The role of topical negative pressure in wound repair: Expression of biochemical markers in wound fluid during wound healing

Abstract

The clinical effects of topical negative pressure therapy (TNP) on wound healing are well described in numerous articles. While the mechanism(s) of action are not completely understood, it is postulated that reduction of local and interstitial tissue edema, increased perfusion of the (peri-) wound area, changed bacterial composition, and mechanical stimulation of the woundbed contribute to the clinical success. Our hypothesis is that with the removal of excessive fluid, proteolytic enzymes negatively influencing the healing process are removed. Our aim was to assess whether the concentrations of albumin, matrixmetalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase (TIMP-1) were different between wounds treated with TNP and conventional gauze therapy. We analyzed wound fluid samples of 33 wounds treated with either TNP therapy (n=15) or conventional therapy (n=18) on albumin, pro- and activated MMP-9, TIMP-1, and the ratio of total MMP-9/TIMP-1. Albumin levels were found to increase significantly in acute wounds compared with chronic wounds; however, no difference could be found on comparing TNP with conventional therapy. We did find significantly lower levels of pro-MMP-9 and lower total MMP-9/TIMP-1 ratio in TNP-treated wounds during the follow-up of 10 days. These data strongly suggest that TNP therapy influences the microenvironment of the wound.

The Effectiveness of Negative Pressure Therapy in Diabetic Foot Ulcers with Elevated Protease Activity: A Case Series

“…Wound fluid samples were collected daily for up to 10 days using a sterile porous filter, and quantitative measurements of pro-MMP-9 and TIMP-1 levels were analyzed using enzyme-linked immunosorbent assay (ELISA). 23 Stechmiller et al reported significant decreased tumor necrosis factor-a levels after 7 days of NPT in six patients with pressure ulcers. Instead, they did not find decreased levels of interleukin-1b (IL-1b), MMP-2, MMP-3, or TIMP-1 from the baseline.…”

“…[29][30][31][32][33][34] Nevertheless only few articles described the NPT influence on MMPs activity. [22][23][24][25] Greene et al described the reduction in MMP-9/ neutrophil gelatinase-associated lipocalin, MMP-9, latent, and active MMP-2 activity by 15% to 76% determined by zymography in three patients (1 DFU) after 2 weeks of NPT. 22 Moues et al showed significantly lower levels of pro-MMP-9 and higher ratio of MMP-9/TIMP-1 in 15 NPT-treated wounds than in 18 conventional treated wounds.…”

Application of vacuum-assisted closure in seawater-immersed wound treatment under different negative pressures

“…In our country, pressure values usually range from 120 to 125 mmHg, as this value is conducive to granulation growth (Mouës et al, 2008). However, there have been reports regarding the application of higher negative pressures (450-600 mmHg) (Morykwas et al, 2001).…”

“…In recent years this technique has experienced rapid development and has been widely used to treat various acute and chronic wounds with excellent outcomes (Gabriel et al, 2009;Witkowski et al, 2009;Palm et al, 2011;Wood and Molnar, 2011;Masden et al, 2012;Ogawa, 2012). Both locally and abroad, the VAC mechanism has attracted a great deal of research, and results show that VAC plays various roles in wound healing: cleaning of wound exudate, reduction of peripheral edema, improvement of local blood supply, removal of bacteria, inhibition of bacterial proliferation, acceleration of granulation growth, and re-epithelialization (Sexena et al, 2004;Labler et al, 2006;Mouës et al, 2008;Chan, 2009;Parker, 2012;Chen et al, 2013;Dong et al, 2013). Thus, this technique can shorten wound healing time and provide a bed for delayed skin grafts.…”

Uso da terapia por pressão subatmosférica em feridas traumáticas agudas

“…SPT assists in the evolution of the wound through several mechanisms: it reduces of local edema 7 , provides wound contraction, stimulates neoangiogenesis, removes exudate 8 , improves blood flow 9 and reduces bacterial colonization 10 . Many of these effects are desirable for the treatment of large traumatic wounds to the limbs, especially the reduction of edema and improvement of blood flow to the wound and to rotated flaps.…”