J Wound Manag Res.  2023 Feb;19(1):21-27. 10.22467/jwmr.2022.02124.

Extracorporeal Shock Wave Therapy and a New Assessment Tool for Intractable Wounds of the Limbs

• Sugiyama T
• Murakami H
• Noguchi K
• Kawano K
• Shibata M
• Shiba N

• KMID: 2540015
• DOI: http://doi.org/10.22467/jwmr.2022.02124

Abstract

Background
Extracorporeal shock wave therapy (ESWT) is indicated for intractable skin wounds and skin ulcers; however, assessing its efficacy for wounds at the periphery of the extremities may be difficult depending on the wound size (small wounds are challenging to differentiate over time with existing scores) and due to unclear metrics for assessing the amount of exudate and inflammation. To overcome this issue, we developed the Hand and Foot Wound Assessment Tool (HFWAT), comprising area and size, necrotic tissue and healthy granulation tissue, depth, amount of exudate, and inflammation and signs of infection. This study aimed to examine the effect of ESWT on obliterating limb wounds and evaluate outcomes using the HFWAT.
Methods
The study included seven patients (four males, three females; 63.4±14.0 years) who visited our hospital between April 2018 and March 2020 and presented with persistent skin wounds on the hands and feet that did not heal despite treatment for more than 2 weeks. Patients received an energy flux density of 0.01 mJ/mm2, which was gradually increased. The HFWAT was used to evaluate the wound, and the pre- and post-ESWT scores were compared.
Results
Successful wound healing was observed in all patients following ESWT. The median HFWAT score improved from 9.0 (interquartile range, 9–10) points before ESWT to 0.0 (interquartile range, 0–0) points at the final evaluation (P=0.05, n=7).
Conclusion
ESWT was effective for intractable wounds, as demonstrated by the significantly improved HFWAT score. Furthermore, the HFWAT could be valuable for assessing small wounds in the peripheral extremities.

Keyword

Extracorporeal shockwave therapy; Wound healing; Hand injuries; Foot injuries; Extremities