Is Negative Pressure Wound Therapy (NPWT) Safe? Comparison Of The Effects Between NPWT And Standard Surgical Dressings (SSDs) On Cancer Wound Beds.
Gurtej Singh, PhD1, Omer Kaymakcalan, MD1, Adam Abbas1, Thomas R. Hays, BS1, Sardar Uddin, PhD1, Alphonse Dimeck2, Jocellie Marquez, MD1, Sagar Mulay, MD1, Soosan Ghazizadeh, PhD3, Ninche Alston, PhD3, Alexander Dagum, MD1, Sami Khan, MD1, Fazel Khan, MD1, Duc Bui, MD1.
1Stony Brook University Hospital, Stony Brook, NY, USA, 2University at Buffalo, Buffalo, NY, USA, 3Stony Brook University, Stony Brook, NY, USA.
PURPOSE – Negative Pressure Wound Therapy (NPWT) serves as an alternative to Standard Surgical Dressings (SSDs) for open wounds. Research highlights NPWT advantages including accelerated wound healing, cost savings, reduced complication rates and shorter hospital stays. Although NPWT is contraindicated in wounds where a malignancy has been resected for concern of tumor recurrence/growth, it is often used for such cases clinically. NPWT is thought to promote the development of secondary tumors by inducing angiogenesis in post-operative oncologic wounds. A study was undertaken to determine whether NPWT stimulates greater tumor cell density on wound beds as compared to SSDs. We hypothesize that the compressive stress of NPWT will induce more cancer growth than SSDs.
METHODS – A full thickness wound (1 cm X 1 cm) was created at the dorsum of 8 male nude rats weighing between 200-300 grams. Green Fluorescent Protein (GFP) labeled Rat Wistar Sarcoma XC cells were then added topically to wounds (1.6 million cells in 100 µL of media), covered in Tegaderm, and incubated for 3 days. The rats were then divided into 2 groups. The wounds of 4 randomly selected rats were then covered with traditional saline soaked wet-to-dry dressings for 6 additional days. NPWT (set to -125 mmHg continuous suction) was applied on the wounds of the 4 remaining rats for the same duration. Both groups received dressing changes after 3 days. 9 days after tumor induction, the rats were euthanized and their wounded beds were harvested, fixed in 4% paraformaldehyde and underwent histological (H&E and Trichrome staining) as well as immunohistochemical analysis with anti-GFP and anti-Ki67 antibodies.
RESULTS – There were no statistically significant differences in weight loss (58.75 +/- 17.15 grams for SSDs and 55.5 +/- 4.51 grams for NPWT) (p=0.369) between the 2 groups of rats. There were also no statistically significant differences between the tumor dimensions for the SSD group (length= 2.55 +/- 0.31 cm, width=2.22 +/- 0.29 cm) and the NPWT group (length=2.33 +/- 0.24 cm, width =2.2 +/- 0.08 cm) (p= 0.438). In both these groups, the tumor was grossly localized within the fascia layer and did not extend beyond. Ki-67 expression, a marker of tumor cell proliferation, was also similar between the 2 groups.
CONCLUSIONS – Our tumor induction method represents the development of micro-metastatic/satellite tumors more accurately than the traditional method of subcutaneously injecting tumor cells. In addition, this method captures a more clinically relevant scenario of micro-tumor burden and reduces variability between the two groups. Our initial studies did not find significant differences between the tumor growth and spread between these 2 groups. We are currently analyzing immunohistochemical slides from each group while also conducting more rat experiments in support of retaining the null hypothesis.
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