Molecular changes in diabetic foot ulcers

Aim: This study investigated the molecular changes of extracorporeal shockwave therapy (ESWT) and hyperbaric oxygen therapy (HBOT) in chronic diabetic foot ulcers. Methods: A cohort study consisted of 39 patients (44 ulcers) in the ESWT group and 38 patients (40 ulcers) in the HBOT group with similar demographic characteristics. The ESWT group received shockwave therapy twice per week for total six treatments. The HBOT group received hyperbaric oxygen therapy daily for total 20 treatments. Biopsy was performed from the periphery of the ulcer before and after treatment. The specimens were immuno-stained, and the positive immuno-activities of vWF, VEGF, eNOS, PCNA, EGF and TUNEL expressions were examined and quantified microscopically. Results: Significant increases in vWF, VEGF, eNOS, PCNA and EGF expressions and a decrease in TUNEL expression were noted after ESWT (P < 0.05), whereas the changes after HBOT were statistically not significant (P > 0.05). The differences of vWF, VEGF, eNOS, PCNA, EGF and TUNEL expressions between the two groups were comparable before treatment (P > 0.05), however, the differences became statistically significant after treatment (P < 0.05) favoring the ESWT group. Conclusion: ESWT showed significant increases in angiogenesis and tissue regeneration over HBOT in diabetic foot ulcers. (C) 2011 Elsevier Ireland Ltd. All rights reserved.