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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