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INTRODUCTION                                        METHODS

          Negative pressure wound therapy (NPWT) is a bio‑stimulating   Ethical approval and informed consent
          treatment for chronic wounds. In recent years, it has   This prospective randomized study was carried out in
          become one of the most frequently adopted treatments for   the Department of Plastic Surgery and Burns, Kasturba
          complex wounds worldwide. While it is generally believed   Medical College and Hospital, Manipal, India. The
          that NPWT improves wound healing and is cost‑effective,   Institutional Ethics Committee reviewed and  approved
          there is a persistent demand for scientific evidence.  the  study  protocol. Informed  consent  was  obtained  from
          Several recent studies  support the use  of NPWT to   all  patients or their next of kin  (as applicable)  before
          enhance wound healing  by  removing excess extracellular   inclusion into the study.
          fluid and decreasing tissue edema, which leads to   Clinical study design
          increased blood  flow  and stabilization of the wound   Two hundred and fifteen patients with chronic wounds of
                            [1]
          environment. A  reduction in systemic  (e.g. interleukins,   more than 4 weeks duration were enrolled and assessed for
          monocytes) and local mediators of inflammation has been   eligibility. After examination of inclusion criteria (nonhealing
                                           [2]
          demonstrated in experimental models,  while decreased   chronic wounds, 12‑65 years of age) and exclusion criteria
                                      [3]
          matrix  metalloproteinase  activity  and bacterial burden   (collagen disorders, diabetes, leprosy, liver cirrhosis, HIV
          have been documented clinically.  In vivo, NPWT has been   positive status, and pregnant women), 140  patients were
                                     [4]
          shown to increase fibroblast proliferation and migration,   randomized  into  the  LAD  group  (n  =  64)  or  conventional
          collagen organization,  and to  increase  the  expression  of   dressing group (n = 76) [Figure 1]. In the LAD group, the
          vascular endothelial growth factor and fibroblast growth   mean age was 38.3  ±  10.56  years  (range: 12‑60  years),
          factor‑2, thereby enhancing wound healing. [5]      with a mean wound size at the time of admission of 19 cm
                                                                                                              2
                                                                            2
                                                              (range: 28‑40 cm ). In the conventional dressing group, the
          Limited  access dressings  (LADs) have been  shown to be
          more effective in the treatment of chronic wounds.  The   mean age was 35.3 ± 14.0 years (range: 17‑65 years) with
                                                      [6]
                                                                                                              2
          present  study evaluates  the  role of intermittent  negative   a  mean  wound  size  at  the  time  of  admission  of  18  cm
                                                                            2
          pressure  in a moist  environment  using  LAD  (cycle of   (range: 26‑39 cm ) [Table 1].
          30‑min suction and 3.5‑h rest) on chronic wounds  by   The LAD group was treated with intermittent  negative
          quantitative and comparative analysis of histopathological   pressure in a moist environment. The conventional closed
          parameters including the amount of necrotic tissue, the   dressing  group was  treated  with  daily  dressing  changes
          number of inflammatory cells, extent of angiogenesis, and   using a squeezed 5% povidone‑iodine gauze which is a
          the level of extracellular matrix (ECM) deposit.    routine protocol in our burn unit. [7]







































          Figure 1: Consort flow chart



          Plast Aesthet Res || Vol 2 || Issue 5 || Sep 15, 2015                                             273
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