The Effectiveness of Negative Pressure Wound Therapy in Inducing Hypoxia Compared to Standard Occlusive Dressing Wound Therapy in the Healing of Traumatic Wounds
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Date
2021Author
Matwa, Christopher O
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
Background: Negative Pressure Wound Therapy has gained popularity as an effective adjunct in
management of wounds. It accelerates wound healing by enhancing granulation tissue formation.
Its mechanism of action was always postulated to increased perfusion and oxygenation to the
wound. However, recent postulates seem to suggest that it reduces perfusion to the wound thus
creating a hypoxic environment which stimulates vascularization and angiogenesis.
Objective: To establish the effectiveness of Negative Pressure Wound Therapy in inducing
hypoxia compared to Standard Occlusive Dressing Wound Therapy in the healing of traumatic
wounds.
Study Design: This was a randomized C;;;ontrolled trial
Settings: The study was undertaken at the Kenyatta National Teaching and Referral Hospital
from the months of October 2020 to April 2021
Materials and Methods: The study participants were patients with traumatic wounds admitted
in the surgical wards at the Kenyatta National Teaching and Referral Hospital and were divided
into two groups where one group was subjected to Negative Pressure Wound Therapy and the
other group subjected to Standard Occlusive Dressing Wound Therapy. The samples for analysis
were obtained though punch biopsies of wounds at two sites; the wound edges and the wound
bases and they were carried out at baseline day 0, day 3 and day 7 in each group. They were
homogenized and stored at -800C until enough samples accumulated for analysis in a 96-well
ELISA plate. ELISA assays for quantitative levels of Hypoxia Inducible Factor 1 alpha and
Fibroblast Activation Protein was carried out to obtain optical densities which were converted to
actual concentrations of the two elements through Standard Absorbance Curves.
Results: The concentration of Hypoxia inducible factor 1 alpha, both at the wound edges and
wound bases, increased by 176% and 194% respectively from baseline to day 7 of therapy in
wounds managed by Negative Pressure Wound Therapy. A slight concentration increase of 23%
and 21% (respectively) was noted in wounds subjected to Standard Occlusive Dressing Wound
Therapy. Similarly, the concentration of Fibroblast Activation Protein increased both at the
wound edges and wound bases by 124% and 146% respectively from baseline to day 7 of
therapy in wounds treated by Negative Pressure Wound Therapy. A slight increase by 37% in
wounds subjected to Standard Occlusive Dressing Wound Therapy was noted at both the wound
edges and wound bases.
Discussion: Our findings are additive to initial studies that demonstrated reduced blood flow and
reduced transcutaneous partial pressure of oxygen in wounds subjected to Negative Pressure
Wound Therapy. Our study further demonstrates the molecular mechanisms that result from the
hypoxia induced in wounds managed by Negative Pressure Wound Therapy and the molecules
generated enhance granulation tissue formation.
Conclusion: Hypoxia induction should be recognized as a mechanism of action through which
Negative Pressure Wound Therapy through increases wound healing by enhancing granulation
tissue formation.
Publisher
Uon
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http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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