The physical and physiological effects of vacuum massage on the different skin layers: a current status of the literature

Study characteristics

The flow diagram of this review is shown in Fig. 2. An extended search of PubMed, Web of Science and Google Scholar identified 481 citations after removing the duplicates. After being screened on title and abstract 444 records were excluded. We assessed 37 full-text articles for eligibility, and finally, 19 full-text articles were included in the qualitative synthesis. The main reasons for exclusion were depressomassage combined with other interventions (n?=?7), the targeted skin layer did not include the dermis or epidermis (n?=?9) and the wrong study design/article format (white paper instead of a scientific article) (n?=?2).

Flow diagram

Among the included trials, eight of them were pilot studies with pre- or post- treatment evaluations [3, 12–18], four were controlled clinical trials [19–22] and seven were identified as randomised controlled trials [1, 23–28].

Ten trials investigated epidermal and dermal structures [3, 14, 17–21, 25, 27, 28], seven trials targeted the dermal/hypodermal junction [1, 13, 15, 16, 23, 24, 26] and in two studies it was unclear which skin layers were investigated [12, 22].

The total number of patients enrolled was 1002. Only two of the studies enrolled a significant number of patients (738 combined) [12, 22], unfortunately these studies lacked valid and reliable outcome measures (the vitro-pressure test and the cutaneous stretch test were at the time of publication not validated or tested for its reliability). Six trials [14, 17–19, 26, 27] studied the effects on 20 to 70 patients and 11 trials [1, 3, 13, 15, 16, 20, 21, 23–25, 28] were set up with less than 20 patients. This low sample size seemed to be common in interventional studies on burns and scars.

Two studies investigated the cutaneous and systemic effects of vacuum massage on animal models with similar metabolism and skin architecture as human beings [1, 23]. Lipodystrophy or cellulite was the target subject of four studies [13, 20, 21, 26]. Physical, physiological and metabolic effects of depressomassage on healthy skin were discussed in five studies [2, 14–16, 28]. One single study examined the effects on ageing skin [19]. In three studies, the investigated conditions were scar-like pathologies [3, 17, 24] (pathologies with characteristics that were similar to scar characteristics like stiffness or indurations) and eventually only four studies examined the effects of vacuum massage on scars [12, 18, 22, 27]. All these study characteristics are summarised in Table 1, ranked from a high to a low methodological score. The articles that scored high in the SIGN methodology checklist or the LESS scale distinguished themselves from others in the study design, baseline equality, the reliability and validity of the outcome measures and the use of appropriate statistics.

Basic information on the papers included for qualitative analysis

RCT randomised controlled trial, CCT controlled clinical trial, tcpO2 transcutaneous oxygen pressure