Boston, Mass.; and Geneva, Switzerland From the Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, and the Department of Surgery, University Hospital of Geneva.
Plast Reconstr Surg. 2009 Nov;124(5):1458-1465. doi: 10.1097/PRS.0b013e3181bbc829.
The vacuum-assisted closure device is a widely used mechanical modulator of wound healing; however, the optimal time kinetics of application have not been determined. The objective of the study was to optimize the kinetics of vacuum-assisted closure application.
Full-thickness wounds in seven diabetic mice per study group were treated with either an occlusive dressing alone, the vacuum-assisted closure device for 6 or 12 hours, or the vacuum-assisted closure device periodically for 4 hours every other day or continuously for 7 days. Wound closure and tissue response were evaluated by macroscopic, histologic, and immunohistochemical analyses on day 7.
Wound closure was significantly faster after short initial vacuum-assisted closure (6-hour and 12-hour groups) when compared with continuous treatment. Increased granulation tissue formation was seen in the 12-hour group (2.4-fold increase) and in those treated periodically for 4 hours every other day (3.2-fold increase) compared with the dressing-alone controls. Significant stimulation of cell proliferation was seen after all vacuum-assisted closure patterns (3.6- to 5.3-fold increase), whereas angiogenesis was augmented only after the device was applied for either three times for 4 hours (4.3-fold) or continuously (4.7-fold) when compared with dressing-treated wounds. Treatment three times for 4 hours showed a superior angiogenic effect also when compared with short initial applications (6-hour and 12-hour groups).
Short vacuum-assisted closure treatment induced an extended biological response in the wound. A total of 12 hours of periodically applied vacuum-assisted closure reached a similar wound tissue response as continuously applied vacuum-assisted closure for 7 days. These findings suggest new clinical approaches for mechanical wound-healing devices.
真空辅助闭合装置是一种广泛应用的机械伤口愈合调节剂；然而，其应用的最佳时间动力学尚未确定。本研究的目的是优化真空辅助闭合的应用动力学。
每组 7 只糖尿病小鼠的全层伤口分别采用闭塞敷料、真空辅助闭合装置治疗 6 或 12 小时，或每隔一天每 4 小时周期性应用真空辅助闭合装置，或连续应用 7 天。第 7 天通过宏观、组织学和免疫组织化学分析评估伤口闭合和组织反应。
与连续治疗相比，短时间初始真空辅助闭合（6 小时和 12 小时组）可显著加快伤口闭合。与单独用敷料处理的对照组相比，12 小时组（增加 2.4 倍）和每隔一天每 4 小时周期性处理组（增加 3.2 倍）的肉芽组织形成增加。所有真空辅助闭合模式均可见细胞增殖显著刺激（增加 3.6-5.3 倍），而仅在装置应用 3 次每次 4 小时（增加 4.3 倍）或连续应用（增加 4.7 倍）时才增强血管生成，与用敷料处理的伤口相比。与短期初始应用（6 小时和 12 小时组）相比，3 次 4 小时的治疗也显示出更好的血管生成效果。
短时间的真空辅助闭合治疗可引起伤口的延长生物学反应。总共 12 小时的周期性应用真空辅助闭合可达到与连续应用真空辅助闭合 7 天相似的伤口组织反应。这些发现为机械伤口愈合装置提供了新的临床方法。
