Prophylactic shockwave therapy to the skin reduces post-surgical scarring

Preoperative extracorporeal shockwave therapy (ESWT) appears to reduce scar formation and symptoms after surgery, according to findings in patients undergoing abdominoplasty.

The rationale behind the investigation was that ESWT—using an acoustic system to stimulate tissue regeneration—has been previously shown to speed wound healing. This led researchers to wonder if it might also reduce scarring.

“Extracorporeal shockwave therapy (ESWT) has been demonstrated as a feasible non-invasive method to improve wound healing. This effect was demonstrated to result from increased perfusion and angiogenesis due to systemic growth factors expression. We therefore hypothesized that preoperative ESWT reduces scar formation after surgery,” said lead author Dr. Elisabeth Russe, in a press release from the American Society of Laser Medicine and Surgery on May 15, 2019. Dr. Russe is a specialist at the department of plastic and reconstructive surgery, Hospital of the Barmherzige Brüder, Paracelsus Medical University Salzburg, in Salzburg, Austria.

In the controlled pilot study, published online ahead of print in Lasers in Medicine and Surgery (April 29, 2019), 24 patients undergoing abdominoplasty were enrolled. To evaluate the efficacy of preoperative unfocused, low energy ESWT, investigators randomly allocated the right and left half of the operative area to ESWT or placebo treatment. One day before abdominoplasty surgery, patients received one ESWT treatment, and a sham treatment that used a device that completely absorbed the transmission of shockwave energy to the patient's body tissue. During ESWT and placebo treatment, 50 impulses per square cm, at a frequency of 4 Hz were applied to an area of approximately 5 cm along both sides of both planed surgical resection margins. The maximum level of intensity was 0.25 mJ per square mm, and the penetration depth was between 0 and 10 mm. Depending on the size of the operative area, treatment lasted up to 10 minutes and was performed without any anaesthesia

A clear trend on the Vancouver and POSAS scar scales was seen favouring ESWT. The largest differences favouring ESWT were observed in scar thickness and overall impression (Vancouver scar scale).

“We conclude that ESWT presumably reduces scar formation and postoperative symptoms after surgery and recommend further studies to confirm ESWT efficacy,” said Dr. Russe.

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