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Topic: Current Concepts in Wound Healing




          A comparative study to evaluate the effect of


          limited access dressing on diabetic ulcers




          Thittamaranahalli Muguregowda Honnegowda , Pramod Kumar , Krishnananda Prabhu ,
                                                                                                             3
                                                                                 1,2
                                                              1
          Ashwini Kumar , Pragna Rao , E. G. Padmanabha Udupa , Shobha Kamath ,
                                                                          3
                                                                                               3
                           4
                                           3
          Antony Sylvan D’ Souza , Krishna Kishore Mahato          6
                                     5
          1 Department of Plastic Surgery and Burns, Kasturba Medical College, Manipal 576104, Karnataka, India.
          2 Department of Plastic Surgery, King Abdulaziz Specialist Hospital, Sakaka 42421, Al‑Jouf, Saudi Arabia.
          3 Department of Biochemistry, Kasturba Medical College, Manipal 576104, Karnataka, India.
          4 Department of Forensic Medicine, Kasturba Medical College, Manipal 576104, Karnataka, India.
          5 Department of Anatomy, Kasturba Medical College, Manipal 576104, Karnataka, India.
          6 Department of Biophysics, School of Life Sciences, Manipal 576104, Karnataka, India.
          Address for correspondence: Dr. Thittamaranahalli Muguregowda Honnegowda, Department of Plastic Surgery and Burns, Kasturba Medical College,
          Manipal 576104, Karnataka, India. E‑mail: honnegowda33@gmail.com
                ABSTRACT
                Aim: Emerging evidence favors the important role of antioxidants, matrix metalloproteinases (MMPs),
                and nitric oxide (NO) in the healing of diabetic wounds. There is a lack of substantial evidence
                regarding the effects of negative pressure on antioxidants, MMPs and NO in chronic wounds
                associated with diabetes.  Methods: A  total of 55 type 2 diabetic patients with leg ulcers were
                divided into 2 groups: a limited access dressing (LAD) group (n = 27) and a conventional dressing
                group (n = 28). Levels of hydroxyproline, total protein, MMP‑2 and MMP‑9, NO and antioxidants
                including reduced glutathione (GSH) and the oxidative biomarker malondialdehyde  (MDA)
                were measured in the granulation tissue at days 0 and 10. Changes in levels between the LAD
                and conventional groups were determined by  the Student’s  t‑test.  Results: After 10  days
                of treatment, the LAD  vs. conventional dressing group showed increase in the levels of
                hydroxyproline  (mean  ±  standard deviation  =  55.2  ±  25.1  vs. 29.2  ±  1, P  <  0.05), total protein
                (12.8 ± 6.5 vs. 8.34 ± 3.2, P < 0.05), NO (1.13 ± 0.52 vs. 0.66 ± 0.43, P < 0.05), GSH (7.0 ± 2.4 vs.
                6.6 ± 2.2, P < 0.05) and decrease in MMP‑2 (0.47 ± 0.33 vs. 0.62 ± 0.30, P < 0.05), MMP‑9 (0.32 ± 0.20 vs.
                0.53 ± 0.39, P < 0.05) and MDA (6.8 ± 2.3 vs. 10.4 ± 3.4, P < 0.05). Conclusion: When compared to
                conventional  dressings,  LAD  induces  biochemical  changes  by  significantly  increasing  the  levels
                of  hydroxyproline,  total  protein,  NO  and  antioxidants  levels,  and  significantly  reducing  MMPs
                (MMP‑2 and MMP‑9) and an oxidative biomarker in diabetic wounds. These biochemical changes
                are thought to favor diabetic wound healing.
                Key words:
                Antioxidants, diabetic wounds, hydroxyproline, limited access dressing, matrix metalloproteinases,
                nitric oxide, reactive oxygen species and oxidative stress biomarker, total protein


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                                                               How to cite this article: Honnegowda TM, Kumar P, Prabhu K,
                                                               Kumar A, Rao P, Padmanabha Udupa EG, Kamath S, D' Souza AS,
                                                               Mahato KK. A comparative study to evaluate the effect of limited
                                   DOI:                        access dressing on diabetic ulcers. Plast Aesthet Res 2015;2:266-71.
                                   10.4103/2347-9264.165448
                                                               Received: 02-05-2015; Accepted: 28-06-2015


           266                                       © 2015 Plastic and Aesthetic Research | Published by Wolters Kluwer - Medknow
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