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INTRODUCTION constitute a substantial number of publications but an
overall low amount of evidence. Evidence is lacking on the
Wound healing is a self‑regulated physiological process use of an intermittent negative pressure dressing which
of cell regeneration which occurs without any external would be more economical and clinically acceptable
[17]
stimuli. This is accomplished by the stages of fibroplasia, than the use of continuous NPWT.
angiogenesis, and migration of fibroblasts, endothelial, The present study evaluates the role of intermittent negative
and epithelial cells, finally leading to the wound pressure using limited access dressing (LAD) (a cycle of
contraction. Inflammation is a vital and protective 30 min of suction and 3.5 h of rest) on diabetic wounds
[1]
response instigated by injured cells at the wound site by measuring and comparing the levels of hydroxyproline,
which begins the process of tissue repair. In response to
[2]
inflammation, reactive oxygen species (ROS) such as free total protein, NO, antioxidants (GSH), and an oxidative
radicals (superoxide anion radical: O ) and nonradical biomarker malondialdehyde (MDA) in the granulation tissue
−
2
hydrogen peroxide (H O ), are generated continuously of type 2 diabetes mellitus ulcer patients.
2
2
until inflammation subsidies. Free radicals and their
[3]
scavenging systems play an important role in normal and METHODS
delayed wound healing. [4,5]
Ethical approval and informed consent
Delayed healing of diabetic wounds is characterized by an This prospective randomized controlled trial study was
increase in matrix metalloproteinases (MMPs), a decrease carried out in the Department of Plastic Surgery, Kasturba
[6]
in the tissue inhibitors of metalloproteinases (TIMPs), Hospital, Manipal. The Institutional Ethics Committee
and an altered magnitude of free radical generation and reviewed and approved the study protocol. Written
disposal. An imbalance between oxidant and antioxidant
[7]
defense mechanisms leads to oxidative stress resulting informed consent was obtained from all patients or their
in lipid peroxidation, DNA damage, and inactivation of next of kin prior to inclusion in the study.
[8]
free radical scavenger enzymes. This leads to tissue Study design
damage and impairs the healing process in diabetic Patients were diagnosed on the basis of history, physical
wounds with reduced angiogenesis, altered proliferation examination, and biochemical investigation. Seventy‑five
of fibroblasts, reduced fibroblast migration, inadequate patients more than 40 years of age (mean age: 56 years)
collagen deposition, advanced glycation, and abnormal suffering from chronic diabetic wounds with insulin‑controlled
mitochondrial function. [9‑11] diabetes were enrolled in the study. After evaluation for
Nitric oxide (NO) is a mediator which plays an important inclusion (diabetic leg ulcers) and exclusion criteria (collagen
role in wound healing and has been implicated in disorders, leprosy, pregnancy, cirrhosis, and HIV positive
diabetic wounds. Reduced levels can cause alterations status), 55 patients were randomized of whom 27 were
in vascular permeability and a reduction of capillary assigned to the LAD group and 28 were assigned to the
flow causing oxidative stress. Antioxidants such as conventional dressing group. Biopsies were taken from both
[12]
reduced glutathione (GSH), glutathione peroxidase (GPx), groups on day 0 of the study. The LAD group patients were
catalase (CAT), and thiol (‑SH) prevent the generation and treated with intermittent negative pressure and a moist
action of ROS. Hence, antioxidants that provide potential wound environment, and wounds were washed daily with
mechanisms for wound healing can ameliorate diabetic a solution of povidone‑iodine. Conventional dressing group
complications by both significantly preventing tissue patients were dressed daily with 5% povidone‑iodine solution
damage and stimulating the wound healing process. [13,14] soaked gauze. On day 10, granulation tissue biopsies were
taken from both groups and subjected to biochemical study
Several studies have demonstrated the negative role of
free radicals on wound healing; reduction of persistent by an investigator blinded to the clinical data.
inflammation; and elimination of free radicals may Randomization
improve healing in diabetic wounds. Although advanced Patients were randomized by generating tables of random
[15]
technologies have been developed for the treatment of numbers through www.random.org. Numbers were
diabetic wounds, outcomes have been poor. Negative assigned to a treatment group and sealed in opaque
pressure wound therapy (NPWT) has emerged as a envelopes containing labeled paper with the treatment
treatment for complex wounds. This is a noninvasive and the patient’s ID.
system which creates a localized and controlled sub
atmospheric pressure environment. Wound healing by Chemicals
delayed primary or secondary intention is promoted All chemical used were of analytical grade. Standard
by the creation of a moist wound environment which L‑hydroxyproline, bovine serum albumin (BSA), standard
prepares the wound bed for closure, reduces edema, and GSH, 1‑chloro‑2,4‑dinitrobenzene, and cumene H O were
2
2
promotes the formation and perfusion of granulation purchased from Sigma‑Aldrich (St. Louis, MO, USA).
tissue. [16,17] The clinical evidence supporting the use of Thiobarbituric acid (TBA), trichloroacetic acid (TCA),
continuous NPWT on diabetic wounds has been based 1,1,3,3‑tetramethoxypropane N‑ethylmaleimide (NEM),
largely on clinician perception, case series, small cohort and orthophosphoric acid were purchased from S.D.
studies, and weakly powered randomized trials that Fine‑Chemicals Ltd. (Boisar, India).

Plast Aesthet Res || Vol 2 || Issue 5 || Sep 15, 2015 267