Effect of Negative Pressure Wound Therapy on Cellular Fibronectin and Transforming Growth Factor-ß1 Expression in Diabetic Foot Wounds.

ABSTRACT

BACKGROUND: Chronic diabetic foot wounds are a leading cause of amputation, morbidity, and hospitalization for patients with diabetes. Negative-pressure wound therapy (NPWT) can putatively facilitate wound healing, but the underlying mechanisms remain unclear. Cellular fibronectin (cFN) and transforming growth factor-ß1 (TGF-ß1) play an important role in wound healing. This prospective randomized controlled trial evaluated the effects of NPWT on the production of cFN and the expression of TGF-ß1 in diabetic foot wounds of patients. METHODS: From January 2012 to January 2015, 40 patients with diabetic foot wounds were randomly and equally apportioned to receive either NPWT or advanced moist wound therapy (control) for 7 days. Granulation tissue was harvested before and after treatment. Immunohistochemistry and Western blot were performed to evaluate protein levels of cFN and TGF-ß1, and real-time polymerase chain reaction (PCR) to measure corresponding mRNA expressions. RESULTS: NPWT facilitated the expression of cFN and TGF-ß1 in diabetic foot wounds. Immunohistochemical analysis revealed higher levels of cFN and TGF-ß1 in the NPWT group than in the control group. Western blot and real-time PCR analysis further showed that protein and mRNA levels of cFN or TGF-ß1 were higher in the NPWT group than that in the control group ( P < .01, both). CONCLUSION: Our results showed that NPWT facilitated the production of cFN and the expression of TGF-ß1 in granulation tissue in diabetic foot ulcers. LEVEL OF EVIDENCE Level I, randomized controlled study.