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Wei S, Wang W, Li L, Meng HY, Feng CZ, Dong YY, Fang XC, Dong QQ, Jiang W, Xin HL, Li ZZ, Wang X. Recombinant human epidermal growth factor combined with vacuum sealing drainage for wound healing in Bama pigs. Mil Med Res 2021; 8:18. [PMID: 33685528 PMCID: PMC7941968 DOI: 10.1186/s40779-021-00308-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/08/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vacuum sealing drainage (VSD) and epidermal growth factor (EGF) both play an important role in the treatment of wounds. This study aims to explore the effects of the combination of VSD and EGF on wound healing and the optimal concentration and time of EGF. METHODS We tested the proliferation and migration capacity of HaCaT and L929 cells at different EGF concentrations (0, 1, 5, 10, and 100 ng/ml) and different EGF action times (2, 10, and 30 min). A full-thickness skin defect model was established using male, 30-week-old Bama pigs. The experiment included groups as follows: routine dressing change after covering with sterile auxiliary material (Control), continuous negative pressure drainage of the wound (VSD), continuous negative pressure drainage of the wound and injection of EGF 10 min followed by removal by continuous lavage (V + E 10 min), and continuous negative pressure drainage of the wound and injection of EGF 30 min followed by removal by continuous lavage (V + E 30 min). The wound healing rate, histological repair effect and collagen deposition were compared among the four groups. RESULTS An EGF concentration of 10 ng/ml and an action time of 10 min had optimal effects on the proliferation and migration capacities of HaCaT and L929 cells. The drug dispersion effect was better than drug infusion after bolus injection effect, and the contact surface was wider. Compared with other groups, the V + E 10 min group promoted wound healing to the greatest extent and obtained the best histological score. CONCLUSIONS A recombinant human epidermal growth factor (rhEGF) concentration of 10 ng/ml can promote the proliferation and migration of epithelial cells and fibroblasts to the greatest extent in vitro. VSD combined with rhEGF kept in place for 10 min and then washed, can promote wound healing better than the other treatments in vivo.
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Affiliation(s)
- Shuai Wei
- Institute of Orthopaedics, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Chinese PLA General Hospital, Beijing, 100583, China.,Zhoushan Dinghai Guanghua Hospital, Zhoushan, 316000, China.,Tianjin Hospital, Tianjin University, Tianjin, 300211, China
| | - Wei Wang
- Geriatric Neurological Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li Li
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830000, China
| | - Hao-Ye Meng
- Institute of Orthopaedics, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Chinese PLA General Hospital, Beijing, 100583, China
| | - Chun-Zhen Feng
- Department of Stomatology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yu-Ying Dong
- Department of Plastic Surgery, General Hospital of Taiyuan Iron and Steel Limited Company, Taiyuan, 030009, China
| | - Xi-Chi Fang
- Hand Microsurgery Department, Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Qi-Qiang Dong
- Third Surgery Department, Zhengzhou Renji Hospital, Zhengzhou, 450000, China
| | - Wen Jiang
- Department of Orthopedics, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, 832000, Uygur Autonomous Region, China
| | - Hai-Li Xin
- Pharmacy Department, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhan-Zhen Li
- Zhoushan Dinghai Guanghua Hospital, Zhoushan, 316000, China.
| | - Xin Wang
- Institute of Orthopaedics, Beijing Key Lab of Regenerative Medicine in Orthopaedics, Chinese PLA General Hospital, Beijing, 100583, China. .,Zhoushan Dinghai Guanghua Hospital, Zhoushan, 316000, China.
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Cocjin HGB, Jingco JKP, Tumaneng FDC, Coruña JMR. Wound-Healing Following Negative-Pressure Wound Therapy with Use of a Locally Developed AquaVac System as Compared with the Vacuum-Assisted Closure (VAC) System. J Bone Joint Surg Am 2019; 101:1990-1998. [PMID: 31764361 DOI: 10.2106/jbjs.19.00125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Negative-pressure wound therapy (NPWT) gained widespread clinical use after its introduction in the 1990s because of its many beneficial effects on the wound environment. However, high treatment costs have limited its use in third-world countries. The present study compares a low-cost, locally developed NPWT system with a commercially available system in terms of efficacy, reliability, ease of application, and safety. METHODS This prospective, randomized controlled trial involved 36 patients who were managed with NPWT with either a low-cost, locally developed system (AquaVac) or a commercially available Vacuum-Assisted Closure Advanced Therapy System (VAC ATS; KCI). The low-cost NPWT system described consists of a converted aquarium pump as a reusable vacuum source and a dressing system that can be found in the hospital supply room: food plastic wrap as an occlusive drape, surgical gauze as wound filler, nasogastric tubes as tubing, and used intravenous (IV) bottles as effluent canisters. The purpose of the study was to compare the 2 systems in terms of (1) time to apply the dressing, (2) exudate levels, (3) amount of granulation tissue, (4) wound size reduction, (5) average cost of treatment, (6) visual analog scale (VAS) pain scores, and (7) complications. RESULTS The experimental low-cost system had a small but statistically insignificant advantage over the commercially available system in terms of application time, pain during dressing changes, and wound contraction percentage. The 2 systems were comparable in terms of the amount of exudate, granulation tissue coverage, and VAS scores during the course of treatment. No wound or periwound complications were observed. The systems were significantly different in terms of cost, with the AquaVac system being 7 times less expensive than the VAC ATS system ($63.75 compared with $491.38 USD). CONCLUSIONS The low-cost AquaVac system was shown to be comparable with the commercial VAC ATS system, suggesting that it is an effective and safe alternative method for NPWT in resource-challenged settings. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hansel Gould B Cocjin
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Jair Kimri P Jingco
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Franklin Delano C Tumaneng
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
| | - Jose Maria R Coruña
- Department of Orthopaedics & Traumatology, Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH), Bacolod City, Philippines
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Cuomo R, Grimaldi L, Nisi G, Zerini I, Giardino FR, Brandi C. Ultraportable Devices for Negative Pressure Wound Therapy: First Comparative Analysis. J INVEST SURG 2019; 34:335-343. [DOI: 10.1080/08941939.2019.1616009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Irene Zerini
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Francesco Ruben Giardino
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
| | - Cesare Brandi
- Unit of Plastic and Reconstructive Surgery, Santa Maria Alle Scotte Hospital, University of Siena, Siena, Italy
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Yang F, Shi B, Cao L. Effect of vacuum sealing drainage on the expression of VEGF and miRNA-17-5p in seawater-immersed blast-injury wounds. Exp Ther Med 2017; 13:1081-1086. [PMID: 28450946 DOI: 10.3892/etm.2017.4057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 02/19/2016] [Indexed: 12/23/2022] Open
Abstract
The aim of the present study was to compare and observe the expression levels of vascular endothelial growth factor (VEGF) and miRNA-17-5p during the treatment of seawater-immersed blast-injury wounds (SIBIW) under different conditions of vacuum sealing drainage (VSD), and to identify the optimized range of VSD treatment and partially explain its mechanisms. The bilateral hips and scapulae of experimental pigs (weight, 25-30 kg) were subjected to blast-injury wounds, followed by the seawater immersion. The animals then underwent conventional dressing treatment under 120, 180 and 240 mmHg VSD. Visual observation, in addition to histological, immunohistochemical and molecular biological techniques were applied to compare and observe the extent of wound healing and expression levels of VEGF and miRNA-17-5p. The wound healing of the VSD treatment group was improved compared with the control group, with 120 mmHg negative pressure producing the most marked effect. miR-17-5p expression was detected in the SIBIW granulation tissues. There was significant difference between each VSD treatment group and control group at each time point (P<0.05). Thus, the present results show that miR-17-5p can be expressed in SIBIW granulation tissues, and this effect is most evident under 120 mmHg negative pressure, which may inform the optimized negative range for the treatment of SIBIW.
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Affiliation(s)
- Fen Yang
- Department of Burns and Plastic Surgery, Bayannur City Hospital, Bayannur, Inner Mongolia 015000, P.R. China
| | - Bing Shi
- Department of Plastic and Reconstructive Surgery, The 309th Hospital of PLA, Beijing 100091, P.R. China
| | - Ling Cao
- Department of Plastic and Reconstructive Surgery, The 309th Hospital of PLA, Beijing 100091, P.R. China
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Soares MO, Dumville JC, Ashby RL, Iglesias CP, Bojke L, Adderley U, McGinnis E, Stubbs N, Torgerson DJ, Claxton K, Cullum N. Methods to assess cost-effectiveness and value of further research when data are sparse: negative-pressure wound therapy for severe pressure ulcers. Med Decis Making 2012; 33:415-36. [PMID: 22927694 DOI: 10.1177/0272989x12451058] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health care resources are scarce, and decisions have to be made about how to allocate funds. Often, these decisions are based on sparse or imperfect evidence. One such example is negative-pressure wound therapy (NPWT), which is a widely used treatment for severe pressure ulcers; however, there is currently no robust evidence that it is effective or cost-effective. This work considers the decision to adopt NPWT given a range of alternative treatments, using a decision analytic modeling approach. Literature searches were conducted to identify existing evidence on model parameters. Given the limited evidence base, a second source of evidence, beliefs elicited from experts, was used. Judgments from experts on relevant (uncertain) quantities were obtained through a formal elicitation exercise. Additionally, data derived from a pilot trial were also used to inform the model. The 3 sources of evidence were collated, and the impact of each on cost-effectiveness was evaluated. An analysis of the value of further information indicated that a randomized controlled trial may be worthwhile in reducing decision uncertainty, where from a set of alternative designs, a 3-arm trial with longer follow-up was estimated to be the most efficient. The analyses presented demonstrate how allocation decisions about medical technologies can be explicitly informed when data are sparse and how this kind of analyses can be used to guide future research prioritization, not only indicating whether further research is worthwhile but what type of research is needed and how it should be designed.
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Affiliation(s)
- Marta O Soares
- Centre for Health Economics, The University of York, York, UK (MOS, LB, KC)
| | - Jo C Dumville
- Department of Health Sciences, The University of York, York, UK (JCD, RLA, CI, DT)
| | - Rebecca L Ashby
- Department of Health Sciences, The University of York, York, UK (JCD, RLA, CI, DT)
| | - Cynthia P Iglesias
- Department of Health Sciences, The University of York, York, UK (JCD, RLA, CI, DT)
| | - Laura Bojke
- Centre for Health Economics, The University of York, York, UK (MOS, LB, KC)
| | - Una Adderley
- School of Health and Social Care, Teesside University, Middlesbrough, UK (UA)
| | - Elizabeth McGinnis
- Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds General Infirmary, Leeds, UK (EM)
| | - Nikki Stubbs
- NHS Leeds Community Healthcare, St Mary’s Hospital, Leeds, UK (NS)
| | - David J Torgerson
- Department of Health Sciences, The University of York, York, UK (JCD, RLA, CI, DT)
| | - Karl Claxton
- Centre for Health Economics, The University of York, York, UK (MOS, LB, KC)
| | - Nicky Cullum
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK (NC)
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Vig S, Dowsett C, Berg L, Caravaggi C, Rome P, Birke-Sorensen H, Bruhin A, Chariker M, Depoorter M, Dunn R, Duteille F, Ferreira F, Francos Martínez J, Grudzien G, Hudson D, Ichioka S, Ingemansson R, Jeffery S, Krug E, Lee C, Malmsjo M, Runkel N, Martin R, Smith J. Evidence-based recommendations for the use of negative pressure wound therapy in chronic wounds: Steps towards an international consensus. J Tissue Viability 2011; 20 Suppl 1:S1-18. [DOI: 10.1016/j.jtv.2011.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Nain PS, Uppal SK, Garg R, Bajaj K, Garg S. Role of negative pressure wound therapy in healing of diabetic foot ulcers. J Surg Tech Case Rep 2011; 3:17-22. [PMID: 22022649 PMCID: PMC3192517 DOI: 10.4103/2006-8808.78466] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Foot disorders such as ulceration, infection and gangrene are the most common, complex and costly sequelae of diabetes mellitus.[1–3] Even for the most superficial wounds, treatment is often difficult with poor healing responses and high rates of complications. The purpose of this study is to compare the rate of ulcer healing with the negative pressure dressing technique to conventional moist dressings in the treatment of diabetic foot ulcers. Materials and Methods: The study was conducted on 30 patients, which were divided into two groups. One group received negative pressure dressing while other group received conventional saline moistened gauze dressing. Results were compared for rate of wound healing. Results: There was a statistically significant difference in the rate of appearance of granulation tissue between the two groups; with granulation tissue appearing earlier in the study group. The study group promised a better outcome (80% complete responders) as compared to the control group (60% complete responders). Conclusions: Negative pressure wound therapy has a definitive role in healing of diabetic foot ulcers.
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Affiliation(s)
- Prabhdeep Singh Nain
- Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Birke-Sorensen H, Malmsjo M, Rome P, Hudson D, Krug E, Berg L, Bruhin A, Caravaggi C, Chariker M, Depoorter M, Dowsett C, Dunn R, Duteille F, Ferreira F, Martínez JF, Grudzien G, Ichioka S, Ingemansson R, Jeffery S, Lee C, Vig S, Runkel N, Martin R, Smith J. Evidence-based recommendations for negative pressure wound therapy: Treatment variables (pressure levels, wound filler and contact layer) – Steps towards an international consensus. J Plast Reconstr Aesthet Surg 2011; 64 Suppl:S1-16. [DOI: 10.1016/j.bjps.2011.06.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/22/2011] [Accepted: 06/03/2011] [Indexed: 01/14/2023]
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Soares MO, Bojke L, Dumville J, Iglesias C, Cullum N, Claxton K. Methods to elicit experts' beliefs over uncertain quantities: application to a cost effectiveness transition model of negative pressure wound therapy for severe pressure ulceration. Stat Med 2011; 30:2363-80. [PMID: 21748773 DOI: 10.1002/sim.4288] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/24/2011] [Accepted: 04/11/2011] [Indexed: 11/09/2022]
Abstract
We can use decision models to estimate cost effectiveness, quantify uncertainty regarding the adoption decision and provide estimates of the value of further research. In many cases, the existence of only limited data with which to populate a decision model can mean that a cost-effectiveness analysis either does not proceed or may misrepresent the degree of uncertainty associated with model inputs. An example is the case of negative pressure wound therapy (NPWT) used to treat severe pressure ulceration, for which the evidence base is limited and sparse. There is, however, substantial practical experience of using this treatment and its comparators. We can capture this knowledge quantitatively to inform a cost-effectiveness model by eliciting beliefs from experts. This paper describes the design and conduct of an elicitation exercise to generate estimates of multiple uncertain model inputs and validate analytical assumptions for a decision model on the use of NPWT. In designing the exercise, the primary focus was the use of elicitation to inform decision models (multistate models), where representations of uncertain beliefs need to be probabilistically coherent. This paper demonstrates that it is feasible to collect formally elicited evidence to inform decision models.
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Affiliation(s)
- Marta O Soares
- Centre for Health Economics, University of York, York, UK.
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