Iscı, et al.: Negative pressure wound therapy on the chemotherapeutic extravasation necrosis 9. Kirsner RS, Katz MH, Eaglstein WH, Falanga V. The biology of wound fluid. Wounds 1993;5:122-8. 10. Raffetto JD, Mendez MV, Marien BJ, Byers HR, Phillips TJ, Park HY, et al. Changes in cellular motility and cytoskeletal actin in fibroblasts from patients with chronic venous insufficiency and in neonatal fibroblasts in the presence of chronic wound fluid. J Vasc Surg 2001;33:1233-41. 11. Greene AK, Puder M, Roy R, Arsenault D, Kwei S, Moses MA, et al. Microdeformational wound therapy: Effects on angiogenesis and matrix metalloproteinases in chronic wounds of 3 debilitated patients. Ann Plast Surg 2006;56:418-22. 12. Chen KD, Li YS, Kim M, Li S, Yuan S, Chien S, et al. Mechanotransduction in response to shear stress. Roles of receptor tyrosine kinases, integrins, and Shc. J Biol Chem 1999; 274:18393-400. 13. Chen SZ, Cao DY, Li JQ, Tang SY. Effect of vacuum-assisted closure on the expression of proto-oncogenes and its significance during wound healing. Zhonghua Zheng Xing Wai Ke Za Zhi 2005;21:197-200. 14. Konas E, Canter HI, Korkusuz P, Demir D, Oner F, Mavili ME. A new concept in the treatment of extravasation injury: Controlled drug delivery systems. J BUON 2010;15:592-600. 15. Heckler FR. Current thoughts on extravasation injuries. Clin Plast Surg 1989;16:557-63. 16. Disa JJ, Chang RR, Mucci SJ, Goldberg NH. Prevention of adriamycin-induced full-thickness skin loss using hyaluronidase infiltration. Plast Reconstr Surg 1998;101:370-4. 17. Luedke DW, Kennedy PS, Rietschel RL. Histopathogenesis of skin and subcutaneous injury induced by adriamycin. Plast Reconstr Surg 1979;63:463-5. 18. Vargel I, Canter HI, Erdem A, Altundag MK. Results of GM-CSF treatment in chemotherapeutic extravasation ulcers. J BUON 2010;15:608-9. 19. Morykwas MJ, Kennedy A, Argenta JP, Argenta LC. Use of
subatmospheric pressure to prevent doxorubicin extravasation ulcers in a swine model. J Surg Oncol 1999;72:14-7. 20. Isci E, Canter HI, Kecik A. A new custom made dressing and wound protective for rabbits. Eur J Plast Surg 2007;30:45-6. 21. Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJ, Alshahrour A, et al. Histologic characterization of vaginal vs. abdominal surgical wound healing in a rabbit model. Wound Repair Regen 2007;15:80-6. 22. Agarwal JP, Ogilvie M, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M, et al. Vacuum-assisted closure for sternal wounds: A first-line therapeutic management approach. Plast Reconstr Surg 2005;116:1035-40. 23. Tang AT, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg 2000;17:482-4. 24. O’Connor J, Kells A, Henry S, Scalea T. Vacuum-assisted closure for the treatment of complex chest wounds. Ann Thorac Surg 2005;79:1196-200. 25. Orgill DP, Bayer LR. Advancing the treatment options of chest wounds with negative pressure wound therapy. Ostomy Wound Manage 2005;51:39S-43. 26. von Gossler CM, Horch RE. Rapid aggressive soft-tissue necrosis after beetle bite can be treated by radical necrectomy and vacuum suction-assisted closure. J Cutan Med Surg 2000;4:219-22. 27. Goon PK, Dalal M. Limb-threatening extravasation injury: Topical negative pressure and limb salvage. Plast Reconstr Surg 2006;117:1064-5. How to cite this article: Isci E, Canter HI, Dadaci M, Atilla P, Cakar AN, Kecik A. The efficacy of negative pressure wound therapy on chemotherapeutic extravasation ulcers: An experimental study. Indian J Plast Surg 2014;47:394-400. Source of Support: Upported by Hacettepe University Research Foundation, Conflict of Interest: None declared.
Commentary The efficacy of VAC therapy on chemotherapeutic extravasation ulcers: An experimental study
T
his is now a well-established fact that the application of sub atmospheric pressure in a closed draining system on acute or chronic Access this article online
Quick Response Code:
Website: www.ijps.org DOI: 10.4103/0970-0358.146613
wounds speeds up the wound healing. This is known as negative pressure wound therapy (NPWT). The therapy in recent years is popularised by Morykwas et al.[1] The sub atmospheric pressure at wound site is usually in the range of minus 80 to minus mm of mercury. Mechanism of action of negative pressure on wound is by following ways: 1. Wound contraction: This purely is mechanical effect 2. Effect on wound interface: Alteration of cytoskeleton of cell on wound bed, thereby increasing the rate of cell division
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
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Iscı, et al.: Negative pressure wound therapy on the chemotherapeutic extravasation necrosis
3. Effect on blood flow: NPWT is known to enhance blood supply of the wound and improves quality of granulation tissue 4. Edema: NPWT helps in reducing all types of oedema that is, acute inflammatory to chronic intractable 5. Infection: NPWT not only control surface bacterial load by continuous suction, but also prevent bacterial invasion of wound thereby controlling sepsis in extensive wounds 6. Isolation of wound from environment: Chances of cross infection of wound are minimised 7. Moist wound healing: Semi-occlusive dressing helps in achieving continuous moist environment, which helps in rapid epithelisation. In acute wounds, including burn wounds,[2] NPWT help in reducing oedema and controlling bacterial migration, thereby preventing wound infection and septicemia. In wounds with exposed hardware or exposed bone, by applying sub atmospheric pressure, healthy granulation cove is achieved, and skin graft will suffice ultimately, which otherwise will need a flap cover. In chronic wounds like bed sores and diabetic ulcer, application of NPWT helps in achieving wound closure. This doesn’t mean that NPWT is the answer for all types of intractable wounds and ulcers. The efficacy of NPWT is doubtful in ischaemic ulcers[3] (e.g., Burger’s disease). Rather many surgeons have bad experience of ulcer getting worse after NPWT. Studies showing good results in Burger’s disease by NPWT therapy are those in which sub atmospheric pressure was applied over the lesion only after proper revascularisation of the limb.[4] The author has used NPWT in ulcers formed after the leakage of the chemotherapeutic agent in experimental animals and has not found any significant wound improvement from the control group being treated by conventional dressings. Only reduction in wound size
401
was appreciable in NPWT group than the control group that author rightly attributed to mechanical forces of negative pressure acting on wound margins. There is not much literature on the role of NPWT on chemotherapeutic agent extravagated ulcers, in all probability these wounds behave akin to ischemic ulcer having prolonged subclinical fibrosis in surrounding areas, making them resistant to NPWT. In clinical practice, these wounds are usually encountered on dorsum of the hand as dorsal vein is easily approachable for multiple sittings of chemotherapy. These ulcers are avascular and fibrotic, and often need a Groin flap to enhance blood supply to prevent extensor tendon adhesions in that area. Role of NPWT in these types of wounds requires further evaluation.
Vinay Kumar Tiwari Department of Burns and Plastic Surgery, R.M.L. Hospital and PGIMER, New Delhi, India Address for correspondence: Dr. V. K. Tiwari, Department of Burns and Plastic Surgery, R.M.L. Hospital and PGIMER, New Delhi, India. E-mail: [email protected]
REFERENCES 1. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg 1997;38:553-62. 2. Kamolz LP, Andel H, Haslik W, Winter W, Meissl G, Frey M. Use of subatmospheric pressure therapy to prevent burn wound progression in human: First experiences. Burns 2004;30:253-8. 3. Armstrong DG, Lavery LA, Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: A multicentre, randomised controlled trial. Lancet 2005;366:1704-10. 4. Nishimura K, Kanaoka Y, Harada S, Saiki M, Marumoto A, Nakamura Y, et al. Vacuum-assisted closure (VAC) for bilateral severe ischemic foot after revascularization: A patient report. Acta Med 2008;51:11-5. How to cite this article: Tiwari VK. The efficacy of VAC therapy on chemotherapeutic extravasation ulcers: An experimental study. Indian J Plast Surg 2014;47:400-1.
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
Copyright of Indian Journal of Plastic Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
subatmospheric pressure to prevent doxorubicin extravasation ulcers in a swine model. J Surg Oncol 1999;72:14-7. 20. Isci E, Canter HI, Kecik A. A new custom made dressing and wound protective for rabbits. Eur J Plast Surg 2007;30:45-6. 21. Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJ, Alshahrour A, et al. Histologic characterization of vaginal vs. abdominal surgical wound healing in a rabbit model. Wound Repair Regen 2007;15:80-6. 22. Agarwal JP, Ogilvie M, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M, et al. Vacuum-assisted closure for sternal wounds: A first-line therapeutic management approach. Plast Reconstr Surg 2005;116:1035-40. 23. Tang AT, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg 2000;17:482-4. 24. O’Connor J, Kells A, Henry S, Scalea T. Vacuum-assisted closure for the treatment of complex chest wounds. Ann Thorac Surg 2005;79:1196-200. 25. Orgill DP, Bayer LR. Advancing the treatment options of chest wounds with negative pressure wound therapy. Ostomy Wound Manage 2005;51:39S-43. 26. von Gossler CM, Horch RE. Rapid aggressive soft-tissue necrosis after beetle bite can be treated by radical necrectomy and vacuum suction-assisted closure. J Cutan Med Surg 2000;4:219-22. 27. Goon PK, Dalal M. Limb-threatening extravasation injury: Topical negative pressure and limb salvage. Plast Reconstr Surg 2006;117:1064-5. How to cite this article: Isci E, Canter HI, Dadaci M, Atilla P, Cakar AN, Kecik A. The efficacy of negative pressure wound therapy on chemotherapeutic extravasation ulcers: An experimental study. Indian J Plast Surg 2014;47:394-400. Source of Support: Upported by Hacettepe University Research Foundation, Conflict of Interest: None declared.
Commentary The efficacy of VAC therapy on chemotherapeutic extravasation ulcers: An experimental study
T
his is now a well-established fact that the application of sub atmospheric pressure in a closed draining system on acute or chronic Access this article online
Quick Response Code:
Website: www.ijps.org DOI: 10.4103/0970-0358.146613
wounds speeds up the wound healing. This is known as negative pressure wound therapy (NPWT). The therapy in recent years is popularised by Morykwas et al.[1] The sub atmospheric pressure at wound site is usually in the range of minus 80 to minus mm of mercury. Mechanism of action of negative pressure on wound is by following ways: 1. Wound contraction: This purely is mechanical effect 2. Effect on wound interface: Alteration of cytoskeleton of cell on wound bed, thereby increasing the rate of cell division
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
400
Iscı, et al.: Negative pressure wound therapy on the chemotherapeutic extravasation necrosis
3. Effect on blood flow: NPWT is known to enhance blood supply of the wound and improves quality of granulation tissue 4. Edema: NPWT helps in reducing all types of oedema that is, acute inflammatory to chronic intractable 5. Infection: NPWT not only control surface bacterial load by continuous suction, but also prevent bacterial invasion of wound thereby controlling sepsis in extensive wounds 6. Isolation of wound from environment: Chances of cross infection of wound are minimised 7. Moist wound healing: Semi-occlusive dressing helps in achieving continuous moist environment, which helps in rapid epithelisation. In acute wounds, including burn wounds,[2] NPWT help in reducing oedema and controlling bacterial migration, thereby preventing wound infection and septicemia. In wounds with exposed hardware or exposed bone, by applying sub atmospheric pressure, healthy granulation cove is achieved, and skin graft will suffice ultimately, which otherwise will need a flap cover. In chronic wounds like bed sores and diabetic ulcer, application of NPWT helps in achieving wound closure. This doesn’t mean that NPWT is the answer for all types of intractable wounds and ulcers. The efficacy of NPWT is doubtful in ischaemic ulcers[3] (e.g., Burger’s disease). Rather many surgeons have bad experience of ulcer getting worse after NPWT. Studies showing good results in Burger’s disease by NPWT therapy are those in which sub atmospheric pressure was applied over the lesion only after proper revascularisation of the limb.[4] The author has used NPWT in ulcers formed after the leakage of the chemotherapeutic agent in experimental animals and has not found any significant wound improvement from the control group being treated by conventional dressings. Only reduction in wound size
401
was appreciable in NPWT group than the control group that author rightly attributed to mechanical forces of negative pressure acting on wound margins. There is not much literature on the role of NPWT on chemotherapeutic agent extravagated ulcers, in all probability these wounds behave akin to ischemic ulcer having prolonged subclinical fibrosis in surrounding areas, making them resistant to NPWT. In clinical practice, these wounds are usually encountered on dorsum of the hand as dorsal vein is easily approachable for multiple sittings of chemotherapy. These ulcers are avascular and fibrotic, and often need a Groin flap to enhance blood supply to prevent extensor tendon adhesions in that area. Role of NPWT in these types of wounds requires further evaluation.
Vinay Kumar Tiwari Department of Burns and Plastic Surgery, R.M.L. Hospital and PGIMER, New Delhi, India Address for correspondence: Dr. V. K. Tiwari, Department of Burns and Plastic Surgery, R.M.L. Hospital and PGIMER, New Delhi, India. E-mail: [email protected]
REFERENCES 1. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg 1997;38:553-62. 2. Kamolz LP, Andel H, Haslik W, Winter W, Meissl G, Frey M. Use of subatmospheric pressure therapy to prevent burn wound progression in human: First experiences. Burns 2004;30:253-8. 3. Armstrong DG, Lavery LA, Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: A multicentre, randomised controlled trial. Lancet 2005;366:1704-10. 4. Nishimura K, Kanaoka Y, Harada S, Saiki M, Marumoto A, Nakamura Y, et al. Vacuum-assisted closure (VAC) for bilateral severe ischemic foot after revascularization: A patient report. Acta Med 2008;51:11-5. How to cite this article: Tiwari VK. The efficacy of VAC therapy on chemotherapeutic extravasation ulcers: An experimental study. Indian J Plast Surg 2014;47:400-1.
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
Copyright of Indian Journal of Plastic Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
