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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