Las ondas de choque acústicas en la prevención y tratamiento de las cicatrices hipertróficas y queloideas en el paciente quemado

Abstract

Nowadays hypertrophic scarring and keloid affects a significant number of post-burned patients. It represents the main cause of morbidity and complications in surviving post-burned patients, without an effective treatment, generating large health cost. Pressure therapy and topical silicon sheets are the traditional methods and still the most used for the prevention and treatment of pathological scarring in burned patients today. However, they only have acceptable scientific evidence and poor results, because in many cases they do not prevent the appearance of scarring sequelae. According to these limited results, new therapies in the treatment of post burned scars are currently under investigation. The shockwave therapy appeared in clinical practice to break up kidney stones and has recently found new applications such as musculoskeletal diseases and ulcers. Experimental studies suggest that it promotes angiogenesis and reduces tissue ischemia. It decreases leukocyte infiltration and hence inflammation. Inflammation and fibrosis are closely related. The shock wave therapy appears to increase eNOS (, thereby inhibiting epithelial-mesenchymal transition which is responsible for tumor invasion and fibrosis. The scar is fibrosis, therefore, the application of this therapy in post-burn scars could limit their progression and thereby reduce their morbidity and improve patients' quality of life. Between July 2013 and August 2015, forty patients who had a deep intermediate burn, and that did not require surgery to heal, underwent a therapy with shock waves to prevent and improve scarring in the service of Plastic Surgery and Burn Unit of the University Hospital of Vall Hebron. The patient was used as control himself. Treatment was applied only in the lower area of the scar. In addition, standard treatment, which includes pressotherapy and topical silicone sheets was applied in the whole scar (that included the area treated with dermaPACE®). The scar was assessed by the Vancouver scale, photographic and anthropometric records were taken with a Tewameter, that measures the skin hydration. a biopsy was performed six months after the treatment to evaluate the effect of shockwave therapy on wound healing compared to the other half that did not receive the treatment. The results obtained by statistical analysis derived from the Vancouver scale and non-invasive device for measuring hydration of the scar, the Tewameter, both gave a significance evidence of p 0. 05. It objectifies a statistically favorable result in terms of relative humidity in the scar. It corroborates the improvement in reducing erythema, thickness and an increase in the elasticity of the scar, which seemed throughout the study and the photographs taken and that most patients confirmed this improvement with its subjective opinion. As for the biopsy, results show no significant difference, although any biopsy reflected signs of chronic inflammation and the level of fibrosis was mild, even very slight, these facts would help strengthen the initial theory that the shock waves therapy may decrease exaggerated collagen synthesis. The study suggests that this non-invasive treatment, performed on an outpatient basis, with immediate return to daily live activities, which can be applied simultaneously with other treatments, provides a statistically significant improvement of the results, with minimal morbidity. If these results were confirmed in wider study with more statistical power, shock wave therapy would be another treatment to be included in clinical practice in burn units.

Date of Award	22 Jan 2016
Original language	Spanish
Supervisor	Manuel Armengol Carrasco (Director)