Study to Determine if Shock Wave Therapy Applied to Traumatic Wounds of the Extremity Improves Healing Time

NCT ID: NCT00486733

Last Updated: 2012-12-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

213 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-04-30

Study Completion Date

2014-12-31

Brief Summary

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The purpose of this study is to determine if adding shock wave therapy to standard-of-care wound treatment for traumatic extremity wounds helps them heal faster.

Detailed Description

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Timely return of combat wounded to functional lives and duty is imperative. Reliance upon traditional wound management principles is restrictive, and a treatment paradigm aimed at high-energy projectile contaminated wounds suits the requirements of our combat casualty care program. The nature of war wounds makes them unsuitable for conventional, saline-soaked-gauze dressings.

Extra-corporeal-shockwave-therapy (ESWT) has been used successfully for orthopedic soft tissue indications. Pilot studies indicate that ESWT enhances tissue healing through growth-factor release and neovascularization, with favorable safety profile and anti-bacterial effect, particularly in problematic wounds including fracture non-unions, post-traumatic wounds, and burns.

The need to improve the healing and quality-of-life of the combat wounded, the potential of this minimal-risk technology to improve healing of difficult-to-treat orthopedic/soft tissue injury and infection, as well as the combat casualty care experience of surgeons at WRAMC, dovetail uniquely to have our wounded soldiers and medical center play a pivotal role as the fundamental proving ground and primary beneficiary of this technology.

Comparison(s): Standard-of-care wound therapy compared to standard-of-care wound therapy + ESWT for extremity wounds with the aim of conducting a definitive critical analysis of the role of ESWT in improved treatment and outcomes of traumatic soft tissue injuries of the extremity.

Conditions

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Soft Tissue Injuries

Keywords

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extracorporeal shock wave therapy soft tissue wounds

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Standard of Care

Standard of Care Treatment; no study treatment

Group Type NO_INTERVENTION

No interventions assigned to this group

Standard of Care plus Study Treatment

Standard of Care Treatment plus study treatment

Group Type EXPERIMENTAL

DermaGold

Intervention Type DEVICE

The first four follow-up study assessment and data collection points will coincide with scheduled operative interventions on the wound guided by clinical situation and the treating physician's judgment (approximately every 3-4 days). Subsequent follow-up study assessment and data collection points will occur on study days 28 ± 3, 42 ± 3, 60 ± 3, and 90 ± 3.

Interventions

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DermaGold

The first four follow-up study assessment and data collection points will coincide with scheduled operative interventions on the wound guided by clinical situation and the treating physician's judgment (approximately every 3-4 days). Subsequent follow-up study assessment and data collection points will occur on study days 28 ± 3, 42 ± 3, 60 ± 3, and 90 ± 3.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patients should be 18 years of age or older, and capable of providing informed consent indicating awareness of the investigational nature of this trial, in keeping with institutional policy.
* Written informed consent must be obtained from each patient prior to entering the study.
* Female patients will not be pregnant. Exclusion of the possibility of pregnancy by HCG testing (urine or serum) or by history (tubal ligation, hysterectomy, or menopause) is required prior to inclusion in the study.
* Patients should be willing to be followed within the military healthcare system, or the participating civilian center during the course of study treatment and follow-up.
* Patients with traumatic wound(s) of the upper and/or lower extremity. The study wound is the wound with the highest Red Cross Wound Classification (RCWC).
* Patients should demonstrate adequacy of limb perfusion by all of the following clinical parameters in the affected extremity to be treated by investigational shock wave therapy: Palpable distal extremity pulse; Absence of compartment syndrome; or Ankle Brachial Index(ABI) ≥ 0.9 or transcutaneous pulse oximetry, tcP02≥20mmHg.
* Patients with non-circumferential, second degree burn wounds of the upper and/or lower extremity.

Exclusion Criteria

* Patients with current participation in another clinical investigation of a medical device or a drug the requirements of which may preclude complete involvement in this study.
* Women who are pregnant.
* One or more of the following findings in the affected extremity to be treated by investigational shock wave therapy: Ankle Brachial Index \< 0.9 or tcP02\<20 mmHg; Significant arterial or venous injury requiring surgical intervention; or Lymphedema.
* Subject has another non-superficial wound near the study wound that is less than 3cm from the study wound or that has a RCWC of 3.
* Active or previous (within 60 days prior to the study screening visit) chemotherapy.
* Active or previous (within 60 days prior to the study screening visit) radiation to the affected extremity to be treated by investigational shock wave therapy.
* Physical or mental disability or geographical concerns (residence not within reasonable travel distance) that would hamper compliance with required study visits.
* The Investigator believes that the subject will be unwilling or unable to comply with study protocol requirements, including the shock wave treatment procedure, standard-of-care self-care requirements, and all study-related follow up visit requirements.
* Patients with 1st degree, 3rd degree, or circumferential extremity burns considered for treatment by investigational shock wave therapy.
* History of sickle cell anemia.
* History of infection with Human Immunodeficiency Virus.
* History of immunodeficiency disorders.
* Severe anemia - Hgb \< 7 g/dl (males) or \< 6.5 (females).
* Deep vein thrombosis within 6 months of study screening visit.
* Chronic renal insufficiency requiring dialysis.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Tissue Regeneration Technologies

INDUSTRY

Sponsor Role collaborator

Walter Reed Army Medical Center

FED

Sponsor Role lead

Responsible Party

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Alexander Stojadinovic

Director, Combat Wound Initiative Program

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alexander Stojadinovic, MD

Role: PRINCIPAL_INVESTIGATOR

Walter Reed Army Medical Center

Locations

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Walter Reed Army Medical Center

Washington D.C., District of Columbia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Tiffany Felix, MS

Role: CONTACT

Phone: 251-300-7397

Email: [email protected]

References

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Wang CJ. An overview of shock wave therapy in musculoskeletal disorders. Chang Gung Med J. 2003 Apr;26(4):220-32.

Reference Type BACKGROUND
PMID: 12846521 (View on PubMed)

Wang CJ, Chen HS, Chen CE, Yang KD. Treatment of nonunions of long bone fractures with shock waves. Clin Orthop Relat Res. 2001 Jun;(387):95-101. doi: 10.1097/00003086-200106000-00013.

Reference Type BACKGROUND
PMID: 11400901 (View on PubMed)

Schaden W, Fischer A, Sailler A. Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop Relat Res. 2001 Jun;(387):90-4. doi: 10.1097/00003086-200106000-00012.

Reference Type BACKGROUND
PMID: 11400900 (View on PubMed)

Ludwig J, Lauber S, Lauber HJ, Dreisilker U, Raedel R, Hotzinger H. High-energy shock wave treatment of femoral head necrosis in adults. Clin Orthop Relat Res. 2001 Jun;(387):119-26. doi: 10.1097/00003086-200106000-00016.

Reference Type BACKGROUND
PMID: 11400872 (View on PubMed)

Meirer R, Kamelger FS, Huemer GM, Wanner S, Piza-Katzer H. Extracorporal shock wave may enhance skin flap survival in an animal model. Br J Plast Surg. 2005 Jan;58(1):53-7. doi: 10.1016/j.bjps.2004.04.027.

Reference Type BACKGROUND
PMID: 15629167 (View on PubMed)

Haupt G, Chvapil M. Effect of shock waves on the healing of partial-thickness wounds in piglets. J Surg Res. 1990 Jul;49(1):45-8. doi: 10.1016/0022-4804(90)90109-f.

Reference Type BACKGROUND
PMID: 2359293 (View on PubMed)

Ludwig J, Lauber S, Lauber J, Hotzinger H. [Shockwave treatment of femur head necrosis in the adult]. Z Orthop Ihre Grenzgeb. 1999 Jul-Aug;137(4):Oa2-5. No abstract available. German.

Reference Type BACKGROUND
PMID: 11051007 (View on PubMed)

Lauber S. [High energy extracorporeal shockwave therapy in femur head necrosis]. Z Orthop Ihre Grenzgeb. 2000 Sep-Oct;138(5):Oa3-4. No abstract available. German.

Reference Type BACKGROUND
PMID: 11084728 (View on PubMed)

Gerdesmeyer L, von Eiff C, Horn C, Henne M, Roessner M, Diehl P, Gollwitzer H. Antibacterial effects of extracorporeal shock waves. Ultrasound Med Biol. 2005 Jan;31(1):115-9. doi: 10.1016/j.ultrasmedbio.2004.08.022.

Reference Type BACKGROUND
PMID: 15653238 (View on PubMed)

Other Identifiers

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06-20028

Identifier Type: -

Identifier Source: org_study_id