Vacuum Therapy of Diabetic Soft Tissue Wounds: the Impact on the Matrix Metalloproteinase Activity
The objective was to investigate the effect of vacuum therapy on the main stages of the healing of purulent wounds of soft tissues in patients with diabetes mellitus, the degree of microbial contamination of wounds and the activity of matrix metalloproteinases (MMP) in the tissues of wound surface. The results of treatment and examination of 48 patients with chronic diabetic wounds of soft tissues were analyzed. In 26 patients (study group), vacuum therapy of wounds was used in the treatment complex. During healing process, microbiological and cytological parameters were determined. MMP activity in the tissues of wound surface of patients from the control and study groups was monitored by the method of gelatine zymography at the various stages of healing. It was found that in patients of the main group, wound purification from necrotic material and microorganisms occurred 5.2 ± 1.5 days earlier than in patients of the control group. Moreover, in the tissues of wound surface of patients from study group, a statistically significant (p < 0.05) decrease in MMP activity was observed, its value on the 5th and 10th days of treatment was respectively 68 and 45 % of the initial level. In the wounds of patients with diabetes mellitus who underwent traditional medical treatment, collagenase activity remained consistently high throughout the period of observation. So, together with antimicrobial and anti-inflammatory effects, the normalization of proteolytic processes in the wound bed can be one of the key mechanisms of high therapeutic effectiveness of VAC-therapy.
Builton AJ, Kirshner RS, Vileikyte L. Neuropathic diabetic foot ulcers. N. Eng. J. Med. 2004; 351:48-55.
Dowsett C, Davis L, Henderson V. The economic benefits of negative pressure wound therapy in community-based wound care in the NHS. Int. Wound. J. 2012; 9; 544-552.
Kane MG, Krasner D. (Eds) (1997) Chronic wound care: a clinical source book for healthcare professionals 2nd ed. Health Management Publications Inc, 427 p.
Kernacki KA, Fridman R, Hazlett LD, Lande MA, Berk RS, Kernacki KA. In vivo characterization of host and bacterial protease expression during Pseudomonas aeruginosa corneal infections in naive and immunized mice. Curr. Eye Res. 1997; 16: 289-97.
Leaper DJ, Harding KG. (1998) Wounds: Biology and Management. Oxford University Press. – 130 р.
Lobman R, Ambrosch A, Schultz G, Waldmann K, Schiweck S, Lehnert H. Expression of gelatinase (MMP-2) in diabetic and non-diabetic wounds. Diabetologia. 2001; 44: 1011-6.
McCarty SM, Cochrane CA, Clegg PD, Percival SL. The role of endogenous and exogenous enzymes in chronic wounds: a focus on the implications of aberrant levels of both host and bacterial proteases in wound healing. Wound Repair Regen. 2012; 20: 125-36.
McCarty SM, Percival SL. Proteases and delayed wound healing. Adv. Wound Care. 2013; 2: 438-47.
Mirastschijski U, Impola U, Jahkola T, Karlsmark T, Agren MS, Saarialho-Kere U. Ectopic localization of matrix metalloproteinase-9 in chronic cutaneous wounds. Human Pathol. 2002; 33: 355-64.
Nain PS, Uppal SK, Garg R, Bajaj K, Garg S. Role of negative pressure wound therapy in healing of diabetic foot ulcers. J. Surg. Tech. Case Rep. 2011; 3: 17-22.
Neely AN, Clendening CE, Gardner J, Greenhalgh DG. Gelatinase activities in wounds of healing-impaired mice versus wounds of non-healing-impaired mice. J. Burn Care Rehabil. 2000; 21:395-402.
Sawicki G, Marcoux Y, Sarkhosh K, Tredget EE, Ghahary A. Interaction of keratinocytes and fibroblasts modulates the expression of matrix metalloproteinases-2 and -9 and their inhibitors. Mol. Cell Biochem. 2005; 269: 209-16.
Schintler MV. Negative pressure therapy: theory and practice. Diabetes Metab. Res. Rev. 2012; 28: 72-7.
Liu Y, Min D, Bolton T, Nubé V, Twigg SM, Yue DK, McLennan SV. Increased matrix metalloproteinase-9 predicts poor wound healing in diabetic foot ulcers. Diabetes Care. 2009; 32: 117-19.
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution 4.0 International License.
© "Publishing House "Zaslavsky", 1997-2017