SLR - April 2010 - William H. Thetford
Reference:
Sherer, S.S., Pietramaggiori, G., Mathews, J.C., Orgill, D.P. (2009). Short periodic applications of the vacuum-assisted closure device cause an extended tissue response in the diabetic mouse model. Plastic and Reconstructive Surgery, 124(5), 1458-1465.
Scientific Literature Reviews
Reviewed by: William H. Thetford, DPM, MS
Residency Program: Detroit Medical Center
Podiatric Relevance:
This study lays out useful data for comparison of short periodic vacuum-assisted closure versus continuously applied vacuum-assisted closure and the biological tissue response. This provides relevant information on the future treatment modalities of the complex diabetic wound.
Methods:
Full-thickness wounds measuring 1 cubic cm were excised on seven homozygous, genitically diabetic, 8-to 12-week old male mice per study group. The seven mice per study group were treated with either an occlusive dressing alone, the vacuum-assisted closure device for 6 or 12 hours, or the vacuum-assisted closure device periodically for 4 hours every other day or continuously for 7 days. Wound closure and tissue response were evaluated by macroscopic, histologic, and immunohistochemical analyses on day 7.
Results:
Wound closure was significantly faster after short initial vacuum-assisted closure (6-hour and 12-hour groups) when compared with continuous treatment. Increased granulation tissue formation was seen in the 12-hour group (2.4-fold increase) and in those treated periodically for 4 hours every other day (3.2-fold increase) compared with the dressing-alone controls. Significant stimulation of cell proliferation was seen after all vacuum-asisted closure patterns (3.6- to 5.3-fold increase), whereas angiogenesis was augmented only after the device was applied for either three times for 4 hours (4.3-fold) or continuously (4.7-fold) when compared to dressing-treated wounds. The group with treatment of three times for 4 hours showed a superior angiogenic effect also when compared with short initial applications (6-hour and 12-hour groups).
Conclusions:
This study showed that short vacuum-assisted closure treatment induced an entended biological response in the wound. In addition, short periodic (total of 12 hours) applications of the device showed healing stimulation similar to 14-fold longer continuous vacuum-assisted closure application. This supports the increasing amount of evidence that cyclical forces offer greater benefit than continuous forces. These findings suggest new clinical approaches for mechanical wound-healing devices and a direction for further study.