From the Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University.
Plast Reconstr Surg. 2023 Sep 1;152(3):561-570. doi: 10.1097/PRS.0000000000010226. Epub 2023 Jan 24.
Negative-pressure wound therapy (NPWT) and autologous fat transplantation (AFT) are two clinical modalities for plastic and reconstructive surgery. At present, there are few reports on the combination of these two methods in treating diabetic wounds. This study aimed to explore the effect of this combined therapy on diabetic wound healing.
Full-thickness dorsal cutaneous wounds in rats with streptozotocin-induced diabetes were treated with either NPWT, AFT, or combined therapy. Rats covered with commercial dressings served as the control group. Macroscopic healing kinetics were examined. The levels of inflammation-related factors, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), monocyte chemoattractant protein-1, arginase-1, and inducible nitric oxide synthase (iNOS) and angiogenesis-related factors such as vascular endothelial growth factor, were measured in the wound tissues on days 3, 7, and 14; immunohistochemical staining for arginase-1, iNOS, and CD31 was performed on days 3, 7, and 14. The length of reepithelialization was investigated on day 14.
The combined therapy promoted faster wound healing than the other treatments. The expression levels of the proinflammatory factors IL-1β, IL-6, monocyte chemoattractant protein-1 (MCP-1), and iNOS were reduced, and arginase-1 expression was increased compared with those in the other groups. The expression levels of vascular endothelial growth factor and CD31 in the NPWT-combined-with-AFT group were significantly higher than those in the other groups. Reepithelialization was faster in the NPWT-combined-with-AFT group (by day 14) than in the other groups.
Combining NPWT and AFT can enhance diabetic wound healing by improving wound inflammation and increasing wound vascularization.
The authors designed a randomized controlled trial of diabetic rats to confirm that NPWT can enhance the vascularization and improve inflammation of the diabetic wound after the autologous fat transplantation treatment. This article may provide a new idea for treating diabetic wounds.
负压伤口疗法（NPWT）和自体脂肪移植（AFT）是整形外科的两种临床方法。目前，关于这两种方法联合治疗糖尿病创面的报道较少。本研究旨在探讨联合治疗对糖尿病创面愈合的影响。
采用链脲佐菌素诱导糖尿病大鼠背部全层皮肤创面，分别采用 NPWT、AFT 或联合治疗。覆盖商品化敷料的大鼠作为对照组。观察宏观愈合动力学。在第 3、7 和 14 天测量创面组织中炎症相关因子白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、单核细胞趋化蛋白-1、精氨酸酶-1 和诱导型一氧化氮合酶（iNOS）以及血管生成相关因子血管内皮生长因子的水平；第 3、7 和 14 天进行精氨酸酶-1、iNOS 和 CD31 的免疫组织化学染色。第 14 天测量上皮再形成的长度。
联合治疗组较其他治疗组促进更快的伤口愈合。与其他组相比，促炎因子 IL-1β、IL-6、单核细胞趋化蛋白-1（MCP-1）和 iNOS 的表达水平降低，精氨酸酶-1的表达水平升高。NPWT 联合 AFT 组血管内皮生长因子和 CD31 的表达水平明显高于其他组。NPWT 联合 AFT 组的上皮再形成速度（第 14 天）快于其他组。
NPWT 联合 AFT 通过改善创面炎症和增加创面血管化，增强糖尿病创面愈合。
作者设计了一项糖尿病大鼠的随机对照试验，以证实 NPWT 可以增强自体脂肪移植治疗后糖尿病创面的血管化和改善炎症。本文可能为治疗糖尿病创面提供新的思路。
