Incisional Negative Pressure Wound Therapy Augments Perfusion and Improves Wound Healing in a Swine Model
Ajul Shah, M.D.1, Brandon Sumpio, BS1, Cynthia Tsay, BS1, Matthew Swallow, BS1, Andre Alcon, MD2, Biraja Dash, PhD1, Stephanie Thorn, PhD1, Albert Sinusas, MD1, Henry Hsia, MD1, Alexander Au, MD1.
1Yale University School of Medicine, New Haven, CT, USA, 2University of California - San Francisco, San Francisco, CA, USA.
Background: A commonly used treatment for open wounds, Negative Pressure Wound Therapy (NPWT) has recently been used to optimize wound healing in the setting of surgically closed wounds; however, the specific mechanisms of action by which NPWT may benefit patients after surgery remains unknown. Using a swine wound healing model, the current study investigates angiogenesis as a candidate mechanism.
Methods: Multiple excisional wounds were created on the dorsums of ten male Yorkshire pigs and closed by primary suture (Figure 1). The closed wounds underwent treatment with either NPWT dressing or control dressings in the absence of negative pressure. Dressings were maintained for 8 days followed by euthanasia of the animal. Wounds were analyzed for angiogenesis markers by immunohistochemistry and enzyme-linked immunosorbent assay (ELISA). Scar evaluation of the wounds by photographic analysis was also performed.
Results: Scar evaluation scores were observed to be significantly higher for the NPWT-treated sites compared to control sites (p < 0.05, Figure 2). ELISA results demonstrated increases for VEGF staining at the incision site treated with NPWT compared to other treatment groups (p < 0.05, Figure 3). Approximately two-fold elevations in VEGF and Factor VIII staining by immunohistochemistry were observed at the NPWT-treated sites (p = 0.047, p = 0.23, Figure 4).
Conclusions: The use of NPWT improves the appearance of wounds and increases VEGF and Factor VIII expression after 8 days in the setting of a closed excisional wound model, suggesting that improved angiogenesis is one mechanism by which NPWT optimizes wound healing when applied to closed surgical wound sites. 
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