Combining VAC Therapy With Advanced Modalities: Can It Expedite Healing?

By Stephanie C. Wu, DPM, MS, Hong Yoon, MS, and David G. Armstrong, DPM, MSc, PhD

What The Literature Reveals About Combining Hyperbaric Oxygen Therapy With NPWT

   Hyperbaric oxygen therapy (HBOT) is an intermittent inhalation therapy in which the patient breathes oxygen at greater than 1 atmosphere of pressure. This modality requires the patient to be in an entirely enclosed pressure chamber for treatments. HBOT relies on the systemic circulation to deliver highly oxygenated blood to target tissues and raise tissue oxygen tensions to levels where one can expect wound healing. HBOT may also potentiate the action of leukocytes and researchers have noted improved healing in living tissues, especially those poor in oxygen.13,14 Numerous studies suggest that HBOT can be an effective adjunct in the management of complicated and compromised wounds.13-17    In a comparative analysis looking at either compromised post-surgical wounds or wounds secondary to arterial insufficiency, Neizgoda et. al., found that the combination of NPWT with HBOT produced results that exceeded those produced when either modality was used alone.18 In addition, the combined use of both therapies helped decrease the average number of HBOT treatments required.18    Conversely, Fabian, et. al., evaluated the efficacy of subatmospheric pressure and hyperbaric oxygen in the treatment of hypoxic full-thickness wounds in a rabbit model.19 They found that using NPWT increased the rate of healing while the application of HBOT did not significantly affect the rate of healing. Further trials are required to validate the combination use of NPWT and HBOT.

Combining Promogran With NPWT: Is It Effective?

   Collagen and oxidized regenerated cellulose (Promogran, Johnson & Johnson) is a sterile, freeze-dried matrix sheet that is approximately 3 mm thick. Oxidized regenerated cellulose (ORC) absorbs wound exudate and forms a soft, biodegradable gel that binds and inactivates matrix metalloproteases (MMP), which researchers have shown to have a detrimental effect on wound healing when present in excessive quantities.20,21    ORC also binds growth factors within the wound, protects them from degradation and releases them back into the wound in an active form as the matrix is slowly broken down. Researchers have demonstrated the effectiveness of ORC in several studies.22,23 ORC seems like an ideal wound healing modality to combine with NPWT as it requires the maintenance of a moist wound healing environment and may be left undisturbed for two to three days if the wound exudate is controlled. Clinical trials are required to help assess the possible clinical benefits of the combination.

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