Background: The vacuum-assisted closure device is a widely used mechanical modulator of wound healing; however, the optimal time kinetics of application have not been determined. The objective of the study was to optimize the kinetics of vacuum-assisted closure application.
Methods: Full-thickness wounds in seven diabetic mice per study group were treated with either an occlusive dressing alone, the vacuum-assisted closure device for 6 or 12 hours, or the vacuum-assisted closure device periodically for 4 hours every other day or continuously for 7 days. Wound closure and tissue response were evaluated by macroscopic, histologic, and immunohistochemical analyses on day 7.
Results: Wound closure was significantly faster after short initial vacuum-assisted closure (6-hour and 12-hour groups) when compared with continuous treatment. Increased granulation tissue formation was seen in the 12-hour group (2.4-fold increase) and in those treated periodically for 4 hours every other day (3.2-fold increase) compared with the dressing-alone controls. Significant stimulation of cell proliferation was seen after all vacuum-assisted closure patterns (3.6- to 5.3-fold increase), whereas angiogenesis was augmented only after the device was applied for either three times for 4 hours (4.3-fold) or continuously (4.7-fold) when compared with dressing-treated wounds. Treatment three times for 4 hours showed a superior angiogenic effect also when compared with short initial applications (6-hour and 12-hour groups).
Conclusions: Short vacuum-assisted closure treatment induced an extended biological response in the wound. A total of 12 hours of periodically applied vacuum-assisted closure reached a similar wound tissue response as continuously applied vacuum-assisted closure for 7 days. These findings suggest new clinical approaches for mechanical wound-healing devices.
Boston, Mass.; and Geneva, Switzerland
From the Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, and the Department of Surgery, University Hospital of Geneva.
Received for publication February 1, 2009; accepted April 8, 2009.
Disclosure: Dennis P. Orgill, M.D., Ph.D., is a principal investigator on a grant from Kinetic Concepts, Inc., to Brigham and Women’s Hospital. He is an expert witness for Kinetic Concepts, Inc., and Wake Forest University. The other authors have no financial interest concerning this study.
Dennis P. Orgill, M.D., Ph.D., Division of Plastic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, Mass. 02115, firstname.lastname@example.org