Use of Collagen Scaffolds in Conjunction with NPWT for the Care of Complex Wounds: Clinical Report

Abstract:

Open wounds treatment is very often a challenge for both the physician and patient. They require long term complex treatment with surgical debridement, dressing changing, additional therapies including expensive medication, with a high risk of failure. The most difficult to treat are the diabetic wounds and those that are associated with advanced arterial disease. In these special cases, the peripheral vascularization is severely impaired and the complications are imminent. Sixteen patients were selected from those appearing to our hospital departments of orthopedic and plastic surgery. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base following trauma or diabetes, in which NPWT was indicated, without exclusion criteria. Patients enrolled were treated with regularly scheduled NPWT dressing change and using of a collagen scaffold. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded. Both applications of these therapies appeared to accelerate the wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Some of the patients were healed partially and plastic surgery techniques were applied. Use of collagen scaffolds in conjunction with negative pressure wound therapy in the care of complex wounds is a reliable and effective method combining both the new granular tissue formation capacity of the scaffold to hold osteoblasts. In our experience, we have noticed that the patients benefit greatly when collagen scaffolds is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds in healing.

• Periodical: Key Engineering Materials (Volume 745)
• Pages: 91-100
• DOI: https://doi.org/10.4028/www.scientific.net/KEM.745.91
• Online since: July 2017
• Authors: Ioan Cristescu, Daniel Vilcioiu*, Florin Safta, Mircea Istodorescu, Claudia Milea, Fabrizio Fiori, Ileana Mariana Mates, Ioan Lascar
• Keywords: Collagen, Diabetic Foot, Negative Pressure Wound Therapy (NPWT), Scaffold, Surgery

References

[1] M.J. Morykwas, L.C. Argenta, E.I. Shelton-Brown, et al., Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation, Ann Plast Surg. 38 (1997) 553–562.

DOI: 10.1097/00000637-199706000-00001

[2] M.Y. DeLange, R.A. Schasfoort, M.C. Obdeijn et al., Vacuum-assisted closure: indications and clinical experience, Eur J Plast Surg 23 (2000) 178–182.

[3] A.K. Deva, G.H. Buckland, E. Fisher et al., Topical negative pressure in wound management, Med J Aust 173 (2000) 128–131.

[4] S. Gupta, T. Cho, A literature review of negative pressure wound therapy, Ostomy Wound Manage 50 (2004) S2–S4.

[5] D.A. Mendonca, R. Papini, P.E. Price, Negative-pressure wound therapy: a snapshot of the evidence, Int Wound J. 3 (2006) 261–271.

DOI: 10.1111/j.1742-481x.2006.00266.x

[6] M.A. Peck, W.D. Clouse, M.W. Cox et al., The complete management of extremity vascular injury in a local population: a wartime report from the 332nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq. J Vasc Surg. 45 (2007).

DOI: 10.1016/j.jvs.2007.02.003

[7] A.J. DeFranzo, L.C. Argenta, M.W. Marks et al., The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone, Plast Reconstr Surg. 108 (2001) 1184–1191.

DOI: 10.1097/00006534-200110000-00013

[8] B.T. Dedmond, B. Kortesis, K. Punger et al., The use of negative-pressure wound therapy (NPWT) in the temporary treatment of soft-tissue injuries associated with high-energy open tibial shaft fractures, J Orthop Trauma 21 (2007) 11–17.

DOI: 10.1097/bot.0b013e31802cbc54

[9] D. Herscovici, R.W. Sanders, J.M. Scaduto et al. Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries, J Orthop Trauma 17 (2003) 683–688.

DOI: 10.1097/00005131-200311000-00004

[10] B.E. Leininger, T.E. Rasmussen, D.L. Smith et al., Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq, J Trauma 61 (2006) 1207–1211.

DOI: 10.1097/01.ta.0000241150.15342.da

[11] J.C. Page, B. Newswander, D.C. Schwenke et al., Retrospective analysis of negative pressure wound therapy in open foot wounds with significant soft tissue defects, Adv Skin Wound Care 17 (2004) 354–364.

DOI: 10.1097/00129334-200409000-00015

[12] L.X. Webb New techniques in wound management: vacuum-assisted wound closure, J Am Acad Orthop Surg 10 (2002) 303–311.

[13] E. Krug, L. Berg, C. Lee, D. Hudson, H. Birke-Sorensen, M. Depoorter et al., Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus, Injury 42 (2011).

DOI: 10.1016/s0020-1383(11)00041-6

[14] M.J. Morykwas, L.C. Argenta, E.I. Shelton-Brown et al., Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation, Ann Plast Surg. 38 (1997) 553–562.

DOI: 10.1097/00000637-199706000-00001

[15] M.Y. DeLange, R.A. Schasfoort, M.C. Obdeijn et al., Vacuum-assisted closure: indications and clinical experience, Eur J Plast Surg 23 (2000) 178–182.

[16] N. Singh, D. G. Armstrong, B. A. Lipsky, Preventing Foot Ulcers in Patients with Diabetes, Journal of the American Medical Association 2 (2005) 217-228.

[17] C. A. Abbott, A. P. Garrow, A. L. Carrington, J. Morris, E. R. Van Ross and A. J. Boulton, Foot Ulcer Risk Is Lower in South-Asian and African-Caribbean Compared with European Diabetic Patients in the UK: The North- West Diabetes Foot Care Study, Diabetes Care 8 (2005).

DOI: 10.2337/diacare.28.8.1869

[18] S. D. Ramsey, K. Newton, D. Blough et al., Incidence, Outcomes, and Cost of Foot Ulcers in Patients with Diabetes, Diabetes Care 3 (1999) 382-387.

DOI: 10.2337/diacare.22.3.382

[19] G. Ragnarson Tennvall, J. Apelqvist, Health-Economic Consequences of Diabetic Foot Lesions, Clinical Infectious Diseases 2 (2004) 132-139.

DOI: 10.1086/383275

[20] A. J. Boulton, Diabetes/Metabolism Research and Reviews, The Diabetic Foot: A Global View 1 (2000) 2-5.

[21] R. G. Frykberg, Diabetic Foot Ulcers: Current Concepts, Journal of Foot and Ankle Surgery 5 (1998) 440-446.

DOI: 10.1016/s1067-2516(98)80055-0

[22] W. Fleischman, Lang, L. Klintzl Vacuum assisted wound closure after dermatofasciotomy of the lower extremity, Unfallchirurg 99 (1996) 283.

[23] D. Herscovici, R.W. Sanders, J.M. Scaduto, et al., Vacuum- assisted wound closure(VAC therapy) for management of patients with high-energy soft tissue injuries, J Orthop Trauma 17 (2003) 683-688.

DOI: 10.1097/00005131-200311000-00004

[24] A.K. Deva, G.H. Buckland, E. Fisher et al., Topical negative pressure in wound management, Med J Aust 173 (2000) 128–131.

[25] P. Botez, P. Sirbu, L. Simion, F. Munteanu, I. Antoniac, Application of a biphasic macroporous synthetic bone substitutes CERAFORM®: clinical and histological results, European Journal of Orthopaedic Surgery and Traumatology, 19( 6), (2009).

DOI: 10.1007/s00590-009-0445-7

[26] I. Antoniac, M.D. Vranceanu, A. Antoniac, The influence of the magnesium powder used as reinforcement material on the properties of some collagen based composite biomaterials, Journal Of Optoelectronics And Advanced Materials, 15( 7-8), (2013).

[27] J.G. Meara, L. Guo, J.D. Smith, et al., Vacuum-assisted closure in the treatment of degloving injuries, Ann Plast Surg, 42 (1999) 589–594.

DOI: 10.1097/00000637-199906000-00002

[28] M.A. Peck, W.D. Clouse, M.W. Cox et al., The complete management of extremity vascular injury in a local population: a wartime report from the 332nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq. J Vasc Surg. 45 (2007).

DOI: 10.1016/j.jvs.2007.02.003

[29] M.M. Hanasono, R.J. Skorack, Securing skin grafts to microvascular free flaps using the vacuum-assisted closure (VAC) device, Ann Plast Surg 58 (2007) 573–6.

DOI: 10.1097/01.sap.0000237638.93453.66

[30] J.A. Nelson, E.M. Kim, J.M. Serletti, L.C. Wu, A novel technique for lower extremity limb salvage: the vastus lateralis muscle flap with concurrent use of the vacuum-assisted closure device, J Reconstr Microsurg 26 (2010) 427–31.

DOI: 10.1055/s-0030-1251561

[31] I. Antoniac, Biodegradability of some collagen sponges reinforced with different bioceramics, Key engineering materials, 32 (2014) 179-184.

DOI: 10.4028/www.scientific.net/kem.587.179

[32] M.D. Vranceanu, I. Antoniac, F. Miculescu, R. Saban, The influence of the ceramic phase on the porosity of some biocomposites with collagen matrix used as bone substitutes, Journal of Optoelectronics and Advanced Biomaterials, 14(7-8), (2012).

[33] T. Petreus, B.A. Stoica, O. Petreus, A. Goriuc, C.E. Cotrut, I. Antoniac, L. Barbu-Tudoran, Preparation and cytocompatibility evaluation for hydrosoluble phosphorous acid-derivatized cellulose as tissue engineering scaffold material, Journal of Materials Science: Materials in Medicine, 25(4), (2014).

DOI: 10.1007/s10856-014-5146-z

[34] I. Antoniac, Biologically responsive biomaterials for tissue engineering, Springer, ISBN 978-1-4614-4327-8 (2013) 24-64.

[35] I. Cristescu, D. Zamfirescu, D. Vilcioiu, et al., Experimental evaluation on rat model of different bioresorbable materials potentially used as orthopedic biomaterials. Key Engineering Materials, 614 (2014) 196-199.

DOI: 10.4028/www.scientific.net/kem.614.196

[36] F. Miculescu, D. Bojin, L.T. Ciocan, I. Antoniac, M. Miculescu, N. Miculescu, Experimental researches on biomaterial-tissue interface interactions, Journal of Optoelectronics and Advanced Materials 9(11), (2007) 3303 – 3306.

DOI: 10.4028/www.scientific.net/kem.638.14