Samuel Tahk, MD, PhD1, Renford Cindass, MD1, Kevin Wu, MD2, Nicholas Robbins, DO3, Jian Ling, PhD4, Bijaya Parida, PhD2, Vijay Gorantla, MD, PhD5, Erik Weitzel, MD2, Michael Davis, MD2. 1San Antonio Military Medical Center, 259th Medical Wing United States Air Force, 3University of Texas Health Sciences Center, 4Southwest Research Institute at San Antonio, 5University of Pittsburgh Medical Center
Objective: Negative pressure wound therapy (NPWT) aims to improve healing by secondary intention of acute and/or chronic wounds by dynamic vacuum assisted removal of wound exudate, promoting granulation tissue formation, angiogenesis, and cellular proliferation. The standard of care in NPWT uses a polyurethane sponge dressing (PUSD) applied to the wound as a filler to help facilitate vacuum suction. The PUSD is non-biodegradable and requires removal every 2-3 days, causing repetitive trauma during wound healing and patient discomfort. We developed three novel bioresorbable/biointegratable/biocompatible sponge dressing scaffolds (3B-SDS) and evaluated their feasibility and efficacy in optimizing wound healing and limiting need for dressing changes in a pre-clinical porcine NPWT wound model.
Methods: Ten full thickness wounds were created on six swine. Four randomly chosen wounds served as controls undergoing wet-to-dry (WTD) dressing changes (two wounds) and PUSD NPWT (two wounds). The remaining six wounds underwent treatment with the novel 3B-SDSs without dressing changes. All wounds were assessed every 3 days until creation of a skin-graftable area or until the project end date of 1 month. The primary outcome measures were wound healing compared to PUSD and time to skin-graftable area. Wound contraction and area of granulation tissue were secondary outcome metrics.
Results: 3B-SDSs were developed with a bioresorbable and biocompatible polymer with an open-cell porous structure. 3B-SDSs were surface treated to increase hydrophilicity and biointegration. Both control treated wounds developed a skin-graftable area by POD9-12. The 3B-SDSs were completely incorporated into the wounds and developed a skin-graftable area by POD12 with a larger area of granulation tissue and less wound contraction compared to controls. Histological assessment of biopsies showed granulation tissue ingrowth into the 3B-SDSs indicating scaffold incorporation. Scanning electron microscopy revealed biocompatible granulation tissue ingrowth into the pores of the 3B-SDSs.
Conclusions: The 3B-SDSs had comparable efficacy for wound healing as PUSD mitigating the need for interval dressing changes. The use of 3B-SDSs provided a regenerative scaffold for cellular ingrowth minimizing wound contraction and were incorporated into the wounds mitigating the need for dressing changes. The 3B-SDSs were biocompatible and bioresorbable eliminating the risk of retained non-degradable foreign body PUSD which may cause severe wound infection and may require surgical removal. Future studies involve optimizing the formulation/structure of 3B-SDSs and to clinically validate efficacy in a wide range of acute and chronic wounds NPWT is currently utilized. These novel bioresorbable, biointegratable, and biocompatible sponges have the potential to revolutionize wound care.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87141
Program Number: MSS06
Presentation Session: Full-Day Military Surgical Symposium – Basic Science Presentations
Presentation Type: MSSPodium