BlueCross BlueShield of Tennessee Medical Policy Manual

Extracorporeal Shock Wave Therapy for Wounds

DESCRIPTION

Extracorporeal shock wave therapy (ESWT) is a nonsurgical treatment that involves the delivery of shock waves to break up kidney stones. This technology (e.g., Dermapace System) is used at lower intensity of energy on musculoskeletal areas of the body with the goal of reducing pain and to promote healing. ESWT is also proposed as a treatment option for wounds and soft tissue injuries with the goal of revascularization and healing of tissue.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

The role of extracorporeal shock wave therapy in the treatment of wounds is uncertain. Additionally, well controlled randomized trials comparing this technology to conventional wound management interventions are necessary to evaluate benefits and harms. The evidence is insufficient to determine the effects of the technology on health outcomes.

SOURCES

American College of Surgeons, (2013, September). Extracorporeal shock wave therapy for wound healing. Retrieved January 28, 2019 from https://www.facs.org/.

Butterworth, P.A., Walsh, T.P., Pennisi, Y.D., Chesne, A.D., Schmitz, C., & Nancarrow, S.A. (2015). The effectiveness of extracorporeal shock wave therapy for the treatment of lower limb ulceration: a systematic review. Journal of Foot and Ankle Research, 8, 3. (Level 2 evidence)

Omar, M.T., Gwada, R.F., Shaheen, A.A., & Saggini, R. (2017). Extracorporeal shockwave therapy for the treatment of chronic wound of lower extremity: current perspective and systematic review. International Wound Journal, 14 (6), 898-908. Abstract retrieved January 28, 2019 from PubMed database.

Society for Vascular Surgery. American Podiatric Association. Society for Vascular Medicine. (2016). Diabetes management guidelines. Retrieved January 28, 2019 from http://www.ndei.org/diabetic-foot-care-joint-guidelines-prevention-of-diabetic-foot-ulcers.aspx.html.

U.S. Food and Drug Administration. (2017). FDA permits marketing of device to treat diabetic foot ulcers. Retrieved from http://www.fda.gov/.

Zhang, I., Weng, C., Zhao, Z., Fu, X. (2017). Extracorporeal shock wave therapy for chronic wounds: A systematic review and meta-analysis of randomized controlled trials. Wound Repair and Regeneration, 25 (4), 697-706. (Level 2 evidence)

ORIGINAL EFFECTIVE DATE:  5/31/2019

MOST RECENT REVIEW DATE:  5/31/2019  

ID_BT

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