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Fibrosis is characterized by scarring and hardening of tissues and organs. It can affect every organ system, and so could result in organ failure due to the accumulation of extracellular matrix proteins. Previous studies suggest that mechanical forces (such as shockwave therapy, SWT) initiate a process of mechanotransduction and thus could regulate fibrosis. Nevertheless, it is largely unexamined which pathways are exactly involved in the application of SWT and can regulate fibrosis. The present article seeks to elucidate the underlying effect of SWT on fibrosis. Evidence shows that SWT activates macrophage activity, fibroblast activity, collagen amount and orientation and apoptosis, which ultimately lead to an adaptation of inflammation, proliferation, angiogenesis and apoptosis. The included articles reveal that other proteins and pathways can be activated depending on the energy levels and frequency of SWT. These findings demonstrate that SWT has beneficial effects on fibrosis by influencing the proteins and pathways. Based on these data, which highlights the underlying mechanisms, we can make preliminary conclusions about the treatment modalities of SWT in scar formation, such as the energy levels and frequencies that are necessary to prevent or treat fibrotic tissue. [ABSTRACT FROM AUTHOR]

Background: Scars have different biomechanical characteristics, including anisotropy and viscoelasticity compared to healthy skin. To assess these characteristics, the CutiScan CS 100® can be used. The aim of the present study is to investigate reliability and validity of this device in breast cancer patients. Materials and methods: Thirty female patients, with scar adhesions following mastectomy were assessed with the CutiScan CS 100®. Maximal distensibility (pixels) (V1), after‐suction return rate (pixels) (V2), and their ratio (%) (V3) at three points on and around the scar were assessed as measures of viscoelasticity. For intra‐ and interrater reliabilities, the intra‐class correlation coefficient (ICC) and its 95% confidence intervals were calculated. The standard error of measurement (SEM) was calculated to interpret reproducibility of these measurements. To investigate criterion validity of the measurement of anisotropy, measurements in the direction of healthy skin were compared with measurements in the direction of the scar, using a paired t‐test. Results: V1, V2, and V3 show poor to moderate intrarater reliability (ICC 0.00–0.72) and interrater reliability (ICC 0.00–0.53). The maximum displacement (V1) on the measurement point above the scar shows the best reliability (ICC 0.33–0.72). The SEM is about the same for all parameters at all three points. The paired sample t‐test showed a significant difference (p < 0.05) between V1 in the direction towards the scar versus the measurement towards healthy tissue, on the point below the scar. Conclusion: These first reliability and validity results of the CutiScan CS 100® for measuring anisotropy and viscoelasticity in scar tissue adhesions after mastectomy seem promising. Further research is needed addressing the limitations of the present study design. [ABSTRACT FROM AUTHOR]