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Topic: Current Concepts in Wound Healing




          Histopathological study of chronic wounds


          modulated by intermittent negative pressure

          therapy under limited access dressing





          Thittamaranahalli Muguregowda Honnegowda , Pramod Kumar , Rekha Singh ,
                                                                                  1,2
                                                                                                    3
                                                               1
          Swarna Shivakumar , Pragna Rao , Hemanth K. Prasad , Sudesh Kumar , Udaya Kumar ,
                                                                                                             6
                                                                        5
                                                                                           6
                                 4
                                                5
          Echalasara Govindarama Padmanabha Udupa             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 Pathology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru 560066, Karnataka, India.
          4 Department of Pathology, Apollo Hospitals, Bengaluru 560066, Karnataka, India.
          5 Department of Biochemistry, Kasturba Medical College, Manipal 576104, Karnataka, India.
          6 Department of Surgery, Government District Hospital, Udupi 576101, 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: Negative pressure wound therapy (NPWT) has achieved widespread success in the treatment of
                chronic wounds. However, its effects have been only partially explored, and investigations have generally
                concentrated on the wound‑dressing interface; a detailed histopathological description of the evolution
                of wounds under NPWT is still lacking. The present study was performed to investigate the effect of
                a limited access dressing (LAD) which exerts intermittent NPWT in a moist environment on chronic
                wounds. Methods: A total of 140 patients were randomized into 2 groups: LAD group (n = 64) and
                conventional dressing group (n = 76). By histopathological analysis of the granulation tissue, the amount
                of inflammatory infiltrate, necrotic tissue, angiogenesis, and extracellular matrix (ECM) deposition was
                studied and compared to determine healing between the 2 groups. Results: After 10 days of treatment,
                histopathological analysis showed a significant decrease in necrotic tissue with LAD compared to the
                conventional dressing group (mean ± standard error, 11.5 ± 0.48 vs. 10.1 ± 0.30, P = 0.007), the number
                of inflammatory cells (12.6 ± 0.60 vs. 8.63 ± 0.35, P = 0.018), a significant increase in new blood vessels
                (12.8 ± 0.58 vs. 9.3 ± 0.29, P = 0.005) and ECM deposit (13.3 ± 0.50 vs. 9.6 ± 0.24, P = 0.001). Conclusion:
                LAD exerts its beneficial effects on chronic wound healing by decreasing the amount of necrotic tissue
                and inflammatory cells while increasing the amount of ECM deposition and angiogenesis.

                Key words:
                Angiogenesis,  chronic  wounds,  extracellular  matrix,  granulation  tissue,  inflammatory  cell,  limited
                access dressing, necrotic tissue, negative pressure wound therapy


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                                                               Shivakumar S, Rao P, Prasad HK, Kumar S, Kumar U, Udupa EG.
                                                               Histopathological study of chronic wounds modulated by intermittent
                                                               negative pressure therapy under limited access dressing. Plast Aesthet
                                   DOI:                        Res 2015;2:272-6.
                                   10.4103/2347-9264.156993
                                                               Received: 20-11-2014; Accepted: 28-01-2015

           272                                       © 2015 Plastic and Aesthetic Research | Published by Wolters Kluwer - Medknow
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