Molecular mechanisms of action of negative pressure wound therapy: a systematic review

Molecular insight of nanosized Ba-Hao herbal ointment in accelerating chronic wound healing

Chronic wound treatment poses a substantial challenge to healthcare systems. Certain herbal medicines have demonstrated clinical efficacy in promoting chronic wound healing, yet their therapeutic mechanisms at the molecular level remain elusive due to their complex composition and multifaceted nature. In this study, Ba-Hao ointment (BHO), a sophisticated herbal formulation with diverse ingredients, is selected as a model to precisely investigate its wound-healing mechanism. Network pharmacology analysis and molecular docking simulations reveal that BHO specifically interacts with key wound-healing proteins, including vascular endothelial growth factor A (VEGFA), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β), suggesting its ability to modulate critical biological pathways involved in inflammation and tissue regeneration. Experimental validation further demonstrates that BHO significantly promotes cell proliferation, suppresses bacterial infection, and enhances the expression of essential growth factors such as epidermal growth factor (EGF) and VEGFA in normal human dermal fibroblasts (NHDF), all of which are vital for effective wound healing. In vivo studies confirm that BHO accelerates wound closure, reduces inflammation, and promotes the development of well-organized granulation tissue via activation of the PI3K-Akt signaling pathway. This study is interesting since it unveils BHO's molecular role in chronic wound healing, furthering herbal medicine development and insights.

A novel approach for managing the incisions of tibial plateau fractures with soft tissue swelling

To investigate the feasibility and clinical efficacy of a novel approach to managing the incisions used to treat tibial plateau fractures (TPFs) with soft tissue swelling. We retrospectively enrolled 64 patients with TPFs who underwent surgery at the Second Hospital of Shandong University. Patients were divided into two groups: Group A (n = 32) underwent early surgery with the novel incision management technique, and Group B (n = 32) underwent conventional surgery after swelling reduction. The perioperative data of the two groups were compared, including the time from injury to surgery, one-stage operation time, intraoperative blood loss, number of dressing changes, wound healing time, and hospitalization time. Preoperative and postoperative complications were assessed in both groups, and pain condition, degree of arthritis, limb function, imaging results, and quality of life were evaluated using validated scales. The time from injury to surgery, number of dressing changes, and hospitalization time in Group A were significantly lower than those in Group B (P < 0.05). There were no significant differences in one-stage operation time, intraoperative blood loss, or wound healing time between the two groups (P > 0.05). There were fewer preoperative and postoperative complications in Group A than in Group B (P < 0.05). The VAS and WOMAC scores were reduced in both groups (P < 0.05); Group A had lower VAS scores two weeks after surgery. There was no statistically significant difference in the WOMAC score between the groups. The modified Rasmussen functional and radiological scores were elevated in both groups (P < 0.05). There was no statistically significant difference between the two groups for the modified Rasmussen functional or radiological score at any of the time points (P > 0.05). In addition, the two groups did not differ in quality of life (P > 0.05). For patients with tibial plateau fractures without congestive blisters, open reduction and internal fixation at the early stage of swelling and wide-spacing interrupted suture and negative pressure wound therapy (NPWT) closure of the wound could help obtain excellent to good functional outcomes with fewer complications. This novel incision management approach and concept expands the surgical indications for these fractures.

Enhancing treatment outcomes for Acute Periprosthetic Hip Joint infection: optimizing debridement, antibiotics, and Implant Retention through vacuum sealing drainage in the deep tissue

BACKGROUND

Debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) is under debated since the reported success rate is inconsistent. This study aimed to explore the efficacy of vacuum sealing drainage (VSD) used as an adjunct to irrigation and debridement for acute PJI.

METHODS

Patients undergoing debridement, irrigation with component retention, and application of vacuum seal drainage in the deep portion surrounding the infected sites from January 2014 to February 2021 were retrospectively reviewed. The definition of failure included the requirement of prosthesis removal; persistent infection-related symptoms; suppressive antibiotics therapy due to failure of controlling the infection; infection-related death.

RESULTS

45 patients were included in this study with a mean follow-up of 45.62 ± 13.87 months. There were 28 males and 17 females with a mean age of 63.29 ± 17.74 months. The overall success rate was 86.67% with 6 failures. Multivariate analysis revealed a significant association between Charlson comorbidity index and treatment failure (OR = 2.226, 95% CI, 1.057-4.687, p = 0.035).

CONCLUSIONS

The incorporation of VSD in the deeper region enhances the outcomes of DAIR, achieving an 86.67% success rate in managing acute PJI. This approach offers a potentially safe and effective treatment, though patients with higher Charlson comorbidity index and elevated preoperative CRP levels face increased risks of failure.

The Efficacy and Safety of Negative-Pressure Wound Therapy Combined With Platelet-Rich Plasma in Chronic Refractory Wounds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background and Aims

Chronic refractory wound is a disease that seriously impairs the quality of life of patients. Negative pressure wound therapy and platelet-rich plasma are commonly used to treat various types of wounds. Further research is necessary to explore the efficacy and safety of the combination of negative pressure wound therapy and platelet-rich plasma in treating chronic refractory wounds.

Methods

PubMed, Web of Science, EMBASE, Cochrane, CINAHL, CNKI, Sino Med, and Wanfang Med Online up until March 2024 were searched(PROSPERO No. CRD42024507963). Two investigators screened literature according to inclusion and exclusion criteria, evaluated bias and certainty of evidence using RoB 2.0 and GRADE. Stata 12.0 was used to analyze the data.

Results

A total of 35 randomized controlled trials involving 2495 participants were included. 34 studies were assessed as having some concerns, and 1 study as having high risk in the risk of bias assessment. The results of meta-analysis showed that effective rate (RR1.23, 95% CI [1.17, 1.30], p < 0.001; I2 = 44.7%, p = 0.013), healing time (WMD-9.32, 95% CI [-10.60, -8.03], p < 0.001; I² = 91.00%, p < 0.001), healing rate (RR1.76, 95% CI [1.50, 2.07], p < 0.001; I2 = 62.6%, p < 0.001), positive rate of bacterial(RR0.25, 95% CI [0.15, 0.40], p < 0.001; I² = 0%, p = 0.841), pain score (WMD-1.43, 95% CI [-2.14, -0.72], p < 0.001; I² = 96.5%, p < 0.001), incidence of complications (RR0.45, 95% CI [0.30, 0.68], p < 0.001; I² = 46.3%, p = 0.098), length of hospital stay (WMD-9.88, 95% CI [-13.42, 6.34], p < 0.001; I2 = 98.9%, p < 0.001), number of dressing changes (WMD-2.56, 95% CI [-4.28, -0.83], p = 0.004; I² = 98.9%, p < 0.001), white blood cell level (WMD-1.71, 95% CI [-2.00, -1.41], p < 0.001; I² = 33.9%, p = 0.195), c-reactive protein level (WMD-0.68, 95% CI [-1.04, -0.33], p < 0.001; I² = 88.8%, p < 0.001), erythrocyte sedimentation rate (WMD-6.09, 95% CI [-8.05, -4.13], p < 0.001; I² = 13%, p = 0.32), score of vancouver scar scale (WMD-1.78, 95% CI [-1.89, -1.66], p < 0.001; I² = 38.3%, p = 0.166) and preparation time of secondary repair (WMD-4.95, 95% CI [-7.03, -2.87], p < 0.001; I² = 84.7%, p < 0.001) had statistically significant effects. However, hospitalization costs (WMD1423.56, 95% CI [-4588.93, 7436.06], p = 0.643; I2 = 100%, p < 0.001) had no significant difference.

Conclusions

This study demonstrates that the combination of negative-pressure wound therapy and platelet-rich plasma can improve the efficacy and safety on chronic refractory wounds. Optimal parameter combinations, elucidation of pathogenesis and treatment mechanisms can be explored in the future.

The ACS-NSQIP Analysis of Negative Pressure Wound Therapy Following Pancreatectomy for Pancreatic Diagnoses

Introduction Surgical site infections (SSIs) continue to be a challenging issue among patients undergoing pancreatectomy. Anecdotally, the use of negative pressure wound therapy (NPWT) following pancreatectomy for cancer has been associated with decreased SSIs. The objective of this study was to compare the postoperative outcomes of NPWT and non-NPWT for incisional wound care following distal pancreatectomy or pancreatoduodenectomy for pancreatic diagnoses using a national surgical database. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried from 2005 to 2019 for patients undergoing distal pancreatectomy or pancreaticoduodenectomy for pancreatic diagnoses using primary Current Procedural Terminology (CPT) codes. The primary outcome was surgical site infection rates between NPWT and non-NPWT patient groups. Secondary outcomes include sepsis, septic shock, readmission, and reoperation. Outcomes of interest were compared using multivariate logistic regression. Results A total of 54,457 patients underwent pancreatectomy with 131 receiving NPWT. Multivariate analysis, while accounting for patient characteristics, including wound classification, showed no difference in postoperative superficial SSI, deep SSI, sepsis, septic shock, or readmission between the NPWT and non-NPWT groups. Organ space SSI was higher in the NPWT group (21% vs 12%, p=0.001). Reoperation related to procedure was also high in the NPWT group (14% vs 4.3%, p<0.001). Conclusion The use of NPWT in distal pancreatectomies and pancreatoduodenectomies is associated with increased organ space SSIs and reoperation rates, with no difference in superficial SSI, deep SSI, or readmission. This large sample study shows no significant benefit of using NPWT incisional wound care after pancreatectomy.

Exploring an Innovative Approach: Integrating Negative-Pressure Wound Therapy with Silver Nanoparticle Dressings in Skin Graft Procedures

BACKGROUND

Skin grafting is a helpful instrument in a plastic surgeon's arsenal. Several types of dressings were designed to facilitate the process of graft integration. Negative-pressure wound therapy is a proven dressing method, enhancing graft survival through several mechanisms: aspiration of secretions, stimulation of neoangiogenesis, and promotion of an anti-inflammatory environment. Silver nanoparticle dressings also bring multiple benefits by bearing an antimicrobial effect and providing a humid medium, which are favorable for epithelialization. The combination of NPWT (negative-pressure wound therapy) with AgNPs (silver nanoparticles) has not been widely studied.

MATERIALS AND METHODS

This study aimed to compare the outcomes of silver nanoparticle sheets with the combination of negative-pressure wound therapy and silver nanoparticle dressings. We conducted a comparative prospective study on 80 patients admitted to the Plastic Surgery Department of "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital between 1st of January 2020 and 31st of December 2022. The study population was randomized to receive either silver nanoparticle dressings or negative-pressure wound therapy (NPWT) combined with silver nanoparticle dressings. Various parameters were monitored, including patient comorbidities and graft-related data such as defect etiology, graft integration, and graft size. Dressings were changed, and graft status was evaluated at 7, 10, and 14 days postoperatively. Additionally, baseline C-reactive protein (CRP) levels were measured before surgery and 7, 10, and 14 days postoperatively.

RESULTS

The study demonstrated an enhanced integration of skin grafts at all evaluation stages when employing NPWT combined with AgNPs, particularly evident 10 days post operation. Significant variations in graft integration were also observed based on factors such as diabetes, cardiovascular disease, graft size, or the origin of the grafted defect. Moreover, dynamic C-reactive protein monitoring showed a statistically significant decrease in CRP levels 10 days post operation among patients treated with NPWT in conjunction with silver dressing, consistent with the nearly complete integration of skin grafts at this evaluation threshold.

CONCLUSION

Several factors influence the postoperative evolution of split-skin grafts. Postoperative dressings target local factors to enhance graft integration further. Our research demonstrated that the innovative combination of NPWT-assisted dressings, complemented by a silver nanoparticle sheet, resulted in improved benefits for graft integration and the alleviation of systemic inflammation.