Summary
Background
Negative pressure wound therapy (NPT) has achieved widespread success in the treatment
of difficult wounds. However, its effects are but partially explored, and investigations
mostly concentrated at the wound–dressing interface; a detailed histological description
of the evolution of wounds under NPT is still lacking.
Materials and Methods
Subsequent punch biopsies of NPT-treated chronic wounds of human patients were analysed.
Phenomena occurring in wounds were quantified by analysis of proliferating cells nuclear
antigen (PCNA) (proliferating nuclei), CD31 (blood vessels), CD68p (macrophages) and
CD45 (lymphocytes) stained slides.
Results
Three layers were identified in day-0 wounds. Over time, under NPT, the layers behaved
differently: the most superficial (1.5 mm) developed granulation tissue, constant
in thickness, with high proliferation index, increased in blood vessels density and
developed acute inflammation. Instead, the two deeper layers decreased in proliferation
rate, maintained vessels density unchanged, were cleared of chronic inflammation and
oedema and underwent progression towards stable tissue.
Discussion
Indeed, while most research has focused on induction of superficial granulation tissue
by NPT, deeper layers appear to be also affected, with relieving of chronic inflammation
and tissue stabilisation. This may be an important and under-appreciated effect, playing
a role in the known positive outcomes of NPT, such as better graft-taking rates.
Keywords
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Article info
Publication history
Published online: September 01, 2011
Accepted:
August 7,
2011
Received:
August 2,
2011
Footnotes
☆The content of the article or part of it was presented at the: European Tissue Repair Society/Wound Healing Society joint meeting 2009.
☆ISCOS (International Spinal Cord Society) annual meeting 2009.
☆SICPRE (Italian Society of Plastic, Reconstructive and Aesthetic Surgery) annual meeting 2010.
☆SIUst (Italian Burns Society) annual meeting 2010.
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
