Low-energy Shockwave Therapy in the Management of Wound Healing Following Fournier's Gangrene

Jens J Rassweiler, Walter Scheitlin, Ali Serdar Goezen, Marie-Claire Rassweiler-Seyfried, Jens J Rassweiler, Walter Scheitlin, Ali Serdar Goezen, Marie-Claire Rassweiler-Seyfried

Abstract

We report on postoperative management of wound healing in four cases of Fournier's gangrene successfully treated with low-intensity shockwave therapy (LI-ESWT). In three cases, LI-ESWT (3 sessions per week with 2000 shockwaves at 3 Hz applied at 0.25 mJ/mm2) was able to close wound dehiscence secondary to plastic surgery with skin flaps. In one patient, LI-ESWT resulted in complete closure of an extensive wound with restoration of the local scrotal and penile skin. This is the first report of successful application of LI-ESWT for this indication. Restoration of local skin rather than wound closure by fibrous tissue could be related to promotion of stem cells, which has been discussed previously for other indications, such as treatment of chronic ulcers and restoration of the pelvic floor.

Keywords: Extracorporeal shockwave therapy; Fournier’s gangrene; Low-intensity shockwaves; Stem cell proliferation; Wound healing.

© 2022 The Author(s).

Figures

Fig. 1
Fig. 1
Low-intensity extracorporeal shockwave therapy (LI-ESWT) for management of secondary wound healing following skin-flap plastic surgery for Fournier’s gangrene. (A) Initial presentation with severe Fournier’s gangrene (acute necrotizing fasciitis) in the genital and perineal area. (B) Radical excision of the involved tissue. (C) Secondary healing after closure of the defect with skin flaps. (D) Healing of the wound after treatment with LI-ESWT (2000 shocks, 3 Hz, 0.25 J/mm2) three times weekly for 6 wk. No further surgical intervention was required after 12 wk.
Fig. 2
Fig. 2
Low-intensity extracorporeal shockwave therapy (LI-ESWT) as a single management strategy for wound healing following radical excision of infected tissue after Fournier’s gangrene. (A) Initial presentation with severe Fournier’s gangrene involving the penis and scrotum. (B) Radical excision of the involved tissue. (C) Development of granulation following LI-ESWT (2000 shocks, 3 Hz, 0.25 J/mm2) three times weekly for 6 wk. (D) Complete restoration of the wound by scrotal and penile tissue after 12 wk. No surgery was required.

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Source: PubMed

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