Shock Wave-Induced Regeneration in Soft Tissue Reconstruction: Clinical Application in Hand Surgery

Background/Objectives: Chronic ulcers are often characterized by impaired microcirculation, delayed epithelialization, and persistent pain. Extracorporeal shock wave therapy (ESWT) has emerged as a regenerative approach capable of modulating angiogenesis and tissue repair. This study aimed to evaluate the effects of ESWT on wound healing, microvascular remodeling, sensory recovery, and joint mobility in patients with chronic ulcerative lesions. Methods: In this prospective observational study, patients with chronic ulcers underwent a standardized ESWT protocol in addition to conventional wound care. Clinical outcomes were assessed at baseline and at the end of follow-up using the Bates–Jensen Wound Assessment Tool (BWAT), pain visual analogue scale (VAS), capillaroscopy, Semmes–Weinstein monofilament test (SWMT), two-point discrimination (2PD), and range of motion (ROM). Results: ESWT was associated with a significant improvement in wound status, pain, sensory function, and ROM. Capillaroscopy showed robust correlations with clinical recovery, inversely with BWAT (ρ = −0.64, p < 0.01), SWMT (ρ = −0.55, p < 0.05), and 2PD (ρ = −0.49, p < 0.05), and positively with ROM recovery (ρ = 0.58, p < 0.01). Diabetic and smoking patients required a longer healing period (5.8 ± 1.3 weeks) than non-diabetic, non-smoking patients (4.2 ± 0.9 weeks, p = 0.03), although BWAT, capillaroscopy, and ROM values converged by week 8. Conclusions: ESWT was associated with meaningful structural, microvascular, and functional improvements in chronic ulcers. Microvascular remodeling, assessed by capillaroscopy, emerged as a key correlate of clinical recovery. Despite slower early healing in diabetic and smoking patients, final regenerative outcomes were ultimately comparable across risk profiles.