A comparative study to evaluate the effect of limited access dressing on diabetic ulcers

Aim: Emerging evidence favors the important role of antioxidants, matrix metalloproteinases (MMPs), and nitric oxide (NO) in the healing of diabetic wounds. There is a lack of substantial evidence regarding the effects of negative pressure on antioxidants, MMPs and NO in chronic wounds associated with diabetes. Methods: A total of 55 type 2 diabetic patients with leg ulcers were divided into 2 groups: a limited access dressing (LAD) group (n = 27) and a conventional dressing group (n = 28). Levels of hydroxyproline, total protein, MMP‐2 and MMP‐9, NO and antioxidants including reduced glutathione (GSH) and the oxidative biomarker malondialdehyde (MDA) were measured in the granulation tissue at days 0 and 10. Changes in levels between the LAD and conventional groups were determined by the Student’s t‐test. Results: After 10 days of treatment, the LAD vs. conventional dressing group showed increase in the levels of hydroxyproline (mean ± standard deviation = 55.2 ± 25.1 vs. 29.2 ± 1, P < 0.05), total protein (12.8 ± 6.5 vs. 8.34 ± 3.2, P < 0.05), NO (1.13 ± 0.52 vs. 0.66 ± 0.43, P < 0.05), GSH (7.0 ± 2.4 vs. 6.6 ± 2.2, P < 0.05) and decrease in MMP‐2 (0.47 ± 0.33 vs. 0.62 ± 0.30, P < 0.05), MMP‐9 (0.32 ± 0.20 vs. 0.53 ± 0.39, P < 0.05) and MDA (6.8 ± 2.3 vs. 10.4 ± 3.4, P < 0.05). Conclusion: When compared to conventional dressings, LAD induces biochemical changes by significantly increasing the levels of hydroxyproline, total protein, NO and antioxidants levels, and significantly reducing MMPs (MMP‐2 and MMP‐9) and an oxidative biomarker in diabetic wounds. These biochemical changes are thought to favor diabetic wound healing.