Therapeutic Intervention

The therapeutic session was conducted using a radial ESWT applicator (Cellactor^® SC1, Storz Medical, Switzerland). The methodology for ESWT ensured safe and sterile conditions as follows: (1) a sterile ultrasound gel was used as a contact medium directly on the entire wound surface and its edges, (2) a sterile barrier in the form of polyurethane film was placed directly over the wound, previously covered by the ultrasound gel, and (3) the same ultrasound gel was applied on top of the film as a second layer to ensure full contact of the ESWT transducer with the tissues.

The delivery of the procedure should be conducted meticulously and with the use of sterile materials. During the ESWT session, the applicator head makes direct contact with the wound, facilitated by sterile ultrasound gel and a sterile polyurethane film. ESWT application should commence from the wound’s edges, moving gently towards the center while meticulously treating the entire wound surface. Special attention is necessary when working near any bone structure, which should be avoided. Figure 1 provides an illustration of a treatment session employing radial ESWT. The ESWT parameters were as follows: 300 baseline pulses + 100 additional pulses per square centimeter, a pulse pressure of 2.5 bars, a pulse energy of 0.15 mJ/mm², and a pulse frequency of 5 Hz. Local anesthesia was not used, and the procedure was conducted without causing pain. Any adverse events and side effects were carefully observed and reported during the ESWT procedures.

Example of a treatment session using radial ESWT for a VLU (A) and DFU (B).

All patients continued their standard wound care procedures, including proper wound care and hygiene, individually selected and standardized dressings, using pressure relief mattresses and appropriate positioning to optimize healing conditions. These standardized and evidence-based practices adhered to the European Pressure Ulcer Advisory Panel (EPUAP) recommendations for PUs management.