Retrospective analysis of combined EMTT and ESWT for hard-to-heal lower extremity ulcers: a single-centre outcome study
Eric J Lullove, Karsten KnoblachObjective:
Hard-to-heal (chronic) lower extremity ulcers represent a significant clinical challenge with substantial morbidity and healthcare costs. Extracorporeal shockwave therapy (ESWT) has emerged as a promising adjunctive treatment modality for hard-to-heal wounds, though evidence for combined electromagnetic transduction therapy (EMTT) and ESWT remains limited. The aim of this study was to describe wound healing and pain outcomes associated with combined EMTT and ESWT, used as an adjunct to standard of care (SoC), in patients with hard-to-heal lower extremity ulcers, and to investigate whether the outcomes warrant further prospective study.
Method:
This retrospective chart review analysed consecutive patients with hard-to-heal post-Mohs excisional lower extremity wounds that had failed primary closure after four weeks of SoC, treated with combined Storz Medical AG EMTT (Storz Medical AG, Switzerland) and ESWT using the Storz Medical AG ESWT with C-ACTOR device (Storz Medical AG, Switzerland) between December 2025 and March 2026. All patients received twice-weekly treatments for four weeks (eight treatments in total). Ankle–brachial pressure index (ABPI) was measured at baseline to assess arterial perfusion. Following completion of shockwave therapy, all patients underwent surgical debridement and received standardised wound dressings consisting of non-adherent foam, gauze and Conforming Stretch Gauze Bandage (Medline, US). Primary outcomes included wound surface area (WSA) reduction at weeks 4 and 8, time to complete wound closure, and pain scores at baseline, at week 4 and at wound closure.
Results:
The cohort consisted of 15 patients (mean age: 82.2±7.1 years; 66.7% female; 80.0% White; 20.0% Hispanic). Mean baseline ABPI was 1.05±0.13 (range: 0.82–1.33). Mean WSA decreased from 2.89±1.08 cm 2 at baseline to 0.88±0.93 cm 2 at week 4 (p<0.001), representing a 69.5% reduction. A total of 13 patients (86.7%) achieved complete wound closure, with a mean time to closure of 5.2±1.3 weeks (range: 3–8 weeks). Visual analogue pain scores decreased from 8.1±1.2 at baseline to 2.3±0.9 at week 4 (p<0.001), representing a 71.9% reduction in pain severity. All patients who achieved complete wound closure reported complete pain resolution. All patients completed the full eight-treatment protocol without reported adverse events.
Conclusion:
In this small, retrospective, uncontrolled, single-centre case series of 15 patients, combined EMTT/ESWT used as an adjunct to SoC was associated with wound closure (86.7%) and positive pain outcomes (71.9% reduction). Because the study lacked a comparator group, randomisation and blinding, these findings should be interpreted as a preliminary hypothesis rather than as evidence of efficacy. They warrant confirmation in prospective controlled studies.