ESWT Wound Therapy

THE FOCUSED PIEZO SHOCKWAVE FOR THE TREATMENT OF WOUNDS IN DIABETIC FOOT SYNDROME
Extracorporeal shockwave therapy (ESWT) is a non-invasive procedure which can stimulate wound healing. Shockwaves are characterized by a high positive pressure amplitude with a very short rise time of a few nanoseconds, followed after a few microseconds by a brief negative pressure amplitude. The pressure then levels out and returns to normal again. The focused shockwaves used in ESWT achieve their peak pressure precisely in the target tissue.

Treating wounds with shockwave therapy

For a long time the biological mechanism of action by which shockwaves improve wound healing were not understood; however, the effects have been precisely described. Research findings have been confirmed by clinical results which showed significant improvements in wound healing.

In recent years, numerous scientific studies and publications, some of which also used focused piezo shockwaves, have described the mechanism of action by which ESWT stimulates wound healing. Basically, ESWT is a strong, targeted, mechanical stimulus which promotes biological self-healing processes. On closer investigation this generalized statement describes a host of complex shockwave effects. Mechanical stimuli affect many cellular functions in living tissue including cell growth, cell differentiation, cell migration, protein synthesis, physiologic apoptosis and tissue necrosis. Extracorporeal shockwaves act as mechanical stressors and induce biochemical changes in living tissue which, on a molecular level, ultimately affect the gene expression of cells; when shockwaves are applied selectively they can elicit certain tissue reactions. This process is referred to as mechanotransduction. 

Mechanisms of action and effects of ESWT described in the literature:

  • Neovascularization
  • Induced release of growth factors such as TGF-ß1, VEGF
  • Stimulation of fibroblast proliferation
  • Stimulation of mesenchymal stem cell migration
  • Antibacterial effect
  • Stimulation of local blood flow and suppression of pro-inflammatory processes

Administering ESWT to treat wounds

SIMPLE AND EFFECTIVE
Wound treatments are well tolerated by patients and ESWT application is uncomplicated. Sedation or anesthesia is generally not required. To achieve optimal coupling of the shockwave it is important to prevent air pockets. As with ultrasound applications, there should be no air pockets between the therapy source and the target tissue.

The most important treatment steps:

The most important treatment steps:

  1. Fill the therapy source with fresh shockwave gel (at least 1x daily)
  2. Insert the gel pad into the therapy source, ensuring that there are no air pockets
  3. Plug in the therapy source, switch on the unit, select the frequency and intensity setting
  4. Clean the wound, carry out wound debridement if necessary
  5. Fill the wound with sterile hydrogel suitable for wounds
  6. Cover the wound with sterile foil, again making sure there are no air pockets
  7. Clean the gel pad again where necessary (use disinfectants if necessary)
  8. Apply shockwave gel (to the gel pad or alternatively to the foil on the patient)
  9. Place the gel pad on the patient, ensuring there are no air pockets. Administer the shockwaves. During shockwave application, move the therapy source slowly and evenly across the wound and the edges of the wound
  10. End the application after administering the planned number of shockwaves
  11. Remove the foil and clean the wound. Wound care should be done in accordance with your own standards of care

Depending on the progress of wound healing, administer shockwaves once a week until the end of therapy.

  1. Fill the therapy source with fresh shockwave gel (at least 1x daily)
  2. Insert the gel pad into the therapy source, ensuring that there are no air pockets
  3. Plug in the therapy source, switch on the unit, select the frequency and intensity setting
  4. Clean the wound, carry out wound debridement if necessary
  5. Fill the wound with sterile hydrogel suitable for wounds
  6. Cover the wound with sterile foil, again making sure there are no air pockets
  7. Clean the gel pad again where necessary (use disinfectants if necessary)
8. Apply shockwave gel (to the gel pad or alternatively to the foil on the patient)
9. Place the gel pad on the patient, ensuring there are no air pockets. Administer the shockwaves. During shockwave application, move the therapy source slowly and evenly across the wound and the edges of the wound
10. End the application after administering the planned number of shockwaves
11. Remove the foil and clean the wound. Wound care should be done in accordance with your own standards of care

Depending on the progress of wound healing, administer shockwaves once a week until the end of therapy.

TECHNOLOGY OF ESWT WOUND THERAPY

UNIQUE IN WOUND THERAPY – THE USE OF LINEAR FOCUSED SHOCKWAVES
Richard Wolf GmbH and ELvation Medical GmbH have developed a new and unique technology: a linear, focused shockwave. The aim was to create a shockwave that could be applied much more uniformly and effectively compared to conventional point-focused shockwaves. Gel pads are used to adjust the penetration depth to between 0 and 20 mm, ensuring that the acoustic field is optimally adapted to the respective dermatological application.

The focal zone of a piezo shockwave is the area (-6dB zone) in which the maximum positive peak pressure drops to half of peak pressure. Shockwaves show a 3-dimensional spatial distribution along the x, y and z axes. This focal zone can be adjusted to precisely target the treatment area as this also minimizes trauma to adjacent tissue. The focal zone of a linear focused piezo therapy source (FBL10x5G2, intensity 10) has a 3-dimensional volume of 46 mm x 20 mm x 4 mm. Because of the direct focusing technology of piezo shockwave systems, the size of the focal zone barely changes, even when the intensity setting is adjusted.
The penetration depth of the focal zone is preselected using gel pads of different thicknesses. A special feature of linear focused shockwaves is the option to select a “0” gel pad. Half of the focal zone remains within the gel pad, ensuring that peak pressure in the focal center is precisely at skin level.
Richard Wolf GmbH and ELvation Medical GmbH have developed a new and unique technology: a linear focused shockwave. The aim was to create a shockwave that could be applied much more uniformly and effectively compared to conventional point-focused shockwaves. Gel pads are used to adjust the penetration depth to between 0 and 20 mm, as this ensures that the acoustic field is optimally adapted to the respective dermatological application. The focal zone of the linear focused piezo therapy source (FBL 10×5 G2, intensity 10) has a 3-dimensional volume of 46 mm x 20 mm x 4 mm. The penetration depth of the focal zone is preselected using gel pads of different thicknesses. A special feature of linear focused shockwaves is the option to select a “0” gel pad. Half of the focal zone remains within the gel pad, ensuring that peak pressure in the focal center is precisely at skin level.
The system can be expanded at any time by purchasing additional optional therapy sources.

The PiezoWave² DERM

The focused piezo shockwave to treat wounds

Standard accessories: 

Therapy source FBL10x5G2 20 mm for the treatment of chronic diabetic foot syndrome
Gel pads
1 bottle of ESWT contact gel, 250 ml
Foot switch
Cart

The tablet PC is not part of the unit.

Technical specifications
:
External power supply: 220–240 VAC / 50–60 Hz
Noise level: 65 dB(A)
Classification: 93/42 EEC class IIb product

Technical specifications for the therapy source
:
Energy flux density: 0.018–0.160 mJ/mm²
Intensity levels: 20 levels
Maximum penetration depth: 20mm
Foot activation, hand activation

Maintenance
The unit requires very little maintenance. To maximize your product’s lifespan, we recommend the following:

Control unit
In the EU, an annual safety inspection is mandatory. The safety inspection should be combined with a functional check carried out by a maintenance engineer.

Therapy source
The therapy source has a guaranteed lifespan of 5 million shockwave pulses and/or 2 years. A functional check carried out by a maintenance engineer is recommended at the end of this period.

 

Richard Wolf GmbH and ELvation Medical GmbH have developed a new and unique technology: a linear focused shockwave. The aim was to create a shockwave that could be applied much more uniformly and effectively compared to conventional point-focused shockwaves. Gel pads are used to adjust the penetration depth to between 0 and 20 mm, as this ensures that the acoustic field is optimally adapted to the respective dermatological application. The focal zone of the linear focused piezo therapy source (FBL 10×5 G2, intensity 10) has a 3-dimensional volume of 46 mm x 20 mm x 4 mm. The penetration depth of the focal zone is preselected using gel pads of different thicknesses. A special feature of linear focused shockwaves is the option to select a “0” gel pad. Half of the focal zone remains within the gel pad, ensuring that peak pressure in the focal center is precisely at skin level.
The system can be expanded at any time by purchasing additional optional therapy sources.

The PiezoWave² DERM

The focused piezo shockwave to treat wounds

Standard accessories: 

Therapy source FBL10x5G2 20 mm for the treatment of chronic diabetic foot syndrome
Gel pads
1 bottle of ESWT contact gel, 250 ml
Foot switch
Cart

The tablet PC is not part of the unit.

Technical specifications
:
External power supply: 220–240 VAC / 50–60 Hz
Noise level: 65 dB(A)
Classification: 93/42 EEC class IIb product

Technical specifications for the therapy source
:
Energy flux density: 0.018–0.160 mJ/mm²
Intensity levels: 20 levels
Maximum penetration depth: 20mm
Foot activation, hand activation

Maintenance
The unit requires very little maintenance. To maximize your product’s lifespan, we recommend the following:

Control unit
In the EU, an annual safety inspection is mandatory. The safety inspection should be combined with a functional check carried out by a maintenance engineer.

Therapy source
The therapy source has a guaranteed lifespan of 5 million shockwave pulses and/or 2 years. A functional check carried out by a maintenance engineer is recommended at the end of this period.