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Hyaluronic Acid–Povidone-Iodine Compound Facilitates Diabetic Wound Healing in a Streptozotocin-Induced Diabetes Rodent Model

Chen, Rong-Fu, Ph.D.; Wang, Chun-Ting, M.S.; Chen, Yu-Hua, Ph.D.; Chien, Ching-Ming, Ph.D.; Lin, Sin-Daw, M.D.; Lai, Chung-Sheng, M.D., Ph.D.; Wang, Ching-Jen, M.D.; Kuo, Yur-Ren, M.D., Ph.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1371–1382
doi: 10.1097/PRS.0000000000005504
Experimental
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Background: This study investigated whether a hyaluronic acid–povidone-iodine compound can enhance diabetic wound healing.

Methods: A dorsal skin defect (6 × 5 cm) in a streptozotocin-induced diabetes rodent model was used. Seventy male Wistar rats were divided into seven groups: I, normal control; II, diabetic control, no treatment; III, diabetic rats, lower molecular weight (100 kDa) hyaluronic acid; IV, rats, higher molecular weight (1000 kDa) hyaluronic acid; V, rats, 0.1% povidone-iodine; VI, rats, lower molecular weight hyaluronic acid plus povidone-iodine; and VII, rats, higher molecular weight hyaluronic acid plus povidone-iodine. Histologic examination was performed with hematoxylin and eosin staining. CD45, Ki-67, prolyl 4-hydroxylase, and vascular endothelial growth factor were evaluated with immunohistochemical staining.

Results: Compared with the control, higher molecular weight hyaluronic acid plus povidone-iodine–treated rats had significantly reduced wound area (p < 0.001). Higher molecular weight hyaluronic acid plus povidone-iodine increased wound healing time when compared with higher molecular weight hyaluronic acid, povidone-iodine, or lower molecular weight hyaluronic acid plus povidone-iodine. Histology revealed significantly increased neovessels and suppressed inflammatory response in the higher molecular weight hyaluronic acid plus povidone-iodine group when compared with the control group. Immunohistochemical staining revealed significantly increased Ki67, prolyl 4-hydroxylase, and vascular endothelial growth factor expression, and suppressed CD45 expression in the higher molecular weight hyaluronic acid plus povidone-iodine group when compared with the other groups.

Conclusion: Higher molecular weight hyaluronic acid plus povidone-iodine complex dressing significantly facilitated diabetic wound healing via increasing neovascularization and tissue regeneration and suppressing a proinflammatory response.

Kaohsiung and Hsinchu, Taiwan

From the Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital; the Department of Healthcare Materials, Material and Chemical Research Laboratories, Industrial Technology Research Institute; the Department of Orthopaedics, Kaohsiung Chang Gung Memorial Hospital; the Faculty of Medicine, College of Medicine, Orthopaedic Research Center, Kaohsiung Medical University; and the Department of Biological Sciences, National Sun Yat-sen University.

Received for publication August 27, 2018; accepted September 14, 2018.

The first two authors contributed equally to this study.

Disclosure:The authors have no financial conflicts of interest to declare.

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Yur-Ren Kuo, M.D., Ph.D., Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung 80756, Taiwan, kuoyrren@gmail.com

©2019American Society of Plastic Surgeons