Evalution of the effectiveness of VAC-therapy in the preparatory stage of plastic wound closure in patients with diabetic foot

Purpose ? to evaluate the efficiency of topical negative pressure wound therapy (NPWT) in comparison to standard therapy in post operative wounds in patients with diabetic foot syndrome. Materials and methods. The effects of negative pressure therapy on the clinical (size, tissue oxygenation), histological (light microscopy), morphometric and immunohistochemical (eNO synthase) aspects of repair of the soft tissue of the lower extremities in patients with diabetes mellitus in comparison with standard treatment. 60 patients with diabetic foot syndrome were included in the study from the moment of debridement till the plastic closure of the wound. During the perioperative period, 28 patients received NPWT (-50 to -120 mmHg) and 32 patients received standard therapy. Results and discussion. A reduction of the wound area by (24,6+12,2)% was achieved with negative pressure therapy compared with baseline data. In the control group, the corresponding values were (12,5+-11,4)%. The results of transcutaneous oximetry showed a greater increase in the level of local micro hemodynamics in the study group as compared to the control group (p <0,05). An important criterion of wound preparation, for plastic closure of the wound is filling it with granulation tissue by more than 75%. 94% of the patients in the study group had (82,1% +-16)% of their wound filled with granulation tissue. The histological data of the study group showed a significant reduction of oedema by 80% (p <0,05), improved extracellular matrix organization (p <0,05), 90% (p <0,05) dissolution of inflammatory infiltrate and the formation of healthy granulation tissue (p<0,05). Immunohistochemical analysis demonstrated a significant increase in the number of fibroblasts in the dermis (p <0,05), increased expression of eNO synthase. Conclusions. The findings suggest that negative pressure therapy (-50 to -120 mmHg) is more efficient compared with standard treatment and achieves more rapid reduction of the area and depth of the wound, increased local microcirculation and decreased inflammation. These findings were confirmed histologically and immunohistochemically. The high efficiency of this method significantly reduced the time required for preparing the wound for autodermoplasty.