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

   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.

Does NPWT Help Facilitate An Increased Efficacy Of Regranex?

   Becaplermin (Regranex, Johnson & Johnson) is a hydrogel that contains 0.01% platelet derived growth factor-BB (rhPDGF-BB) and is currently the only commercially available topical growth factor for use in cutaneous wound healing.

   Researchers have shown that PDGF-BB promotes wound healing by increasing proliferation and migration of dermal fibroblasts and extracellular matrix deposition. PDGF also promotes chemotaxis of neutrophils, monocytes and smooth muscle cells in wounds.24 Several studies have demonstrated the efficacy and safety of becaplermin.25,26

   Some clinicians advocate combining becaplermin with NPWT with the belief that NPWT may remove excess fluid to create an environment that helps facilitate the actions of the PDGF-BB. It has been suggested that the imbalance between levels of matrix metalloproteases and their inhibitors in the fluids of ulcers causes elevated levels of proteases.26 The proteases in turn destroy essential growth factors, extracellular matrix proteins and receptors, including the ones specific for PDGF-BB, to ultimately prevent wounds from healing.20 Others argue that NPWT may indiscriminately remove the PDGF-BB while removing the excess fluid. There is currently no published data pertaining to the combination of becaplermin gel with NPWT. Further research and analysis are necessary to understand, validate and refine this approach to facilitate wound healing.

What You Should Know About Bioengineered Skin Replacements And NPWT

   Researchers have noted that a human fibroblast-derived dermal substitute (Dermagraft, Smith and Nephew) and an allogeneic bilayered cultured skin equivalent (Apligraf, Organogenesis) facilitate angiogenesis and promote the healing of chronic ulcerations. Numerous studies have shown the efficacy of these modalities in the healing of full thickness chronic wounds.27-32

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