Monday, August 30, 2010

Do shock waves aid healing?

Exuberant granulation tissue ("proud flesh") is a common complication of wounds to the horse's lower limbs. It may delay healing and make scar formation more likely.

Dr Andressa Silveira and colleagues at the University of Guelph in Ontario, Canada, have been examining whether shock wave therapy could be used to promote healing and reduce the risk of exuberant granulation tissue.

They found that wounds treated with unfocussed extracorporeal shock wave therapy (ESWT) seemed to produce less exuberant granulation tissue, and looked healthier than untreated wounds, although they did not heal more quickly.

The researchers made five full-thickness skin wounds, (2.5 cm x 2.5cm) on the dorsal aspect of the metacarpus of both fore limbs of each of six horses.

They treated one leg from each horse with ESWT, and left the other limb untreated to act as a control.

The wounds were treated immediately after they were made and then at weekly intervals for a total of four occasions. Each treatment comprised 625 pulses - distributed evenly around the wound and surrounding healthy skin edges.

The researchers found that control wounds were more likely (1.9x) to appear inflamed than were treated wounds. Untreated wounds also had higher exuberant granulation tissue scores.

However, there was no significant difference between biopsies taken from treated and untreated wounds at weekly intervals throughout the study. Neither did treatment have any effect on wound size.

Further investigations are required before shock wave therapy can be recommended for wound treatment. ESWT may be helpful, but so far, there is not enough evidence to support its use in clinical cases.

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