelet-derived growth factor for the treatment of diabetic neuropathic foot ulcers.Wound Repair Regen. 2005; 13 ([PMID: 16283867]): 531-536
- Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity ulcers.Plast Reconstr Surg. 2006; 117 ([PMID: 16799381]): 143S-149S
- Clinical effectiveness of an acellular dermal regenerative tissue matrix compared to standard wound management in healing diabetic foot ulcers: a prospective randomized, multicentre study.Int Wound J. 2009; 6 ([PMID: 19368581]): 196-208
- Extracorporeal shockwave treatment for chronic diabetic foot ulcers.J Surg Res. 2009; 152 ([PMID: 18619622]): 96-103
- Extracorporeal shockwave therapy enhanced wound healing via increasing topical blood perfusion and tissue regeneration in a rat model of STZ-induced diabetes.Wound Repair Regen. 2009; 17 ([PMID: 19614917]): 522-530
- Treatment of diabetic foot ulcers: a comparative study of extracorporeal shockwave therapy and hyperbaric oxygen therapy.Diab Res Clin Pract. 2011; 92 ([PMID: 21310502]): 187-193
- Shock wave therapy: an innovative treatment method for partial thickness burns.Burns. 2005; 31 ([PMID: 16199297]): 921-922
- Extracorporeal shock wave may enhance skin flap survival in an animal model.Br J Plast Surg. 2005; 58 ([PMID: 15629167]): 53-57
- Shock wave therapy for acute and chronic soft tissue wounds: a feasible study.J Surg Res. 2007; 143 ([PMID: 17904157]): 1-12
- The Proteolytic Environment of chronic wounds.Wound Repair Regen. 1999; 7 ([PMID: 10633002]): 433-441
- Shock wave enhanced neovascularization at the bone tendon junction. A study in a dog model.J Foot Ankle Surg. 2002; 41 ([PMID: 11858601]): 16-22
- Shock wave induces neovascularization at the tendon-bone junction. A study in rabbits.J Orthop Res. 2003; 21 ([PMID: 14554209]): 984-989
- Biological Mechanism of Musculoskeletal Shockwaves.Int Soc Musculoskeletal Shockwave Ther Newsletter. 2004; 1: 8(1)
- The nitric oxide connection: hyperbaric oxygen therapy, becaplermin, and diabetic ulcer management.Adv Skin Wound Care. 2000; 13 ([PMID: 11075012]): 169-174
- Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study.Diabetes care. 1996; 19 ([PMID: 8941460]): 1338-1343
- Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up.J Diabetes Complications. 2002; 16 ([PMID: 12039398]): 153-158
- Treatment of diabetic foot ulcers with hyperbaric oxygen.J Wound Care. 2000; 9 ([PMID: 11933305]): 193-197
- Hyperbaric oxygen accelerates the healing rate of nonischemic chronic diabetic foot ulcers: a prospective randomized study.Diabetes Care. 2003; 26 ([PMID: 12882865]): 2378-2382
- Effects of hyperbaric oxygen on inflammatory response to wound and trauma: possible mechanism of action.Scientific World J. 2006; 6 ([PMID: 16604253]): 425-441
- Basic mechanisms of hyperbaric oxygen in the treatment of ischemia-reperfusion injury.Int Anesthesiol Clin. 2000; 3 ([PMID: 10723671]): 91-109
- The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind randomised-controlled trial.Eur J Vasc Endovasc Surg. 2003; 25 ([PMID: 12787692]): 513-518
Article info
Publication history
Published online: July 11, 2011
Accepted:
June 13,
2011
Received:
March 24,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
