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Clinical Research
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Composition of wound fluid from pressure ulcers treated with negative pressure wound therapy DV. Kilpadi, A. McNulty, JK. Stechmiller, K. Derrick, TD. Feeley, M. Schmidt, P. Villanueva, L. Cowan, M. Comerio, GS. Schultz, K. Kieswetter Introduction: Negative pressure wound therapy (NPWT) has exhibited success in treating wounds. Changes in wound fluid composition are purported to be indicative of its mechanisms of action. The purpose of this study was to characterize changes in the biochemical composition of fluid collected from chronic pressure ulcers in adults treated with NPWT. Methods: Eight adult patients, who were primarily in home-health or extended care, with Stage III or IV pressure ulcers were treated with NPWT (V.A.C.¨ Therapy, KCI, San Antonio, TX; continuous -125 mmHg, GranuFoam¨ Dressing). ELISAs were used for measuring concentrations of inflammatory cytokines (IL-1ß, TNF-a), metalloproteinases (MMP-3, MMP-9), and TIMP-1 in wound fluids at baseline and after 1 day, 3 days and 7 days of continuous NPWT. Multiplex analyses were performed to simultaneously measure inflammatory cytokines (IL-2, IL-4, IL-6, IL-8, IL-10, GM-CSF, interferon-a, TNF-a). Repeated measures 1-way ANOVA were used to test for differences; student Newman-Keuls tests were used for multiple comparisons. P<0.05 was considered statistically significant. Results: MMP-3 levels and MMP-3 to TIMP-1 ratios were significantly and comparably lower than baseline at days 1, 3, and 7. MMP-9 levels significantly decreased from baseline at days 1 and 3. IL-8 levels at day 1 were significantly higher than at day 0. There were no significant differences for any of the other biomolecules at any of the time points when compared to baseline. Discussion: Previous studies have shown consistent decrease in protease levels(1) and topical application of IL-8(2) to have prognostic value for healing. Thus, the change in composition of fluids from pressure ulcers treated with NPWT is considered to be in a manner beneficial to wound healing. Future studies should be conducted with randomized control-treatment arms and should consider wound etiology, systemic confounders, and care setting. Wound Rep Regen, 2002;10:26;..Ann Burns Fire Disasters, 2000;XIII(4)220. |
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