Complex Analysis of Healing Complex Poly-Structural Wounds оf Limbs with Local Application of Negative Pressure

Vacuum-assisted closure of the wound (VAC) has proven itself to be an economically beneficial and effective method of treatment over the past two decades. Nonetheless, a variety of tissue damage received by patients in severe poly-structural (including combat) injuries requires further investigation of the negative pressure effect on wounds healing process. The purpose of the study was to provide a comprehensive analysis of the effectiveness of vacuum assistance closure (VAC) wound therapy in association with white blood count changes as well as with cytological findings at wound bed in patients with severe poly-structural high-energy combat wounds. Material and methods. 34 cases of severe musculoskeletal injuries of the lower and upper limbs were examined. 18 patients were included into the investigated group with application of negative pressure on the wound. Standard wound treatment with antiseptics and the application of gauze dressings were applied to 16 patients in the control group. Evaluation of the results included a comparison of VEGF serum level by ELISA, white blood count with the calculation of integral leukocyte coefficients, and cytological examination of the cells harvested from wound bed before the application of treatment, and after the 3rd and the 7th days of application in patients of main and control groups. Results and discussion. Vacuum-therapy of wounds accelerates the change of degenerative-necrotic type of wound cytological profile to regenerative one. At the 3rd day of treatment in 37.5% of patients receiving vacuum therapy, the degenerative-necrotic type of cytological changes to the inflammatory type, which is significantly higher than with the use of conventional gauze bandages (18.3% of patients). At the 7th day we observed suppression in 81.63% of patients with negative pressure and in 68.75% with normal gauze dressings there appeared regenerative types of cytological profiles (p <0.05). On the basis of wounds vacuum therapy, an acceleration of white blood cells parameters normalization, including integral indicators of endogenous intoxication and non-specific immunological reactivity, was observed due to the decrease in the volume of necrosis. Conclusions. Concentration of vascular endothelial growth factor (VEGF) in blood serum of patients was significantly increased (p<0.05) in patients with vacuum wound treatment compared to control group. This happened due to stimulation of local hypoxia and mechanical stimulation of the wound bed with negative pressure. Vacuum therapy reduces wound preparation time for reconstructive surgical interventions in patients with negative pressure on average by 5.2±0.8 days.