Extracorporeal shock wave treatment in ischemic tissues: what is the appropriate number of shock wave impulses?

The dose-dependent effect of extracorporeal shock wave technology (ESWT) was evaluated using a murine skin flap model. Thirty-six Sprague-Dawley rats were divided into six groups (ESWT groups 1 through 5 and a control group). After surgery, shock wave impulses doses were administered: 200 (group 1), 500 (group 2), 1500 (group 3), 2500 (group 4), 5000 (group 5), and 0 (control group 6). Flap viability was evaluated on day 7. Overall, significantly smaller percentages of necrotic zones were observed in groups 2, 3, and 4 compared with groups 1, 5, and the control group ( P < 0.05). ESWT treatment with 200 impulses was found to be ineffective. ESWT treatment of 5000 impulses resulted in a significant increase in the percentage of necrosis compared with other ESWT groups ( P < 0.05). However, ESWT treatments between 500 and 2500 impulses at 0.11 mJ/mm (2) enhanced epigastric skin flap survival significantly.