Negative-Pressure Wound Therapy After Fasciotomy Reduces Muscle-Fiber Regeneration in a Pig Model

Wilkin, Geoffrey; Khogali, Shiemaa; Garbedian, Shawn; Slagel, Bradley; Blais, Simon; Gofton, Wade; Liew, Allan; Renaud, Jean‐Marc; Papp, Steven

doi:10.2106/jbjs.m.01010

Cited by 14 publications

(7 citation statements)

References 27 publications

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“… 2009b ) and also resemble those observed in compartment syndrome in terms of muscle regeneration and pressure stress (Wilkin et al. 2014 ; Pavan et al. 2017 ).…”

Section: Discussionsupporting

confidence: 56%

Computational modelling of wounded tissue subject to negative pressure wound therapy following trans-femoral amputation

Zeybek

Fernandez

et al. 2017

Biomech Model Mechanobiol

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Proof-of-concept computational models were developed and applied as tools to gain insights into biomechanical interactions and variations of oxygen gradients of wounded tissue subject to negative pressure wound therapy (NPWT), following trans-femoral amputation. A macro-scale finite-element model of a lower limb was first developed based on computed tomography data, and distributions of maximum and minimum principal stress values we calculated for a region of interest (ROI). Then, the obtained results were applied iteratively as new sets of boundary conditions for a specific spatial position in a capillary sub-model. Data from coupled capillary stress and mass- diffusion sub-models were transferred to the macro-scale model to map the spatial changes of tissue oxygen gradients in the ROI. The −70 mmHg NPWT resulted in a dramatic change of a wound surface area and the greatest relative contraction was observed at −150 mmHg. Tissue lateral to the depth of the wound cavity revealed homogenous patterns of decrease in oxygenation area and the extent of such decrease was dependent on the distance from the wound surface. However, tissue lateral to the width of the wound demonstrated heterogeneous patterns of change, as evidenced by both gradual increase and decrease in the oxygenation area. The multiscale models developed in the current study showed a significant influence of NPWT on both macro-deformations and changes of tissue oxygenation. The patterns of changes depended on the depth of the tissue, the geometry of the wound, and also the location of tissue plane.Electronic supplementary materialThe online version of this article (doi:10.1007/s10237-017-0921-7) contains supplementary material, which is available to authorized users.

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“… 2009b ) and also resemble those observed in compartment syndrome in terms of muscle regeneration and pressure stress (Wilkin et al. 2014 ; Pavan et al. 2017 ).…”

Section: Discussionsupporting

confidence: 56%

Computational modelling of wounded tissue subject to negative pressure wound therapy following trans-femoral amputation

Zeybek

Fernandez

et al. 2017

Biomech Model Mechanobiol

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“…[ 21 ] Wound VAC therapy has become a widely accepted technique for assistance in the closure of large open wounds but data on its efficacy and reports of associated muscle fiber degeneration in animal models warrant further validation of this treatment. [ 22 23 ] Presentation of CS following fracture leads to prolonged LOS and early use of SG for wound closure in contrast to serial repeat debridement to achieve DPC can shorten LOS although the functional and aesthetic results are less satisfying for patients. [ 24 25 ] The observed 8.2% rate of amputation following CS during hospital admission and the high rates of association with male gender and concomitant vascular injury are similar to the 10% rate reported in a meta-analysis study.…”

Section: Discussionmentioning

confidence: 99%

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Lollo

Grabinsky

2016

Int J Crit Illn Inj Sci

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Background:Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy.Methods:Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted.Results:One hundred twenty-four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty-one percent were male. Motorized vehicles caused 51% of injuries in males. Forty-one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty-seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long-term follow-up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work.Conclusion:Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.

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“…But recently some different voice emerged, demonstrating that NPWT may prolong the healing time to wound closure and cause an increased need for skin grafts for fasciotomy wounds [ 28 ]. Another experimental study demonstrated that there was a detrimental effect exerted by NPWT on the extent of muscle fiber regeneration on a pig model [ 29 ]. Therefore, a complementary therapy that can compensate the drawback of NPWT is worth evaluating.…”

Section: Discussionmentioning

confidence: 99%

Enhancement of Bone-Marrow-Derived Mesenchymal Stem Cell Angiogenic Capacity by NPWT for a Combinatorial Therapy to Promote Wound Healing with Large Defect

Shou

Niu

Zheng

et al. 2017

BioMed Research International

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Poor viability of engrafted bone marrow mesenchymal stem cells (BMSCs) often hinders their application for wound healing, and the strategy of how to take full advantage of their angiogenic capacity within wounds still remains unclear. Negative pressure wound therapy (NPWT) has been demonstrated to be effective for enhancing wound healing, especially for the promotion of angiogenesis within wounds. Here we utilized combinatory strategy using the transplantation of BMSCs and NPWT to investigate whether this combinatory therapy could accelerate angiogenesis in wounds. In vitro, after 9-day culture, BMSCs proliferation significantly increased in NPWT group. Furthermore, NPWT induced their differentiation into the angiogenic related cells, which are indispensable for wound angiogenesis. In vivo, rat full-thickness cutaneous wounds treated with BMSCs combined with NPWT exhibited better viability of the cells and enhanced angiogenesis and maturation of functional blood vessels than did local BMSC injection or NPWT alone. Expression of angiogenesis markers (NG2, VEGF, CD31, and α-SMA) was upregulated in wounds treated with combined BMSCs with NPWT. Our data suggest that NPWT may act as an inductive role to enhance BMSCs angiogenic capacity and this combinatorial therapy may serve as a simple but efficient clinical solution for complex wounds with large defects.

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Negative-Pressure Wound Therapy After Fasciotomy Reduces Muscle-Fiber Regeneration in a Pig Model

Abstract: NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.

Cited by 14 publications

References 27 publications

Computational modelling of wounded tissue subject to negative pressure wound therapy following trans-femoral amputation

Computational modelling of wounded tissue subject to negative pressure wound therapy following trans-femoral amputation

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Enhancement of Bone-Marrow-Derived Mesenchymal Stem Cell Angiogenic Capacity by NPWT for a Combinatorial Therapy to Promote Wound Healing with Large Defect

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