Influence of Negative-Pressure Wound Therapy on Tissue Oxygenation of the Foot

 

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Background Negative-pressure wound therapy (NPWT) is believed to accelerate wound healing by altering wound microvascular blood flow. Although many studies using laser Doppler have found that NPWT increases perfusion, recent work using other modalities has demonstrated that perfusion is reduced. The purpose of this study was to investigate the influence of NPWT on tissue oxygenation of the foot, which is the most sensitive region of the body to ischemia.

Methods Transcutaneous partial pressure of oxygen (TcpO₂) was used to determine perfusion beneath NPWT dressings of 10 healthy feet. The sensor was placed on the tarso-metatarsal area of the foot and the NPWT dressing was placed above the sensor. TcpO₂ was measured until it reached a steady plateau state. The readings obtained at the suction-on period were compared with the initial baseline (pre-suction) readings.

Results TcpO₂ decreased significantly immediately after applying NPWT, but gradually increased over time until reaching a steady plateau state. The decrease in TcpO₂ from baseline to the steady state was 2.9 to 13.9 mm Hg (mean, 9.3±3.6 mm Hg; 13.5±5.8%; P<0.01). All feet reached a plateau within 20 to 65 minutes after suction was applied.

Conclusions NPWT significantly decrease tissue oxygenation of the foot by 2.9 to 13.9 mm Hg. NPWT should be used with caution on feet that do not have adequate tissue oxygenation for wound healing.

This article was presented at the 71th Congress of Korean Society of Plastic and Reconstructive Surgeons on November 1-3, 2013 in Seoul, Korea.

Publication History

Received: 30 May 2014

Accepted: 26 June 2014

Article published online:
05 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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• References

• 1 Argenta LC, Morykwas MJ, Marks MW. et al. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg 2006; 117: 127S-142S
  CrossrefPubMedGoogle Scholar
• 2 Banwell P, Teot L. Topical negative pressure (TNP): the evolution of a novel wound therapy. J Tissue Viability 2006; 16: 16-24
  Google Scholar
• 3 Morykwas MJ, Simpson J, Punger K. et al. Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg 2006; 117: 121S-126S
  CrossrefPubMedGoogle Scholar
• 4 Timmers MS, Le Cessie S, Banwell P. et al. The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Ann Plast Surg 2005; 55: 665-671
  CrossrefPubMedGoogle Scholar
• 5 Wackenfors A, Gustafsson R, Sjogren J. et al. Blood flow responses in the peristernal thoracic wall during vacuum-assisted closure therapy. Ann Thorac Surg 2005; 79: 1724-1730
  CrossrefPubMedGoogle Scholar
• 6 Wackenfors A, Sjogren J, Gustafsson R. et al. Effects of vacuum-assisted closure therapy on inguinal wound edge microvascular blood flow. Wound Repair Regen 2004; 12: 600-606
  CrossrefPubMedGoogle Scholar
• 7 Basic theory and operating principles of laser Doppler blood flow monitoring and imaging (LDF & LDI), issue 1 [Internet]. Devon; Moor Instruments; 2014 [2014 Jul 1]. Available from: http://www.moor.co.uk/ckfinder/userfiles/files/Moor_Laser_doppler_theory_Issue_1.pdf
• 8 Detre JA, Ances BM, Takahashi K. et al. Signal averaged laser Doppler measurements of activation-flow coupling in the rat forepaw somatosensory cortex. Brain Res 1998; 796: 91-98
  CrossrefPubMedGoogle Scholar
• 9 Morales F. Improving the clinical applicability of laser Doppler perfusion monitoring. Enschede: Print Partners Ipskamp; 2005
  Google Scholar
• 10 Ichioka S, Watanabe H, Sekiya N. et al. A technique to visualize wound bed microcirculation and the acute effect of negative pressure. Wound Repair Regen 2008; 16: 460-465
  CrossrefPubMedGoogle Scholar
• 11 Kairinos N, Voogd AM, Botha PH. et al. Negative-pressure wound therapy II: negative-pressure wound therapy and increased perfusion. Just an illusion?. Plast Reconstr Surg 2009; 123: 601-612
  CrossrefPubMedGoogle Scholar
• 12 Franzeck UK, Talke P, Bernstein EF. et al. Transcutaneous PO2 measurements in health and peripheral arterial occlusive disease. Surgery 1982; 91: 156-163
  PubMedGoogle Scholar
• 13 Rooke TW, Osmundson PJ. Variability and reproducibility of transcutaneous oxygen tension measurements in the assessment of peripheral vascular disease. Angiology 1989; 40: 695-700
  CrossrefPubMedGoogle Scholar
• 14 Lindstedt S, Malmsjo M, Gesslein B. et al. Topical negative pressure effects on coronary blood flow in a sternal wound model. Int Wound J 2008; 5: 503-509
  CrossrefPubMedGoogle Scholar
• 15 Chen SZ, Li J, Li XY. et al. Effects of vacuum-assisted closure on wound microcirculation: an experimental study. Asian J Surg 2005; 28: 211-217
  CrossrefPubMedGoogle Scholar
• 16 Schultz GS, Sibbald RG, Falanga V. et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen 2003; 11 Suppl 1 S1-S28
  CrossrefPubMedGoogle Scholar
• 17 Shai A, Maibach HI. Natural course of wound repair versus impaired healing in chronic skin ulcers. In: Shai A, Maibach HI. Wound healing and ulcers of the skin: diagnosis and therapy-the practical approach. Berlin: Springer; 2005: 7-17
  Google Scholar
• 18 Glotzbach JP, Levi B, Wong VW. et al. The basic science of vascular biology: implications for the practicing surgeon. Plast Reconstr Surg 2010; 126: 1528-1538
  CrossrefPubMedGoogle Scholar
• 19 Kairinos N, Solomons M, Hudson DA. Negative-pressure wound therapy I: the paradox of negative-pressure wound therapy. Plast Reconstr Surg 2009; 123: 589-598
  CrossrefPubMedGoogle Scholar
• 20 Jang SY, Jeong TW, Han SK. et al. Transcutaneous oxygen pressure to predict wound healing in mild diabetic feet. J Korean Soc Plast Reconstr Surg 2011; 38: 585-589
  Google Scholar