Cellular benefits of single‐use negative pressure wound therapy demonstrated in a novel ex vivo human skin wound model

Abstract

Negative pressure wound therapy is a widely used treatment for chronic, nonhealing wounds. Surprisingly, few studies have systematically evaluated the cellular and molecular effects of negative pressure treatment on human skin. In addition, no study to date has directly compared recently available single‐use negative pressure modalities to traditional negative pressure devices in a controlled setting. Here we developed a novel large‐scale ex vivo human skin culture system to effectively evaluate the efficacy of two different negative pressure wound therapy modalities. Single‐use and traditional negative pressure devices were applied to human ex vivo wounded skin sheets cultured over a period of 48 hours. Cellular tissue response to therapy was evaluated via a combination of histological analysis and transcriptional profiling, in samples collected from the wound edge, skin adjacent to the wound, and an extended skin region. Single‐use negative pressure wound therapy caused less damage to wound edge tissue than traditional application, demonstrated by improved skin barrier, reduced dermal‐epidermal junction disruption and a dampened damage response. Transcriptional profiling confirmed significantly less activation of multiple pro‐inflammatory markers in wound edge skin treated with single‐use vs traditional negative pressure therapy. These findings may help to explain the greater efficacy of sNPWT in the clinic, while offering a noninvasive system to develop improved NPWT‐based therapies.

Efficacy of prophylactic negative pressure wound therapy after open ventral hernia repair: a systematic review meta-analysis

“…Nevertheless, studies indicate that there is no noteworthy increase in the incidence of wound-related adverse events associated with NPWT when compared to standard dressings [ 44 ]. Appropriate preventive measures may help mitigate adverse events [ 45 ].…”

Novel cell culture system for monitoring cells during continuous and variable negative‐pressure wound therapy

“…Although initially used only for open wounds, it is now widely used in wound bed preparation to achieve wound closure with skin grafts or skin flaps owing to its granulation effect 15 . Recently, devices, such as the NPWT with instillation and dwell time (NPWTi‐d) 4 (which repeatedly injects cleaning solution, immerses the wound, and performs aspiration), the single‐use NPWT, 16,17 (which is highly portable and causes few skin problems), and the NPWT used for temporary closure of open abdomen, 18 have evolved significantly, owing to which, indications have expanded to include infected wounds and exposed organs, which had previously been considered unsafe 4 . The efficacy of NPWT in preventing wound infection, primarily in closed wounds, 19,20 has been described in a Cochrane review 20,21 …”

A robotic venous leg ulcer system reveals the benefits of negative pressure wound therapy in effective fluid handling

“…22,24,25 Single-use negative pressure wound therapy (sNPWT) systems, which are portable and can be carried by patients in their pockets or on their belts have recently been reported to be superior to traditional, bedside NPWT technology, causing less damage to wound edge tissues than traditional application, as demonstrated by improved skin barrier and reduced dermal-epidermal junction disruption at the peri-wound skin. 26 Currently, there is no optimal SOC wound dressing for managing VLUs, as evident by the wide range of available products with different materials, constructions and designs, and the varying levels of effectiveness and costs. 27,28 Moreover, the growing use of sNPWT in wound care and its increasing popularity among healthcare professionals challenges the idea of using SOC passive dressings for treating chronic wounds.…”

“…For achieving the above positive effects on wound healing, the absolute pressure level delivered by the NPWT system must be kept consistently above a certain therapeutic threshold, which was reported in a few recent studies to be at the |−50| to |−40| mmHg range, that is, lower absolute pressures (of less than |−40| mmHg) would not be able to sufficiently stimulate the peri‐wound region for an added value of active care over SOC dressings that provide passive care 22,24,25 . Single‐use negative pressure wound therapy (sNPWT) systems, which are portable and can be carried by patients in their pockets or on their belts have recently been reported to be superior to traditional, bedside NPWT technology, causing less damage to wound edge tissues than traditional application, as demonstrated by improved skin barrier and reduced dermal‐epidermal junction disruption at the peri‐wound skin 26 …”

“… 22 , 24 , 25 Single‐use negative pressure wound therapy (sNPWT) systems, which are portable and can be carried by patients in their pockets or on their belts have recently been reported to be superior to traditional, bedside NPWT technology, causing less damage to wound edge tissues than traditional application, as demonstrated by improved skin barrier and reduced dermal‐epidermal junction disruption at the peri‐wound skin. 26 …”