(CS-155) Clinical Observations Suggest Elastic Compression Therapy Creates Cell Micro Distortion with Mechano Transduction Signaling that Upregulates Gene Expression and Protein Synthesis Required for Healing

Introduction:

Enhancing Wound Bed Preparation (WBP) (Schultz), (Sibbald) guides evidence based bedside leg ulcer management advancements: textile compression, Aristotle 365 BCE, moist wound care, aggressive debridement, and recently Negative Pressure Wound Therapy (NPWT). (Argenta) In NPWT, individual oval P<em>olyurethane Foam Cells (PFC) act as tiny physiologic mandrils delivering physiologic static Newtonian force to granulation tissue. Tissue experiences compression under PFC walls and tension in the center of each PFC resulting in Cell Micro Distortion (CMD). CMD idealizes conditions for mechano transduction signaling to the local DNA upregulating gene expression to synthesize the myriad proteins required during four stages of wound healing (see figures 1 & 2). (Saxena)(Orgill )(Novak)

Methods:

Clear close up photos with detailed captions document WBP and healing outcomes in five real world cases of non-healing refractory venous leg ulcer/mixed leg wounds outliers. Fuzzy wale compression stockinet* in intimate contact with the peri wound skin and granulation tissue delivered elastic compression therapy.

Results:

Photos document details of treatment, epiboly resolution, exuberant inflammatory granulation tissue abatement, clearing of peri wound stasis dermatitis, and early reepithelization along “cornrow” furrows in subcutaneous fat that form beneath fuzzy wales.

Discussion:

We posit that fuzzy wale compression stockinet*, as a wound contact layer, is an effective physiologic mandrel delivering static Newtonian force from spandex elastomer to skin and wound tissue in furrows that form beneath fuzzy wales. Therapeutic static Newtonian force is common to both NPWT and to elastic textile compression. Local tissue response to both therapies is Cell Micro Distortion that optimizes mechano transduction signaling to nuclear DNA upregulating gene expression and protein synthesis. Unique to textile compression is clearing of peri wound stasis dermatitis (recall NPWT foam disrupts intact skin) and healing of chronic mixed wounds, prompting the term Postive Pressure Wound Therapy (PPWT)** (see figure 3). (Ehmann) (Winkler) Is Aristotle smiling; further study is underway.

Trademarked Items: *Fuzzy Wale Elastic Compression Stockinet, EdemaWear®, Compression Dynamics LLC, Omaha, Nebraska 68102

**Positive Pressure Wound Therapy© (PPWT), Suzanne Ehmann, North Myrtle Beach, North Carolina

References: Schultz G, Sibbald G. Wound bed preparation: a systematic approach to wound management - Wound Repair and Regeneration 2003;11:1–28

Sibbald G, et al. Special Considerations in Wound Bed Preparation: An Update. Advances in Skin & Wound Care, Sept 2011 –
[PDF] (researchgate.net) (WWW.WOUNDCAREJOURNAL.COM)

Argenta, L. et.al. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Annals of Plastic Surgery, 1997 -journals.lww.com [journals.lww.com]

Saxena, V. et al. Vacuum-Assisted Closure: Micro deformations of Wounds and Cell Proliferation. Plastic and Reconstructive Surgery, October 2004, Volume 114, Issue 5, 1086-1096.

Orgill, D. et al. The Mechanism of Action of the Vacuum-Assisted Closure Device. Plastic and Reconstructive Surgery, September 2008, Volume 122, Issue 3, 786-797.

Novak, A. et al. The evidence-based principles of negative pressure wound therapy in trauma & orthopedics. Open Orthop J. 2014 Jun 27;8:168-77. doi: 10.2174/1874325001408010168. PMID: 25067971; PMCID: PMC4110388.

Ehmann S, Fazzari E. Fuzzy Wale Compression (FWC) Stockinet Delivers Positive Pressure Wound Therapy (PPWT) 2022 Science Poster SAWC Link accessed 05/30/23. https://compressiondynamics.com/wp-content/uploads/2022/06/PosterFuzzy-Wale-Compression-FWC-Stockinet-Delivers-Positive-Pressure-Wound-Therapy-PPWTEhmann-Fazzari-Erikson-OstlerSAWC-Spring-2022.pdf

Winkler, M. Does Fuzzy Wale Elastic Compression Therapy Deliver Positive Pressure Wound Therapy (PPWT)? Bedside Observations of Refractory Wound Responses to textile Compression with a Third Dimension - a Non-Flat Surface. 2022 SAWC Science Poster Link accessed 05/30/23. https://compressiondynamics.com/wp-content/uploads/2023/02/PosterThree-Dimensional-Elastic-Compression-Therapy-Positive-Pressure-Wound-Therapy.pdf