Topical negative pressure therapy: Does it accelerate neovascularisation within the dermal regeneration template, Integra? A prospective histological in vivo study

• Published in: Burns Vol. 36; no. 6; pp. 764 - 768
• Main Authors: Moiemen, Naiem S, Yarrow, Jeremy, Kamel, Dia, Kearns, Daniel, Mendonca, Derek
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.09.2010; Elsevier
• Subjects: Adult; Biocompatible Materials - therapeutic use; Biological and medical sciences; Biopsy; Burns; Burns - physiopathology; Burns - surgery; Burns - therapy; Chondroitin Sulfates; Collagen; Critical Care; Dermal regeneration template; Female; Fibrin Tissue Adhesive - administration & dosage; Histology, Vascularisation; Humans; Integra; Male; Medical sciences; Middle Aged; Negative-Pressure Wound Therapy; Neovascularization, Physiologic - physiology; Prospective Studies; Skin - blood supply; Skin - pathology; Skin substitutes; Skin Transplantation - methods; Topical negative pressure; Traumas. Diseases due to physical agents; Wound Healing; Young Adult; Topical negative pressure; Dermal regeneration template; Histology, Vascularisation; Integra; Skin substitutes; Skin disease; Histology; Burn; In vivo; Regeneration; Local administration; Treatment; Skin; Neovascularization; Derm
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2010.04.011

Abstract Background The use of topical negative pressure (TNP) dressings with dermal regeneration template (DRT), Integra, has improved outcomes and simplified aftercare. Previous clinical studies have suggested accelerated vascularisation; with a reduction in the duration of the 1st stage after the application of Integra, from 2 to 4 weeks to as little as 4 days, but with no histological evidence. However, histological studies, without TNP, have shown that vascularisation occurs between the second and the fourth week. This study set out to examine histologically the rate of DRT neovascularisation when combined with TNP. Methods Eight patients with nine reconstruction sites were enlisted. Unmeshed Integra and fibrin sealant to promote adherence were used. TNP was applied for the duration between the 1st and the 2nd stages. Patients underwent serial biopsies on days 7, 14, 21 and 28 post-application. The biopsies were stained with H&E and endothelial markers CD31 and CD34. Template vascularisation was assessed as a percentage of the template depth in which patent, canalised vascular channels could be demonstrated. Results The median percentage of the template depth which demonstrated canalised channels was 0%, 20%, 61% and 80% for days, 7, 14, 21 and 28, respectively. Conclusion The application of TNP dressings to dermal templates can reduce shearing forces, restrict seroma and haematoma formation, simplify wound care and improve patient tolerance. However, this study could not demonstrate that TNP accelerates neovascularisation as verified by the presence of histologically patent vascular channels.