The Effect of Vacuum-assisted Closure on the Tissue Oxygenation of Venous Ulcers: A Pilot Study
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Initial sensor positions were marked with a surgical marker and remarked on day 3 (during dressing change) to ensure that measurements were obtained from the same skin areas.
Due to financial constraints in the public system, a Duplex ultrasound scan of the venous system to identify reflux in the deep or perforator veins was not performed. However, as we measured the response of tissue oxygenation with VAC therapy, the presence of reflux in the deep system would probably not affect the results of this study.
TCOM is used to assess patients being considered for HBOT, to monitor the response to HBOT, and to predict the healing patterns of lower limb amputation levels.17,22–24 Studies have revealed that in order for wounds to heal successfully, TcPO2 must remain > 40 mmHg.23 However, a similar study suggests that TCOM does not significantly predict venous ulcer recurrence in patients with healed venous ulcers.25
A study of negative pressure therapy in induced wounds in a rabbit model showed the negative pressure increased blood flow by increasing capillary density and the caliber diameter.9 These acquired experimental wounds might differ significantly from chronic venous ulceration in humans and this may partially explain the lack of observed change in TCOM in this study. Christenson26 showed that patients with venous ulcers had elevated subcutaneous and intramuscular pressures and reduced TcPO2. Patients who had subcutaneous fasciotomy following superficial reflux elimination surgery had significantly improved wound healing rates and improved TcPO2 compared to the group who had surgery alone.26 This possibly explains why TcPO2 following negative pressure therapy did not improve during our observed period.
Intermittent compression treatment has been shown to improve skin perfusion and tissue oxygenation of venous ulcers when applied over a 60-minute period.27 Future experiments using quantitative techniques such as capillary microscopy, laser Doppler flowmeter and TCOM in patients with venous ulcers can be used to examine the skin blood flow response while TNP is applied in situ and post therapy. In addition, longer study duration might reveal a more established change in the microcirculation.
Negative pressure therapy applied over a 6-day period did not change oxygen partial pressure of the skin close to chronic venous ulcers. However, the study demonstrated moderate tissue hypoxia despite normal ABPIs.
The authors thank Dr. Mike Davis and the nursing staff from the Hyperbaric Medicine Unit at Christchurch Hospital for access to their facility, Intermed-KCI Auckland for providing the VAC equipment, and Dr. John Pearson for his statistical assistance in manuscript preparation.
Disclaimer: All VAC equipment was provided by Intermed-KCI. This did not influence the study design, data analysis, or submission of the manuscript for publication.
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