Extracorporeal shockwave therapy in plastic, hand, aesthetic, and reconstructive surgery.

Plastic surgery is a multidimensional surgical discipline including reconstructive surgery, hand surgery, aesthetic surgery, and burn surgery, all on the fundament of plastic surgical research. In all of these disciplines, extracorporeal shockwave therapy (ESWT) has been studied both experimentally and clinically. In reconstructive surgery, experimental data clearly demonstrate better survival of flaps when either pre- and/or postconditioned with ESWT, with fewer complications. In hand surgery, ESWT has been described for bone indications like scaphoid non-unions or lunate necrosis aka Kienböck's disease, tendon indications, nerve indications like carpal tunnel syndrome, or soft tissue indications like Dupuytren's disease. In aesthetic surgery, cellulite has been studied extensively, with more than 15 clinical studies, some of them randomized. Both radial and focused ESWT improve cellulite after 6-8 sessions by 25-35%. For facial antiaging, radial ESWT has been shown to reduce skin pore size by 80% and improve skin tone. In breast reconstruction, ESWT has been shown to reduce the capsular fibrosis associated with breast implants. For filler complications, ESWT can improve the situation, with a beneficial effect on granuloma-associated biofilm. As detailed in this article, ESWT is successfully applied in the entire field of plastic surgery-in reconstructive surgery, hand surgery, burn surgery, and aesthetic surgery, improving outcomes and reducing complications.