title: Negative pressure wound therapy of chronically infected wounds using 1% acetic Acid irrigation.
abstract: BACKGROUND
  Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required.
  
  
  METHODS
  Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed.
  
  
  RESULTS
  Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05).
  
  
  CONCLUSIONS
  By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Hii Sun
authors.initials: HS
authors.lastname: Jeong
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Byeong Ho
authors.initials: BH
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
authors.forename: Hyoung Suk
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
authors.forename: Min Seon
authors.initials: MS
authors.lastname: Moon
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: In Suck
authors.initials: IS
authors.lastname: Suh
keywords: Acetic acid; Biofilm; Negative pressure wound therapy