Vacuum Therapy of Diabetic Soft Tissue Wounds: the Impact on the Matrix Metalloproteinase Activity

Abstract

The objective was to investigate the effect of vacuum therapy on the main stages of the healing of purulent wounds of soft tissues in patients with diabetes mellitus, the degree of microbial contamination of wounds and the activity of matrix metalloproteinases (MMP) in the tissues of wound surface. The results of treatment and examination of 48 patients with chronic diabetic wounds of soft tissues were analyzed. In 26 patients (study group), vacuum therapy of wounds was used in the treatment complex. During healing process, microbiological and cytological parameters were determined. MMP activity in the tissues of wound surface of patients from the control and study groups was monitored by the method of gelatine zymography at the various stages of healing. It was found that in patients of the main group, wound purification from necrotic material and microorganisms occurred 5.2 ± 1.5 days earlier than in patients of the control group. Moreover, in the tissues of wound surface of patients from study group, a statistically significant (p < 0.05) decrease in MMP activity was observed, its value on the 5th and 10th days of treatment was respectively 68 and 45 % of the initial level. In the wounds of patients with diabetes mellitus who underwent traditional medical treatment, collagenase activity remained consistently high throughout the period of observation. So, together with antimicrobial and anti-inflammatory effects, the normalization of proteolytic processes in the wound bed can be one of the key mechanisms of high therapeutic effectiveness of VAC-therapy.

Keywords

• diabetes mellitus
• soft tissue diabetic wounds
• vacuum therapy
• cytograms
• matrix metalloproteinases.