Efficacy of combined treatment with vacuum sealing drainage and recombinant human epidermal growth factor for refractory wounds in the extremities and its effect on serum levels of IL-6, TNF-α and IL-2

Abstract

The objective of this study was to investigate the efficacy of combined treatment with vacuum sealing drainage (VSD) and recombinant human epidermal growth factor (rhEGF) for refractory wounds in the extremities, and its effect on serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and IL-2. Ninety-eight patients with refractory wounds in the extremities were recruited and randomly divided into the combined treatment group (underwent VSD and rhEGF treatment) and control group (underwent VSD only) with 49 cases each. Formation of granulation tissue on the wound surface was assessed and scored. The wound healing rate was calculated after 1 week of treatment, and the time of complete healing was recorded. Serum levels of IL-6, IL-2, and TNF-α were measured using enzyme-linked immunosorbent assay. After 1 week of treatment, granulation tissue formation on wound surfaces was significantly improved (p<0.05) compared with that before treatment in both groups. Moreover, granulation tissue formation on wound surfaces was superior in the combined treatment group than in the control group (p<0.05). The wound healing rate was 63.50±4.75% in the combined treatment group and 31.79±3.52% in the control group, and the difference was statistically significant (p<0.05). The time of complete healing was 15.11±2.24 days in the combined treatment group and 19.63±2.76 days in the control group, and the difference was statistically significant (p<0.05). The serum levels of IL-6, IL-2, and TNF-α, in the two groups were significantly lower than those before treatment (p<0.05). Moreover, the levels in the combined treatment group were significantly lower than those in the control group (p<0.05). In conclusion, combined treatment with VSD and rhEGF reduced inflammation and shortened the time of complete healing of refractory wounds in the extremities. Measurement of the levels of related inflammatory factors provided a reference for the prognosis of refractory wounds.

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“…Chronic wound healing can result in infection and eventually cancer. One of the aims of modern medicine is shortening wound-healing time, increasing bioavailability and reducing the side effects of drugs [1][2][3]. Among the many proposed wound-healing protocols, physical methods such as infrared waves [4], high-voltage electric waves [5], and drug delivery involving biomolecules such as endostatin [6], vitamin A [7], ascorbic acid [8] and growth factors [9] can be considered.…”

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“…Although the VSD is a good option for refractory wound complication, 24 risk factors for VSD use include patients at high risk for bleeding and haemorrhage, and the VSD is contraindicated on the wound with active bleeding 7,8 . So the use of VSD might be contraindicated in the setting of PWH with coagulation disorders.…”

“…Vacuum sealing drainage (VSD) is a therapeutic technique which involves a vacuum dressing to promote healing of acute or chronic wounds 6 . VSD has been applied in cases of refractory wound, leading to clear wound surface drainage, accelerated tissue growth and early wound closure 7,8 . However, the application of VSD in PWH is still controversial because of the abnormal haemostasis.…”

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“…TNF-α and IL-6 serve a dual role by promoting as well as hindering wound healing (41). During the early stages of the inflammatory response, TNF-α and IL-6 promote the chemotaxis of inflammatory cells to remove necrotic tissues and pathogens, and promote the production and secretion of various cell growth factors including VEGF, basic fibroblast growth factor and IL-8 (14,15), further accelerating the differentiation and proliferation of various repair cells, extracellular matrix formation and neovascularization, ultimately promoting wound healing (42). However, the continuation of the inflammatory response and overexpression of TNF-α and IL-6 may cause the accumulation of harmful substances and severely impair granulation tissue formation and wound healing (43).…”

“…Numerous factors may delay the wound healing process, including the inhibition of cytokine production by fibroblasts and inflammatory cells. During the early stages of wound healing, the overexpression of inflammatory factors, such as interleukin (IL)-6 and tumor necrosis factor (TNF)-α (14,15), severely impairs the formation of granulation tissue and further delays wound healing. However, a number of studies have revealed that growth factors, including vascular endothelial growth factor (VEGF) (2,4,16), epidermal growth factor (17,18) and transforming growth factor-β (TGF-β) (19,20), serve an important role in the promotion of wound healing.…”