Meenakshi Budhraja · @gastromom
23rd Aug 2011 from Osfoora
Shock Waves May Speed Burn Wound Healing
By James E. Barone MD
NEW YORK (Reuters Health) Aug 19 - A single session of extracorporeal shock wave therapy (ESWT) helped burn wounds heal significantly faster in a recent phase II trial.
Patients treated with low-energy defocused ESWT for superficial 2nd-degree burns within 24 hours after debridement had complete healing three days ahead of a control group that got standard care, the research team reports.
The randomized double-blind trial included 50 patients: 22 who received standard care, 22 who had standard care plus a single application of ESWT to the burned area, and six who were lost to follow-up.
The average time it took to achieve at least 95% epithelialization of the wound was 9.6 days in the study group vs 12.5 days in controls (p<0.0005), according to a July 19th online report in the Annals of Surgery.
Most of the burns involved the extremities or face. ESWT consisted of 100 impulses/cm2 at 0.1 mJ/mm2.
Dr. Christian Ottomann from the Center for Severe Burns and Plastic Surgery at Unfallkrankenhaus Berlin, who led the study, told Reuters Health by email that about 10% of patients had pain during ESWT, but "in no patient was an interruption of extracorporeal shock wave therapy necessary."
Dr. Ottomann and his colleagues say they believe shock wave therapy may work by increasing blood flow to the tissues and providing an anti-inflammatory effect.
The same researchers previously found similar reductions in the time for healing of skin-graft donor sites, a wound similar to a superficial second-degree burn, using this technique.
But Dr. Basil A. Pruitt, Jr., former president of the American Burn Association and Editor of the Journal of Trauma for the last 18 years, had some reservations about the study. He told Reuters Health, "While the concept is intriguing, I'm not convinced."
The researchers said their two groups "were balanced" except for age (which averaged 53 in the ESWT group vs 38 in controls). But Dr. Pruitt believes that while some differences between the groups were not significant taken one-by-one, in the aggregate they may have resulted in the controls having more serious burns. He pointed out, for example, that control patients had more flame burns, inhalation injuries and intensive care admissions.
Dr. Pruitt had other concerns, too, such as the small size of the cohort. He would like to have known how many patients who might have been eligible were not enrolled in the study.
He would also have preferred more accurate assessments of burn wound depth and healing. The authors determined depth "on clinical grounds" instead of with laser Doppler imaging, and they evaluated healing without histologic confirmation. "This is an area where animal research using standardized burn injuries would be better," Dr. Pruitt said.
Dr. Ottomann said his group is addressing these issues now in animal studies.
There are not many reports in the medical literature on ESWT for burn wounds. Asked why this might be so, Dr. Ottomann said, "Before I got in intensive contact with the ESWT, I did not believe in this kind of therapy, but after giving the ESWT a chance, I was convinced. Unfortunately in medicine scientific findings establish sometimes in slow motion."
Two of the study's eight authors reported current or past financial interests in Tissue Regeneration Technologies, LLC (Woodstock, Georgia), the company that makes the investigational ESWT device used in the study.
The study was funded by the U.S. Combat Wound Initiative Program in Rockville, Maryland and the Internationales Zentrum fur Stosswellentherapie in Berlin.
SOURCE: http://bit.ly/rne6x6
Ann Surg 2011.
Reuters Health Information © 2011 Shock Waves May Speed Burn Wound Healing
By James E. Barone MD
NEW YORK (Reuters Health) Aug 19 - A single session of extracorporeal shock wave therapy (ESWT) helped burn wounds heal significantly faster in a recent phase II trial.
Patients treated with low-energy defocused ESWT for superficial 2nd-degree burns within 24 hours after debridement had complete healing three days ahead of a control group that got standard care, the research team reports.
The randomized double-blind trial included 50 patients: 22 who received standard care, 22 who had standard care plus a single application of ESWT to the burned area, and six who were lost to follow-up.
The average time it took to achieve at least 95% epithelialization of the wound was 9.6 days in the study group vs 12.5 days in controls (p<0.0005), according to a July 19th online report in the Annals of Surgery.
Most of the burns involved the extremities or face. ESWT consisted of 100 impulses/cm2 at 0.1 mJ/mm2.
Dr. Christian Ottomann from the Center for Severe Burns and Plastic Surgery at Unfallkrankenhaus Berlin, who led the study, told Reuters Health by email that about 10% of patients had pain during ESWT, but "in no patient was an interruption of extracorporeal shock wave therapy necessary."
Dr. Ottomann and his colleagues say they believe shock wave therapy may work by increasing blood flow to the tissues and providing an anti-inflammatory effect.
The same researchers previously found similar reductions in the time for healing of skin-graft donor sites, a wound similar to a superficial second-degree burn, using this technique.
But Dr. Basil A. Pruitt, Jr., former president of the American Burn Association and Editor of the Journal of Trauma for the last 18 years, had some reservations about the study. He told Reuters Health, "While the concept is intriguing, I'm not convinced."
The researchers said their two groups "were balanced" except for age (which averaged 53 in the ESWT group vs 38 in controls). But Dr. Pruitt believes that while some differences between the groups were not significant taken one-by-one, in the aggregate they may have resulted in the controls having more serious burns. He pointed out, for example, that control patients had more flame burns, inhalation injuries and intensive care admissions.
Dr. Pruitt had other concerns, too, such as the small size of the cohort. He would like to have known how many patients who might have been eligible were not enrolled in the study.
He would also have preferred more accurate assessments of burn wound depth and healing. The authors determined depth "on clinical grounds" instead of with laser Doppler imaging, and they evaluated healing without histologic confirmation. "This is an area where animal research using standardized burn injuries would be better," Dr. Pruitt said.
Dr. Ottomann said his group is addressing these issues now in animal studies.
There are not many reports in the medical literature on ESWT for burn wounds. Asked why this might be so, Dr. Ottomann said, "Before I got in intensive contact with the ESWT, I did not believe in this kind of therapy, but after giving the ESWT a chance, I was convinced. Unfortunately in medicine scientific findings establish sometimes in slow motion."
Two of the study's eight authors reported current or past financial interests in Tissue Regeneration Technologies, LLC (Woodstock, Georgia), the company that makes the investigational ESWT device used in the study.
The study was funded by the U.S. Combat Wound Initiative Program in Rockville, Maryland and the Internationales Zentrum fur Stosswellentherapie in Berlin.
SOURCE: http://bit.ly/rne6x6
Ann Surg 2011.
Reuters Health Information © 2011