Combination of activated protein C and topical negative pressure rapidly
regenerates granulation tissue over exposed bone to heal recalcitrant orthopedic
wounds.
Author(s): Wijewardena A, Vandervord E, Lajevardi SS, Vandervord J, Jackson CJ.
Affiliation(s): Royal North Shore Hospital, Sydney, New South Wales, Australia.
Publication date & source: 2011, Int J Low Extrem Wounds. , 10(3):146-51
Chronic wounds arising from orthopedic surgery present a major clinical
challenge. Osteomyelitis may develop from polymicrobial infection, which can be
unresponsive to treatment and lead to amputation. Topical negative pressure (TNP)
is an effective treatment in wound management and is now used worldwide.
Activated protein C (APC) is an anticoagulant with cytoprotective and healing
properties. The aim of this study was to determine whether combined treatment of
TNP and APC was tolerated and was efficacious for treatment of difficult-to-treat
wounds. Four patients who presented to Royal North Shore Hospital with wounds
that were not responsive to conventional therapy were studied. All cases showed a
marked reduction in wound size and depth within 1 week of starting treatment and
progressively improved over time. There was a remarkable increase in the volume
of granulation tissue. After treatment, wounds either completely closed or
provided sufficient granulation tissue to allow split-thickness skin grafting.
The treatment was well tolerated, and the patients were able to be managed on
out-patient basis. Long-term follow-up suggested that this treatment prevented
osteomyelitis. This innovative treatment is very promising and may significantly
increase quality of care for patients with recalcitrant orthopedic wounds. A
randomized, placebo-controlled double blind trial is required to further
determine the efficacy of APC plus TNP.
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