Sogorski Alexander, Becker Amira, Dadras Mehran, Wallner Christoph, Wagner Johannes Maximillian, Glinski Maxi V, Lehnhardt Marcus, Behr Björn
Department of Plastic Surgery and Hand Surgery, Burn Center, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bochum, Germany.
Front Surg. 2022 Mar 3;9:822122. doi: 10.3389/fsurg.2022.822122. eCollection 2022.
Despite a common utilization of "Negative Pressure Wound Therapy" (NPWT) Devices in a wide range of specialties, some of the basic mechanisms of action of the techniques are still on debate. Conflicting results from prior studies demonstrate our lack of understanding how wound-bed perfusion or cutaneous microcirculation is affected by NPWT.
We conducted a prospective randomized study which included 45 healthy subjects to further investigate the acute effects of NPWT on cutaneous microcirculation underneath the applied dressing. Three modes of application, namely, continuous, intermittent, cyclic, were tested. Amongst others, measurements of elicited surface pressure and a comprehensive microcirculatory analysis were carried out by utilizing an O2C-device. For the detection of (systemic) remote effects, perfusion changes of the contra-lateral thigh were evaluated.
All three tested modes of application led to a significant ( < 0.05) improvement in local tissue perfusion with an increased blood flow of max +151% and tissue oxygen saturation of +28.2% compared to baseline values. Surface pressure under the dressing significantly increased up to 29.29 mmHg due to the activation of the NPWT device. Continuous, intermittent, and cyclic application of negative pressure were accurately sensed by participants, resulting in reported pain values that mirrored the different levels of applied suction. Although the cyclic application mode showed the most pronounced effects regarding microcirculatory changes, no statistical significance between groups was observed.
We could demonstrate a significant improvement of cutaneous microcirculation under an applied NPWT dressing with favorable effects due to cyclic mode of application. An increased surface pressure leads to a better venous drainage of the tissue, which was shown to increase arterial inflow with a consecutive improvement of oxygen supply. Further research is warranted to evaluate our findings regarding wound bed perfusion in the clinical field with respect to formation of granulation tissue and wound healing.
尽管“负压伤口治疗”（NPWT）设备在广泛的专业领域中普遍使用，但该技术的一些基本作用机制仍存在争议。先前研究的结果相互矛盾，表明我们对NPWT如何影响伤口床灌注或皮肤微循环缺乏了解。
我们进行了一项前瞻性随机研究，纳入了45名健康受试者，以进一步研究NPWT对敷料下方皮肤微循环的急性影响。测试了三种应用模式，即连续、间歇、循环模式。除其他外，利用O2C设备进行表面压力测量和全面的微循环分析。为了检测（全身）远程效应，评估了对侧大腿的灌注变化。
与基线值相比，所有三种测试应用模式均导致局部组织灌注显著改善（<0.05），最大血流增加151%，组织氧饱和度增加28.2%。由于NPWT设备的激活，敷料下的表面压力显著增加至29.29 mmHg。参与者能够准确感知负压的连续、间歇和循环应用，导致报告的疼痛值反映了不同水平的吸力。尽管循环应用模式在微循环变化方面显示出最明显的效果，但组间未观察到统计学差异。
我们可以证明，在应用NPWT敷料下，皮肤微循环有显著改善，循环应用模式具有良好效果。表面压力增加导致组织静脉引流更好，这表明动脉血流增加，进而改善了氧气供应。有必要进一步研究，以评估我们关于伤口床灌注的研究结果在临床领域中对肉芽组织形成和伤口愈合的影响。
