Extracorporeal shock wave for the treatment of chronic venous ulcers: a pilot study.
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This thesis reports a pilot study investigating the use of extracorporeal shock wave therapy (ECSW) in the treatment of chronic venous ulcers. The studies primary aim was to assess the clinical effectiveness of this treatment when combined with current best practice, multilayer compression bandaging. Venous ulceration of the lower limbs is a well-recognised, chronic condition. It affects a significant proportion of the population, results in reduced quality of life and is associated with substantial financial burden to health care systems. ECSW was first put to clinical use in the treatment of kidney stones (urolithiasis) and later in the treatment of orthopaedic non-union fractures. More recently, the ability of ECSW to improve the healing of soft tissue wounds has been assessed. A review of the current literature base revealed a limited number of clinical studies which included venous ulceration in their cohort. Despite this, positive outcomes were reported including complete wound healing in around a third of patients, improved healing rates and reductions in pain and exudate levels. Justification for a study focusing upon the effect of ECSW in the treatment of this specific condition was established, including the need for focus upon quality of life outcomes. Quantitative methodology was employed in the structuring of a prospective pilot study, utilising a before-after design. 28 participants were recruited, none were lost to follow up. ECSW was administered alongside current best practice treatment, simple primary wound dressings and multilayer compression therapy. Treatment was delivered at two week intervals for a maximum of six treatments, with study follow up at 6 months. Wound healing, effect upon pain, exudate level and impact upon quality of life were measured to establish clinical effectiveness. Through discussion of study results, this thesis concludes that ECSW appears to be a safe treatment modality, beneficial in the management of longstanding, large ulcers, not responding to multilayer compression therapy. Building upon the findings of this study, further research is required to validate the use of ECSW in the treatment of chronic venous ulceration.