Kilpadi Deepak V, Lessing Chris, Derrick Kathleen
KCI, 6203 Farinon Drive, San Antonio, TX, USA,
Aesthetic Plast Surg. 2014 Aug;38(4):767-78. doi: 10.1007/s00266-014-0339-x. Epub 2014 Jun 10.
Computer and bench models have shown previously that surgical incision management with negative pressure (SIM) immediately decreases lateral tissue tension and increases incisional apposition. Better apposition is known to improve healing. Thus, SIM was hypothesized to improve the quality of incisional healing. This study evaluated the impact that 5 days of SIM had on mechanical properties and associated changes in the histology/histomorphometry and gene expression of healed porcine incisions.
One incision in each of the 4 pairs of contralateral, sutured, full-thickness incisions in each of 6 Yucatan swine were treated with either SIM (Prevena™ Incision Management System; n = 24 incisions/treatment group) or standard of care (SOC; sterile absorbent abdominal pads; n = 24/group) for 5 days, after which both groups received SOC for an additional 5 days. Biopsies for gene-expression analyses were collected on days 5 (n = 6 pairs/group), 20 (n = 6 pairs/group), and 40 (n = 12 pairs/group). On day 40, the animals were killed, after which healed incisions were harvested for mechanical testing (n = 12/group) and histologic/histomorphometric evaluation (n = 12/group).
Compared with SOC-treated incisions, SIM-treated incisions had significantly improved (p < 0.05) mechanical properties (strain energy density, peak strain) and a narrower scar/healed area in the deep dermis on day 40. Differences in gene expression between SOC- and SIM-treated specimens were observed primarily on day 5. The SIM-treated specimens had significantly fewer genes, which were differentially expressed and showed reduced upregulation of genes associated with inflammation, hypoxia, retardation of reepithelialization, impaired wound healing, and scarring.
Early application of SIM improved the quality of healed porcine incisions in terms of mechanical, histomorphometric, and gene-expression properties.
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计算机模型和实验台模型先前已表明，负压手术切口管理（SIM）可立即降低组织侧向张力并增加切口对合度。已知更好的对合度可促进愈合。因此，推测SIM可提高切口愈合质量。本研究评估了5天的SIM对愈合的猪切口的力学性能、组织学/组织形态计量学及基因表达相关变化的影响。
对6只尤卡坦猪的每对双侧全层缝合切口中的一个切口，用SIM（Prevena™ 切口管理系统；每个治疗组24个切口）或标准护理（SOC；无菌吸水腹部垫；每组24个）处理5天，之后两组均再接受5天的SOC处理。在第5天（每组6对）、第20天（每组6对）和第40天（每组12对）采集用于基因表达分析的活检样本。在第40天，处死动物，之后获取愈合的切口用于力学测试（每组12个）和组织学/组织形态计量学评估（每组12个）。
与接受SOC处理的切口相比，接受SIM处理的切口在第40天时力学性能（应变能密度、峰值应变）显著改善（p < 0.05），真皮深层的瘢痕/愈合区域更窄。SOC处理样本和SIM处理样本之间的基因表达差异主要在第5天观察到。接受SIM处理的样本中差异表达的基因显著更少，且与炎症、缺氧、再上皮化延迟、伤口愈合受损和瘢痕形成相关的基因上调减少。
早期应用SIM在力学、组织形态计量学和基因表达特性方面改善了愈合的猪切口质量。
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