Effect of negative pressure therapy on repair of soft tissues of the lower extremities in patients with neuropathic and neuroischaemic forms of diabetic foot syndrome

Aim.
To evaluate the efficiency of topical negative pressure wound therapy (NPWT) compared with standard therapy for the regeneration of the soft tissues of the lower extremities in patients with diabetic foot syndrome.
Materials and Methods.
The effects of negative pressure therapy on the clinical (size, tissue oxygenation), histological (light microscopy) and immunohistochemical (CD68, MMP-9, TIMP-1) aspects of repair of the soft tissue of the lower extremities in patients with diabetes mellitus were compared with those of standard treatment. Thirty-one patients with diabetic foot ulcers were included in the study from the moment of debridement until the plastic closure of the wound. During the perioperative period, 13 patients received NPWT (-90 to -120 mmHg) and 18 patients received standard therapy.
Results.
A reduction of the wound area (26.6%?17.2%) and the depth of the defects (40.5%?25.6%) were achieved with negative pressure therapy compared with baseline data. In the control group, the corresponding values were 25.3%?19.4% and 21.8%?21.6%, respectively. The results of transcutaneous oximetry showed a greater increase in the level of local hemodynamics in the study group (p <0.04). An important criterion for wound preparation for a plastic closure is filling it with granulation tissue by more than 75%. In the study group, 95% of patients had wounds filled with 89.9%?17% of abundant granulation tissue. The histological data of the study group show a significant reduction of oedema by 80% (p <0.05), improved extracellular matrix organization (p <0.05), 90% (p <0.05) dissolution of inflammatory infiltrate and the formation of healthy granulation tissue (p <0.05). Immunohistochemical analysis demonstrated a significant decrease in the number of macrophages in the dermis (CD68 expression) (p <0.05). In both groups, the level of MMP-9 was decreased. However, the ratio of MMP-9:TIMP-1 was lower in the study group (p <0.05).
Conclusion.
The findings suggest that negative pressure therapy (-90 to -120 mmHg) is more efficient compared with standard treatment and achieves more rapid reduction of the area and depth of the wound, increased local microcirculation and decreased inflammation. These findings were confirmed histologically and immunohistochemically. The high efficiency of this method significantly reduced the time required for preparing the wound for the next surgical treatment.

diabetes mellitus, chronic wounds, local treatment, negative pressure therapy, tissue repair, immunohistochemical markers, histology

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