Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
Department of Metabolic Diseases, University Hospital, Krakow, Poland.
Eur J Clin Invest. 2019 Apr;49(4):e13067. doi: 10.1111/eci.13067. Epub 2019 Jan 29.
Diabetes and its complications constitute a rising medical challenge. Special attention should be given to diabetic foot syndrome (DFS) due to its high rate of associated amputation and mortality. Negative pressure wound therapy (NPWT) is a frequently used supportive modality in a diabetic foot with ulcerations (DFUs).
Here, we reviewed the current knowledge concerning the tissue and molecular mechanisms of NPWT action with an emphasis on diabetes research followed by a summary of clinical DFU studies and practice guidelines.
Negative pressure wound therapy action results in two types of tissue deformations-macrodeformation, such as wound contraction, and microdeformation occurring at microscopic level. Both of them stimulate a wound healing cascade including tissue granulation promotion, vessel proliferation, neoangiogenesis, epithelialization and excess extracellular fluid removal. On the molecular level, NPWT results in an alteration towards more pro-angiogenic and anti-inflammatory conditions. It increases expression of several key growth factors, including vascular endothelial growth factor and fibroblast growth factor 2, while expression of inflammatory cytokinesis reduced. The NPWT application also alters the presence and function of matrix metalloproteinases. Clinical studies in DFU patients showed a superiority of NPWT over standard therapy in terms of efficacy outcomes, primarily wound healing and amputation rate, without a rise in adverse events. International guidelines point to NPWT as an important adjuvant therapy in DFU whose use is expected to increase.
This current knowledge improves our understanding of NPWT action and its tailoring for application in diabetic patients. It may inform the development of new treatments for DFU.
糖尿病及其并发症构成了一个日益严峻的医学挑战。由于糖尿病足综合征（DFS）截肢率和死亡率高，应特别关注该疾病。负压伤口疗法（NPWT）是一种常用于治疗糖尿病足溃疡（DFU）的辅助治疗方法。
在这里，我们回顾了 NPWT 作用的组织和分子机制的现有知识，重点关注糖尿病研究，随后总结了 DFU 的临床研究和实践指南。
NPWT 的作用导致两种类型的组织变形——宏观变形，如伤口收缩，以及发生在微观水平的微观变形。它们都能刺激伤口愈合级联反应，包括组织肉芽形成促进、血管增殖、新血管生成、上皮化和过多细胞外液的去除。在分子水平上，NPWT 导致向更有利于血管生成和抗炎的条件转变。它增加了几种关键生长因子的表达，包括血管内皮生长因子和成纤维细胞生长因子 2，同时减少了炎症细胞因子的表达。NPWT 的应用还改变了基质金属蛋白酶的存在和功能。DFU 患者的临床研究表明，NPWT 在疗效方面优于标准治疗，主要是伤口愈合和截肢率，而不良事件没有增加。国际指南指出，NPWT 是 DFU 的重要辅助治疗方法，预计其使用量将会增加。
这些现有知识提高了我们对 NPWT 作用的理解及其在糖尿病患者中的应用。它可能为 DFU 的新治疗方法的发展提供信息。
