Extracorporeal Shock Wave Therapy for Wound Healing

Extracorporeal shock wave therapy (ESWT) employs focused or radial acoustic pulses delivered non-invasively to injured tissue to stimulate biological processes that underpin wound repair. By inducing microtrauma and mechanical stress, ESWT promotes angiogenesis, re-epithelialisation and extracellular matrix remodelling. Key cell types—including fibroblasts, keratinocytes and endothelial cells—respond through mechanotransduction pathways that activate growth factors, extracellular enzymes and cytoskeletal regulators. Clinically, ESWT has been applied to chronic diabetic foot ulcers, pressure injuries, hypertrophic burn scars and other non-healing wounds, demonstrating accelerated closure rates, reduced pain and improved scar quality. As chronic wounds impose a growing global burden alongside ageing populations and metabolic disease, ESWT offers a versatile adjunct to standard debridement, dressing and pharmacotherapy, with ongoing research focused on optimising energy settings, treatment intervals and combination approaches.

Research from Nature Portfolio

Recent laboratory studies have dissected the molecular response of human keratinocytes derived from hypertrophic scar tissue to shock-wave exposure. In vitro application adjusted the balance of proliferation markers (keratins 5 and 14), activation indicators (keratins 6 and 17) and differentiation proteins (keratins 1, 10 and involucrin), while also modulating apoptosis regulators (Bax, Bcl-2, caspase-14). Crucially, cell-cycle inhibitors p21 and p27 and the Notch1 signalling axis were re-expressed towards levels seen in normal epidermis. These findings suggest that controlled ESWT can reprogramme scar keratinocytes, restoring epidermal integrity and reducing fibrotic features by engaging key mechanotransductive circuits.

Extracorporeal Shock Wave Therapy for Wound Healing publication trend

The graph below shows the total number of articles in extracorporeal shock wave therapy for wound healing across all publications each year (not limited to Nature Index journals).

Technical terms

Extracorporeal Shock Wave Therapy (ESWT): Non-invasive application of acoustic shock waves to stimulate tissue regeneration and repair.

Re-epithelialisation: Restoration of the epidermal layer across a wound surface through keratinocyte migration and proliferation.

Angiogenesis: Formation of new blood vessels from pre-existing vasculature, essential for nutrient delivery and tissue regeneration.

Mechanotransduction: Conversion of mechanical stimuli into cellular biochemical signals via specialised sensors and pathways.

Myofibroblast: Contractile fibroblast variant that expresses α-smooth muscle actin and contributes to wound contraction and matrix remodelling.

References

1. Can Shockwave Treatment Elicit a Molecular Response to Enhance Clinical Outcomes in Pressure Ulcers? The SHOck Waves in wouNds Project. Biomedicines (2024).
2. Effect of extracorporeal shock wave therapy on keratinocytes derived from human hypertrophic scars. Scientific Reports (2021).
3. The Acceleration of Diabetic Wound Healing by Low-Intensity Extracorporeal Shockwave Involves in the GSK-3β Pathway. Biomedicines (2020).