Acute and chronic soft tissue wounds
CONSULT TREATMENT PROTOCOL

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GLOSSARY OF DISEASES

NameTissueType of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome
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MORE INFORMATION

Diabetic foot ulcer, pressure ulcer and venous stasis ulcer are the most common chronic skin and soft tissue wounds. A chronic wound is usually one that has failed to heal within three months.

Diagnosis is based on the clinical features of the disease. The incidence is approximately 1%, with chronic wounds mostly affecting people 60 years or older. Accordingly, the number of chronic wounds will rise as the population ages.

Factors that contribute to chronic wounds include poor circulation, (diabetic) neuropathy, bacterial colonization and infection, systemic illnesses, age, repeated trauma, vasculitis, immune suppression (including the use of steroids over a long period), but also emotional stress.

According to the University of Texas Wound Classification system, wounds are categorized into four stages (A: without infection and ischemia; B: with infection; C: with ischemia; D: with infection and ischemia) and four grades (0: pre- or postulcerative lesion completely epithelialized; 1: superficial wounds, not involving tendon, capsule or bone; 2: wounds penetrating to tendon or capsule; 3: wound penetrating to bone or joint). Wound healing is classically divided into four phases (i: hemostasis; ii: inflammation; iii: proliferation; iv: remodeling) with considerable overlapping among individual phases.

These phases are controlled by a wealth of growth factors that are involved in wound healing such as vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and transforming growth factors α and β (TGF-α and -β), to mention only a few. Inadequate levels of growth factors may also contribute to the formation of chronic wounds.

Therapeutic strategies for chronic wounds aim at preventing and treating infection, fighting ischemia, and replacing and/or stimulating growth factors. This can be achieved by surgical wound debridement, application of hyperbaric oxygen, negative pressure wound therapy, and topical and systemic application of molecules such as cell adhesion proteins, cytokines, enzymes, or EGF-like growth factor. Mesenchymal stem cell therapy has become another potential future target for intervention.

Recently radial shock wave therapy (RSWT) was introduced into the management of chronic wounds (Stages/Grades A1 and A2, as well as C1 and C2 with great care), based on its proven abilities to improve the functional microvasculature, stimulate expression of growth factors such as VEGF, and increase cell proliferation. RSWT is particularly interesting for those chronic wounds that are too small for negative pressure wound therapy.

CLINICAL EVIDENCE

Zoech. JATROS Orthop 2009;(1):46-47.

ESW-Therapy in diabetic foot ulcers

READ ABSTRACT

TREATMENT PROTOCOL

Specific recommendations prior to RSWT Perform standard wound cleaning and debridement prior to RSWT

Place sterile plastic foil over the wound and surrounding tissue

Apply sterile coupling gel onto the drape

Specific recommendations after RSWT Remove gel and plastic foil, clean with sterile saline solution

Apply standard wound dressing according to the individual phase of wound healing

Number of treatment sessions 10
Interval between two sessions 2 times a week
Air pressure Evo Blue® 2 to 4 bar
Air pressure Power+ 1.5 to 3 bar
Impulses 200 - 300 impulses / cm2 point
Frequency 8Hz to 12Hz
Applicator 36mm
Skin pressure Light to Moderate

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