Comparative study on microbiological and histopathological examination of diabetic wounds managed by conventional dressing and vacuum assisted closure therapy

Authors

  • P. Ganesh Kumar Department of General Surgery, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
  • K. Raja Department of Plastic Surgery, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
  • P. Haritha Undergraduate student, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
  • A. D. Saravanakumari Department of Community Medicine, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
  • D. Shanthi Department of Pathology, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
  • S. Vasanthi Department of Microbiology, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20211297

Keywords:

Vacuum assisted closure, Negative pressure wound therapy, Conventional dressing, Diabetic wounds

Abstract

Background: Diabetes mellitus and its complications are rising. Managing the diabetic foot wound is very challenging. Early intervention and intense management using modern technique will improve the diabetic wounds for a definitive procedure and also prevent, reduce the level of amputation of extremity. Our study compares the microbiological and histopathological results of diabetic wounds managed by conventional dressing and VAC (vacuum assisted closure) therapy.

Methods: This was an institutional based prospective study conducted between July 2018 and July 2019 consisting of 50 patients with diabetic wound of lower extremities. Patients were divided into group A- 25 patients underwent conventional dressing and group B- 25 patients underwent negative pressure wound therapy (NPWT). Wound swab and tissue biopsy was obtained on day 0 and day 10 from both groups and compared.

Results: Among patients, 76% and 24% were males and females respectively. Histopathologically, necrosis and inflammatory cell infiltrate were significantly decreased in group B compared to group A. Angiogenesis increased notably in group B. On microbiological grounds, from both groups Pseudomonas aeruginosa was found to be the most common organism on day 0 and 10. But the prevalence of infection in group B was grossly reduced when compared to group A.

Conclusions: VAC therapy is a better modality to treat diabetic wound compared to conventional dressing as it accelerates the healing of a chronic wound by increasing angiogenesis and decreasing necrosis, inflammatory cell infiltrate and microbial growth.

References

Kumar V, Abbas A, Aster J. Inflammation and repair. In Robbins and Cotran Pathologic Basis of Disease South Asian edition. Elsevier. 2014;108.

Guo S, DiPietro LA. Factors Affecting Wound Healing. J Dent Res. 2010;89(3):219-29.

Potula VS. Conventional treatment versus vacuum therapy for diabetic foot ulcers treatment. Int Surg J. 2017;5:1.

Aziz N, Chionh S, Han A, Chan P, Nambiar A. Effectiveness of Vacuum-assisted Closure (VAC) Therapy in the Healing of Chronic Diabetic Foot Ulcers. Ann Acad Med. 2010;39:353-8.

King GL, Loeken MR. Hyperglycemia-induced oxidative stress in diabetic complications. Histochem Cell Biol. 2004;122:333.

Kumar V, Abbas A, Aster J. The endocrine system. In Robbins and Cotran Pathologic Basis of Disease South Asian edition. Elsevier. 2014;1105.

Wu SC, Driver VR, Wrobel JS, Armstrong DG. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.

Patmo AS, Krijnen P, Tuinebreijer WE, Breederveld RS. The effect of Vacuum-Assisted Closure on the Bacterial Load and Type of Bacteria: A Systematic Review. Adv Wound Care (New Rochelle). 2014;3(5):383-9.

Honnegowda TM, Kumar P, Singh R, Shivakumar S, Rao P, Prasad HK, Kumar S, Kumar U, Udupa EG. Histopathological study of chronic wounds modulated by intermittent negative pressure therapy under limited access dressing. Plast Aesthet Res. 2015;2:272-6.

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.

James SM, Sathasivam S, Thirthar E, Debasis N, Chellappa V, Palanivel C. Comparison of vacuum-assisted closure therapy and conventional dressing on wound healing in patients with diabetic foot ulcer: A randomized controlled trial. Nigerian J Surg. 2019;25:14.

Kim JL, Shin JY, Roh SG, Chang SC, Lee NH. Factors Affecting Vascular Clogging, Wound Status and Bacterial Culture in Diabetic Foot Ulcers. J Wound Manag Res. 2019;15(2):57-67.

Ranjit U, Ranjit A, Viswanathan M. Diabetes mellitus and its complications in India. Nature Rev Endocrinol. 2016;12.

Ambady R, Snehalatha C, Vijay V. Burden of type 2 diabetes and its complications-The Indian scenario. Diab Research. 2001;83.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28.

Kumar V, Abbas A, Aster J. Cellular responses to stress and toxic insults: Adaptation, injury and death. In Robbins and Cotran Pathologic Basis of Disease South Asian edition. Elsevier. 2014;108.

Lone AM, Zaroo MI, Laway BA, Pala NA, Bashir SA, Rasool A. Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study. Diabetic Foot Ankle. 2014;5(1):23345.

Armstrong DG, Lavery LA. Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: A multicentre, randomised controlled trial. Lancet. 2005;366:1704-10.

Zhang D, Li Z, Wang Z, Zeng F, Xiao W, Yu A. MicroRNA-126: a promising biomarker for angiogenesis of diabetic wounds treated with negative pressure wound therapy. Diabetes Metab Syndr Obes. 2019;12:1685-96.

Huang C, Leavitt T, Bayer LR, Orgill DP. Effect of negative pressure wound therapy on wound healing. Curr Probl Surg. 2014;51:301-31.

Rastogi A, Bhansali A. Diabetic Foot Infection: An Indian Scenario. J Foot Ankle Surg (Asia-Pacific). 2016;3(2):71-9.

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Published

2021-03-26

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Original Research Articles