Histological evolution of chronic wounds under negative pressure therapy

Franco Bassetto, Luca Lancerotto, Roberto Salmaso, Laura Pandis, Giorgio Pajardi, Mauro Schiavon, Cesare Tiengo, Vincenzo Vindigni

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)91-99
Number of pages9
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume65
Issue number1
DOIs
Publication statusPublished - Jan 2012

Keywords

  • Negative pressure therapy
  • Ulcer
  • VAC Therapy
  • Vacuum
  • Wound

ASJC Scopus subject areas

  • Surgery

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