The effects of intermittent negative pressure on the lower extremities' peripheral circulation and wound healing in four patients with lower limb ischemia and hard‐to‐heal leg ulcers: a case report

Abstract

Peripheral circulation is severely compromised in the advanced stages of peripheral arterial disease. Recently, it was shown that the application of −40 mmHg intermittent negative pressure (INP) to the lower leg and foot enhances macro‐ and microcirculation in healthy volunteers. In this case report, we describe the effects of INP treatment on four patients with lower limb ischemia and hard‐to‐heal leg and foot ulcers. We hypothesized that INP therapy may have beneficial hemodynamic and clinical effects in the patients. Four patients (age range: 61–79 years) with hard‐to‐heal leg and foot ulcers (6–24 months) and ankle‐brachial pressure indices of ≤0.60 on the affected side were included. They were treated with an 8‐week intervention period of −40 mmHg INP (10 sec negative pressure and 7 sec atmospheric pressure) on the lower limbs. A custom‐made vacuum chamber was used to apply INP to the affected lower leg and foot for 2 h per day. After 8 weeks of INP therapy, one ulcer healed completely, while the other three ulcers were almost completely healed. These cases suggest that INP may facilitate wound healing. The theoretical foundation is that INP assists wound healing by improving blood flow to the small blood vessels in the affected limb, increasing the flow of oxygen and nutrients to the cells.

The acute effects of lower limb intermittent negative pressure on foot macro- and microcirculation in patients with peripheral arterial disease

“…We observed increases in ABPIs after eight weeks of INP therapy two hours per day [9]. Our findings on the acute effect of INP on increased macro- and microcirculatory circulation in the present study on PAD patients may explain the clinically beneficial effect of ambient pressure therapy applied to the lower limb on wound healing and ischemic limbs, consistent with the aforementioned studies.…”

Intermittent negative pressure applied to the lower limb increases foot macrocirculatory and microcirculatory blood flow pulsatility in people with spinal cord injury

“…Similar findings were later replicated in peripheral arterial disease patients using the same method in a randomized, placebo-controlled crossover study [9]. Moreover, a recent case study on patients with late-stage peripheral arterial disease and chronic leg and foot ulcers (including one paraplegic patient) indicated that 8 weeks of INP therapy 2 h per day improves foot perfusion and wound healing [6]. These clinical findings are consistent with the INP-induced increase in foot circulation in two separate experimental studies: on healthy subjects [4] and on patients with peripheral arterial disease [5].…”

“…Recent studies in healthy subjects [4] and in patients with peripheral arterial disease [5,6] showed that applying intermittent negative pressure (INP; −40 mm Hg) to the lower leg and foot increased foot macrocirculation and microcirculation. The increased foot circulation was due to INP-induced increases in blood flow pulsatility (variability in blood flow velocity and skin blood flow) [4,5].…”

“…The theoretical foundation for the use of INP is that it improves blood flow to the small blood vessels of the skin by inducing rapid changes in perfusion pressure at the onset of negative pressure [7,8]. This increases the delivery of oxygen and nutrients to the cells, thereby facilitating wound healing [6]. Several clinical studies suggest that INP improves wound healing of chronic ulcers [6,7] and increases peripheral circulation [9][10][11].…”

“…This increases the delivery of oxygen and nutrients to the cells, thereby facilitating wound healing [6]. Several clinical studies suggest that INP improves wound healing of chronic ulcers [6,7] and increases peripheral circulation [9][10][11].…”