118 A Randomized Controlled Study Comparing Vacuum Assisted Closure to Standard Dressing Changes in the Development of Angiogenesis

Abstract

Hypothesis: The use of Vacuum Assisted Closure (VAC) therapy will stimulate the development of angiogenesis in the subjacent tissues underlying and surrounding the wound base to a greater degree than can be achieved with standard wound healing efforts. Study Background: The presence of tissue ischemia and hypoxia due to compromised arterial blood flow is a primary factor compromising wound healing. Wounds that are compromised by impaired angiogenesis will have poor blood supply and are unlikely to progress through the stages of healing in an orderly and timely fashion. The VAC is a subatmospheric pressure system utilizing medical grade polyurethane foam wound dressing that is fitted at the bedside to the appropriate size for each patient’s wound, and then covered with an adhesive drape to create an airtight seal. The VAC enhances wound healing by stimulating granulation tissue. The etiology of this granulation is thought to be increased blood flow to the wound base and stimulation of angiogenesis, but the physiologic tissue changes due to VAC therapy that lead to the development of angiogenesis has not been proven or documented. A recent clinical observation demonstrated angiographic evidence of subadjacent angiogenesis in a patient with a wound that was managed successfully with VAC therapy. However, to date no randomized controlled trials have been performed to document wound angiogenesis. We propose that subatmospheric pressure dressings applied to lower extremity ulcers will promote angiogenesis more effectively than moist wound therapy dressings.