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mean ± standard deviation (SD). P < 0.05 was considered   the conventional group  (8.34  ±  3.2  mg/g wet tissue
          to be significant, when appropriate, statistical uncertainty   weight), P = 0.011.
          was expressed by 95% confidence levels.
                                                              Matrix metalloproteinases‑2 and matrix
          RESULTS                                             metalloproteinases‑9
                                                              After 10 days of treatment, MMP‑2 (0.47 ± 0.33 ng/mg tissue
                                                              protein, P = 0.041) and MMP‑9 levels (0.32 ± 0.20 ng/mg tissue
          A total of 75 patients were enrolled of which 55 patients
          were  randomized; with  27  patients  assigned  to  the  LAD   protein, P = 0.037) in LAD group were significantly lower
          group and 28 patients assigned to the conventional group   than the conventional group  MMP‑2 (0.62  ± 0.30  ng/mg
          [Figure 1]. Five participants were lost to follow‑up (two in   tissue  protein) and MMP‑9 (0.53 ± 0.39 ng/mg  tissue
          the LAD and three in the conventional group) before the   protein).
          biopsies  could be taken.  The results of hydroxyproline,   Nitric oxide
          total protein, MMP‑2 and MMP‑9, GSH, NO, and MDA    After 10  days of treatment,  the LAD group had a
          levels in diabetic ulcers are shown [Table 1].      significantly high total protein level (mean ± SD =
          Hydroxyproline                                      1.13 ±  0.52 nmol/mg  protein)  than  the  conventional
          After 10 days of treatment,  the  LAD group had     group (0.66 ± 0.43 nmol/mg protein), P = 0.019.
          significantly  higher  hydroxyproline level (mean ± SD =   Reduced glutathione
          55.2 ± 25.1 µg/mg dry tissue weight) than the conventional   After 10 days of treatment, antioxidant (reduced GSH)
          group (29.2 ± 13.5 µg/mg dry tissue weight), P = 0.000.  levels in the LAD group were significantly higher
          Total protein                                       (mean ± SD = 7.0 ± 2.4 µmol/mg protein) as compared to
          After  10  days  of   treatment,  the  LAD  group   those in the conventional dressing group (6.6 ± 2.2 µmol/mg
          had   significantly  higher  total  protein  levels  protein), P = 0.044.
          (mean ± SD = 12.8 ± 6.5 mg/g wet tissue weight) than   Malondialdehyde
                                                              After 10  days of treatment, MDA levels were
                                                              significantly  higher  in the conventional dressing  group
                                                              (mean ± SD = 10.4 ± 3.4 nmol/mg protein) as compared
                                                              to the LAD group (6.8 ± 2.3 nmol/mg protein), P = 0.024.

                                                              DISCUSSION

                                                              Diabetes  is  a  multisystem  disorder which  induces
                                                              physiological changes in tissues  and cells that impair
                                                              the normal healing process. Diabetic  wounds can have
                                                              prolonged periods in the inflammatory phase of healing,
                                                              with  a  continuous  influx  of  neutrophils that  release
                                                              cytotoxic enzymes,  free  radicals, and inflammatory
                                                              mediators,  causing  extensive  collateral damage  to  the
                                                              surrounding tissue. [24‑26]
                                                              In  the  treatment  of diabetic  ulcers,  the  NPWT  wound
                                                              dressing  provides  faster wound resolution as compared
                                                              to gauze dressings.  NPWT may be beneficial in the
          Figure 1: Consort flow chart                        treatment of nonhealing diabetic wounds  of the lower

          Table 1: Results of hydroxyproline, total protein, MMP-2 and MMP-9, NO, GSH, and MDA levels in granulation
          tissue of diabetic ulcer in LAD group and conventional dressing group
           Parameters                                                  Mean ± SD                             P

                                                       LAD group               Conventional dressing group
                                               Day 0     Day 10   Day (0-10)  Day 0     Day 10   Day (0-10)
           Hydroxyproline (µg/mg of dry weight of tissue)  46.9 ± 16.0  100 ± 6.6  55.2 ± 25.1  51.5 ± 10.9  80.7 ± 15.6  29.2 ± 13.5  0.000
           Total protein (mg/g of wet weight tissue)  11.7 ± 3.2  24.3 ± 5.9  12.8 ± 6.5  12.0 ± 2.6  20.6 ± 4.8  8.34 ± 3.2  0.011
           MMP-2 (ng/mg tissue protein)      0.95 ± 0.20  0.48 ± 0.42  0.47 ± 0.33  0.97 ± 0.52  0.35 ± 0.49  0.62 ± 0.30  0.041
           MMP-9 (ng/mg tissue protein)      0.87 ± 0.54  0.55 ± 0.25  0.32 ± 0.20  0.93 ± 0.22  0.40 ± 0.32  0.53 ± 0.39  0.037
           NO (nmol/mg protein)               2.0 ± 1.42  3.13 ± 1.3  1.13 ± 0.52  2.74 ± 1.4  3.4 ± 1.44  0.66 ± 0.43  0.019
           GSH (µmol/mg protein)              16.1 ± 4.3  23.1 ± 3.3  7.0 ± 2.4  14.9 ± 3.5  21.5 ± 3.79  6.6 ± 2.2  0.044
           MDA (nmol/mg protein)              19.3 ± 3.8  12.5 ± 4.8  6.8 ± 2.3  19.9 ± 4.5  9.5 ± 4.5  10.4 ± 3.4  0.024
           MMP: Matrix metalloproteinase, NO: Nitric oxide, GSH: Glutathione, MDA: Malondialdehyde, LAD: Limited access dressing, SD: Standard deviation

          Plast Aesthet Res || Vol 2 || Issue 5 || Sep 15, 2015                                             269
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