The Clinical Utility of Extracorporeal Shock Wave Therapy on Burns
Condition: Burn Scar
MeSH terms: Burns
Study type: Interventional

Summary: 
      In burn patients, the wound healing process may lead to a fibrotic hypertrophic scar, which
      is raised, inflexible and responsible functional impairments. There are few studies which
      have investigated the effect of extracorporeal shock wave therapy (ESWT) on hypertrophic scar
      characteristics using objective measurements. Thus, this study aimed to ascertain the effects
      of ESWT on burn scars using objective measurements. This double-blinded, randomized,
      controlled trial involved 36 patients with burns. Patients were randomized into a ESWT (an
      energy flux density (EFD) of 0.05 to 0.30 mJ/mm2, frequency of 4Hz, and 1000 to 2000
      impulses) or a sham stimulation group.
    

Detailed description: 
      In burn patients, the wound healing process may lead to a fibrotic hypertrophic scar, which
      is raised, inflexible and responsible functional impairments. There are few studies which
      have investigated the effect of extracorporeal shock wave therapy (ESWT) on hypertrophic scar
      characteristics using objective measurements. Thus, this study aimed to ascertain the effects
      of ESWT on burn scars using objective measurements. This double-blinded, randomized,
      controlled trial involved 36 patients with burns. Patients were randomized into a ESWT (an
      energy flux density (EFD) of 0.05 to 0.30 mJ/mm2, frequency of 4Hz, and 1000 to 2000
      impulses) or a sham stimulation group. Each intervention was applied to the hypertrophic
      scars of upper extremities after autologous split-thickness skin grafting (STSG) using
      Materiderm for 4 weeks once per week. The ESWT group (n=18) received shock waves with
      low-energy flux density (0.05-0.30 mJ/mm2). The interval between treatments is a 1-week. The
      ESWT group also received standard treatment. The control group (n=18) received sham
      stimulation with standard treatment. The investigators compared the skin quality of the ESWT
      and control groups. Participants were made comfortable and acclimatized to room conditions.
      Room temperature was maintained at 20-25'C and relative humidity at 40-50 %. In the supine
      position, skin properties were measured. The thickness was measured with a ultrasonic wave
      equipment (128 BW1 Medison, Korea). Mexameter® (MX18, Courage-Khazaka Electronics GmbH,
      Germany) was used to measure melanin levels and the severity of erythema. The higher values
      indicating a darker and redder skin. TEWL was measured with a Tewameter® (Courage-Khazaka
      Electronic GmbH, Germany), which is used for evaluating water evaporation. Sebum in the scars
      was measured with the Sebumeter® (Courage-Khazaka Electronic GmbH, Germany). The measurement
      is based on the principle of grease-spot photometry using a cassette with its special tape. A
      microprocessor calculates the result, which is shown on the display in mg/cm2. Elasticity was
      measured using Cutometer SEM 580® (Courage-Khazaka Electronic GmbH, Cologne, Germany), which
      applies negative pressure (450 mbar) on the skin. The numeric values (mm) of the skin's
      distortion is presented as the elasticity. Two seconds of negative pressure of 450 mbar is
      followed by 2 s of recess, and this consists of a complete cycle. Three measurement cycles
      were conducted, and the average values were obtained.
    

Intervention name(s): Extracorporeal shock wave therapy; conventional occupational therapy
Intervention type(s): Other; Other
Intervention description(s): ESWT was conducted using the Duolith SD-1® device (StorzMedical, Tägerwilen, Switzerland) with an electromagnetic cylindrical coil source for the focused shock wave (Fig. 2). ESWT was performed around the primary treatment site at 100 impulses/cm2, an energy flux density(EFD) of 0.05 to 0.30 mJ/mm2, frequency of 4Hz, and 1000 to 2000 impulses were administered at 1-week intervals for 4 sessions.; Standard accupational therapy consist of range of motion exercise, strengthening exercises, and activities of daily living exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients' burn scars had re-epithelialized after split-thickness skin graft (STSG). We included patients aged ≥18 years with a deep partial-thickness (second-degree) burn or a full thickness (third-degree) burn to their upper extremities, having been transferred to the rehabilitation department after acute burn treatment, and less than 6 months since the onset of the burn injury.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: burn scar; extracorporeal shock wave therapy; skin characteristics