CC BY-NC-ND 4.0 · Indian J Plast Surg 2014; 47(03): 394-400
DOI: 10.4103/0970-0358.146611
Original Article
Association of Plastic Surgeons of India

The efficacy of negative pressure wound therapy on chemotherapeutic extravasation ulcers: An experimental study

Evren Isci
Departments of Plastic and Reconstructive Surgery, Private Aile Hospital, Istanbul, Turkey
,
Halil I. Canter
1   Faculty of Medicine, Acibadem University, Istanbul, Turkey
,
Mehmet Dadaci
2   Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Turkey
,
Pergin Atilla
3   Departments of Histology and Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
,
Ayse N. Cakar
3   Departments of Histology and Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
,
Abdullah Kecik
4   Plastic and Reconstructive Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
› Author Affiliations
Further Information

Address for correspondence:

Dr. Evren Isci
Department of Plastic and Reconstructive Surgery, Private Aile Hospital
Talatpasa Caddesi, Begonya Sokak No. 7, Bahcelievler, Istanbul
Turkey   

Publication History

Publication Date:
26 August 2019 (online)

 

ABSTRACT

Context: The extravasation of the chemotherapeutic agents is not an unusual phenomenon. Necrosis of the skin and underlying structures has been reported, depending on the cytotoxicity of the extravasating drug. Despite the presence of some antidotes, such wounds tend to enlarge with time and are likely to resist the treatment. Aims: The objective of this study was to investigate the efficacy of negative pressure wound therapy (NPWT) on extravasation ulcers. Settings and Design: Animals were separated into two groups; conventional dressing group and NPWT group. Materials and Methods: Extravasation necrosis was established by intradermal doxorubicin injection. Following the debridement of the necrotic areas, one group of animals was treated with the conventional dressing while NPWT was applied to the other group. The wound areas were measured, and then biopsies were taken on the 3rd, 7th and 14th days after the debridement. Statistical Analysis Used: SPSS 11.5 for Windows was used. Two-way ANOVA test was used to compare wound areas between groups. Willcoxon sign test with Bonferroni correction was used to compare histological scores between groups. Chi-square test with Bonferroni correction was used to compare histological scores within the group between the days. Results: There is no significant difference in terms of inflammatory cell count, neovascularisation, granulation tissue formation between the groups. Contrary to these results wound areas at the end of the treatment were smaller in the NPWT group compared with the dressing group. Conclusion: There is the superiority of NPWT over conventional dressing in chemotherapeutic extravasation wounds as well as the wound area is concerned, but it is not proven histologically.


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Conflict of Interest

None declared.

  • REFERENCES

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  • 2 Orgill DP, Bayer LR. Update on negative-pressure wound therapy. Plast Reconstr Surg 2011; 127: 105S-115
  • 3 Argenta LC, Morykwas MJ, Marks MW, DeFranzo AJ, Molnar JA, David LR. Vacuum-assisted closure: State of clinic art. Plast Reconstr Surg 2006; 117: 127S-42
  • 4 Morykwas MJ, Simpson J, Punger K, Argenta A, Kremers L, Argenta J. Vacuum-assisted closure: State of basic research and physiologic foundation. Plast Reconstr Surg 2006; 117: 121S-6
  • 5 Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg 1997; 38: 553-62
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  • 14 Konas E, Canter HI, Korkusuz P, Demir D, Oner F, Mavili ME. A new concept in the treatment of extravasation injury: Controlled drug delivery systems. J BUON 2010; 15: 592-600
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  • 16 Disa JJ, Chang RR, Mucci SJ, Goldberg NH. Prevention of adriamycin-induced full-thickness skin loss using hyaluronidase infiltration. Plast Reconstr Surg 1998; 101: 370-4
  • 17 Luedke DW, Kennedy PS, Rietschel RL. Histopathogenesis of skin and subcutaneous injury induced by adriamycin. Plast Reconstr Surg 1979; 63: 463-5
  • 18 Vargel I, Canter HI, Erdem A, Altundag MK. Results of GM-CSF treatment in chemotherapeutic extravasation ulcers. J BUON 2010; 15: 608-9
  • 19 Morykwas MJ, Kennedy A, Argenta JP, Argenta LC. Use of subatmospheric pressure to prevent doxorubicin extravasation ulcers in a swine model. J Surg Oncol 1999; 72: 14-7
  • 20 Isci E, Canter HI, Kecik A. A new custom made dressing and wound protective for rabbits. Eur J Plast Surg 2007; 30: 45-6
  • 21 Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJ, Alshahrour A. et al. Histologic characterization of vaginal vs abdominal surgical wound healing in a rabbit model. Wound Repair Regen 2007; 15: 80-6
  • 22 Agarwal JP, Ogilvie M, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M. et al. Vacuum-assisted closure for sternal wounds: A first-line therapeutic management approach. Plast Reconstr Surg 2005; 116: 1035-40
  • 23 Tang AT, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg 2000; 17: 482-4
  • 24 O’Connor J, Kells A, Henry S, Scalea T. Vacuum-assisted closure for the treatment of complex chest wounds. Ann Thorac Surg 2005; 79: 1196-200
  • 25 Orgill DP, Bayer LR. Advancing the treatment options of chest wounds with negative pressure wound therapy. Ostomy Wound Manage 2005; 51: 39S-43
  • 26 von Gossler CM, Horch RE. Rapid aggressive soft-tissue necrosis after beetle bite can be treated by radical necrectomy and vacuum suction-assisted closure. J Cutan Med Surg 2000; 4: 219-22
  • 27 Goon PK, Dalal M. Limb-threatening extravasation injury: Topical negative pressure and limb salvage. Plast Reconstr Surg 2006; 117: 1064-5

Address for correspondence:

Dr. Evren Isci
Department of Plastic and Reconstructive Surgery, Private Aile Hospital
Talatpasa Caddesi, Begonya Sokak No. 7, Bahcelievler, Istanbul
Turkey   

  • REFERENCES

  • 1 Marks MW, Argenta LC, DeFranzo AJ. Principles and aplications of vacuum-assisted closure (VAC). In: Weinzweig J. editor Plastic Surgery Secrets. 2 nd ed. Philadelphia: Mosby Inc.; 2010: p. 38-44
  • 2 Orgill DP, Bayer LR. Update on negative-pressure wound therapy. Plast Reconstr Surg 2011; 127: 105S-115
  • 3 Argenta LC, Morykwas MJ, Marks MW, DeFranzo AJ, Molnar JA, David LR. Vacuum-assisted closure: State of clinic art. Plast Reconstr Surg 2006; 117: 127S-42
  • 4 Morykwas MJ, Simpson J, Punger K, Argenta A, Kremers L, Argenta J. Vacuum-assisted closure: State of basic research and physiologic foundation. Plast Reconstr Surg 2006; 117: 121S-6
  • 5 Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg 1997; 38: 553-62
  • 6 Chen SZ, Li J, Li XY, Xu LS. Effects of vacuum-assisted closure on wound microcirculation: An experimental study. Asian J Surg 2005; 28: 211-7
  • 7 Menke NB, Ward KR, Witten TM, Bonchev DG, Diegelmann RF. Impaired wound healing. Clin Dermatol 2007; 25: 19-25
  • 8 Ladwig GP, Robson MC, Liu R, Kuhn MA, Muir DF, Schultz GS. Ratios of activated matrix metalloproteinase-9 to tissue inhibitor of matrix metalloproteinase-1 in wound fluids are inversely correlated with healing of pressure ulcers. Wound Repair Regen 2002; 10: 26-37
  • 9 Kirsner RS, Katz MH, Eaglstein WH, Falanga V. The biology of wound fluid. Wounds 1993; 5: 122-8
  • 10 Raffetto JD, Mendez MV, Marien BJ, Byers HR, Phillips TJ, Park HY. et al. Changes in cellular motility and cytoskeletal actin in fibroblasts from patients with chronic venous insufficiency and in neonatal fibroblasts in the presence of chronic wound fluid. J Vasc Surg 2001; 33: 1233-41
  • 11 Greene AK, Puder M, Roy R, Arsenault D, Kwei S, Moses MA. et al. Microdeformational wound therapy: Effects on angiogenesis and matrix metalloproteinases in chronic wounds of 3 debilitated patients. Ann Plast Surg 2006; 56: 418-22
  • 12 Chen KD, Li YS, Kim M, Li S, Yuan S, Chien S. et al. Mechanotransduction in response to shear stress. Roles of receptor tyrosine kinases, integrins, and Shc. J Biol Chem 1999; 274: 18393-400
  • 13 Chen SZ, Cao DY, Li JQ, Tang SY. Effect of vacuum-assisted closure on the expression of proto-oncogenes and its significance during wound healing. Zhonghua Zheng Xing Wai Ke Za Zhi 2005; 21: 197-200
  • 14 Konas E, Canter HI, Korkusuz P, Demir D, Oner F, Mavili ME. A new concept in the treatment of extravasation injury: Controlled drug delivery systems. J BUON 2010; 15: 592-600
  • 15 Heckler FR. Current thoughts on extravasation injuries. Clin Plast Surg 1989; 16: 557-63
  • 16 Disa JJ, Chang RR, Mucci SJ, Goldberg NH. Prevention of adriamycin-induced full-thickness skin loss using hyaluronidase infiltration. Plast Reconstr Surg 1998; 101: 370-4
  • 17 Luedke DW, Kennedy PS, Rietschel RL. Histopathogenesis of skin and subcutaneous injury induced by adriamycin. Plast Reconstr Surg 1979; 63: 463-5
  • 18 Vargel I, Canter HI, Erdem A, Altundag MK. Results of GM-CSF treatment in chemotherapeutic extravasation ulcers. J BUON 2010; 15: 608-9
  • 19 Morykwas MJ, Kennedy A, Argenta JP, Argenta LC. Use of subatmospheric pressure to prevent doxorubicin extravasation ulcers in a swine model. J Surg Oncol 1999; 72: 14-7
  • 20 Isci E, Canter HI, Kecik A. A new custom made dressing and wound protective for rabbits. Eur J Plast Surg 2007; 30: 45-6
  • 21 Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJ, Alshahrour A. et al. Histologic characterization of vaginal vs abdominal surgical wound healing in a rabbit model. Wound Repair Regen 2007; 15: 80-6
  • 22 Agarwal JP, Ogilvie M, Wu LC, Lohman RF, Gottlieb LJ, Franczyk M. et al. Vacuum-assisted closure for sternal wounds: A first-line therapeutic management approach. Plast Reconstr Surg 2005; 116: 1035-40
  • 23 Tang AT, Ohri SK, Haw MP. Novel application of vacuum assisted closure technique to the treatment of sternotomy wound infection. Eur J Cardiothorac Surg 2000; 17: 482-4
  • 24 O’Connor J, Kells A, Henry S, Scalea T. Vacuum-assisted closure for the treatment of complex chest wounds. Ann Thorac Surg 2005; 79: 1196-200
  • 25 Orgill DP, Bayer LR. Advancing the treatment options of chest wounds with negative pressure wound therapy. Ostomy Wound Manage 2005; 51: 39S-43
  • 26 von Gossler CM, Horch RE. Rapid aggressive soft-tissue necrosis after beetle bite can be treated by radical necrectomy and vacuum suction-assisted closure. J Cutan Med Surg 2000; 4: 219-22
  • 27 Goon PK, Dalal M. Limb-threatening extravasation injury: Topical negative pressure and limb salvage. Plast Reconstr Surg 2006; 117: 1064-5