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Negative pressure wound therapy promotes wound healing by alleviating inflammatory reaction in patients with diabetic feet

WANG Tao1, ZHAO Jun1, YU Min1，YANG Wen-chao1, JIANG Yu-jie1, HE Rui2, LIU Fang2, JIA Wei-ping2   

  1. 1. Department of Vascular Surgery, 2. Department of Endocrinology & Metabolism, Multi-disciplinary Diabetic Foot Collaborative Group, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai 200233, China

  • Online:2016-08-29 Published:2016-08-31
  • Supported by:

    National Natural Science Foundation of China，81270397；Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support，20152232

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Abstract:

Objective · To apply the negative pressure wound therapy (NPWT) to the wounds in patients with diabetic feet and observe the effect of NPWT on inflammatory reaction. Methods · Twenty-two patients with diabetic feet were enrolled and randomly assigned to two groups, i.e. the experimental group (n=11) treated with NPWT and debridement regiment and the control group (n=11) treated with debridement regiment alone. Wound tissue samples were collected 0, 7, and 14 d after therapy and the hematoxylin staining was performed to observe the inflammatory reaction. IL-6 and TNF-α levels were measured with immunohistochemistry and changes in levels of iNOS and COX-2 proteins were detected with ELISA. Results · The inflammatory response was milder in the experimental group than in the control group 7 and 14 d after therapy. Results of immunohistochemistry suggested that the areas of TNF-α positive regions were smaller in the experimental group than in the control group 7 d after therapy [(619.5±15.7) μm2 vs (636.1±14.1) μm2, t=2.597, P=0.017]. The areas of IL-6 positive regions were smaller in the experimental group than in the control group 7 and 14 d after therapy [(626.0±11.5) μm2 vs (664.6±18.8) μm2, t=5.810, P=0.000; (611.4±19.2) μm2 vs (642.1±22.5) μm2, t=3.447, P=0.003]. The results of ELISA showed that the levels of iNOS protein were significantly lower in the experimental group than in the control group 7 and 14 d after therapy [(367.0±24.9) pg/mL vs (404.6±29.9) pg/mL, t=3.206, P=0.004; (241.8±24.1) pg/ml vs (356.7±41.9) pg/mL, t=7.882, P=0.000]. The levels of COX-2 protein were significantly lower in the experimental group than in the control group 7 d after therapy [(622.1±52.4) pg/mL vs (725.1±15.4) pg/mL, t=6.256, P=0.000], as well as 14 d after therapy [(554.3±25.7) pg/mL vs (639.2±50.8) pg/mL, t=4.945, P=0.000]. Conclusion · Inhibition of inflammatory reaction in wounds is one of mechanisms that NPWT can promote the ulcer healing in patients with diabetic feet.

Key words: negative pressure wound therapy, inflammatory reaction； diabetic wound