• 1

    Menke A, Casagrande S, Geiss L, et al.: Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA 314: 1021, 2015.

  • 2

    Armstrong DG, Lavery LA, Wunderlich RP, et al.: 2003 William J. Stickel Silver Award. Skin temperatures as a one-time screening tool do not predict future diabetic foot complications. JAPMA 93: 443, 2003.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Lefebvre KM, Lavery LA: Disparities in amputations in minorities. Clin Orthop Relat Res 469: 1941, 2011.

  • 4

    Rice JB, Desai U, Cummings AKG, et al.: Burden of diabetic foot ulcers for Medicare and private insurers. Diabetes Care 37: 651, 2014.

  • 5

    Lavery LA, Hunt NA, Ndip A, et al.: Impact of chronic kidney disease on survival after amputation in individuals with diabetes. Diabetes Care 33: 2365, 2010.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Lavery LA, Armstrong DG, Wunderlich RP, et al.: Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. Diabetes Care 26: 1435, 2003.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Bendy RH Jr, Nuccio PA, Wolfe E, et al.: Relationship of quantitative wound bacterial counts to healing of decubiti: effect of topical gentamicin. Antimicrob Agents Chemother 10: 147, 1964.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Robson MC, Heggers JP: Bacterial quantification of open wounds. Mil Med 134: 19, 1969.

  • 9

    Halbert AR, Stacey MC, Rohr JB, et al.: The effect of bacterial colonization on venous ulcer healing. Australas J Dermatol 33: 75, 1992.

  • 10

    Huovinen S, Kotilainen P, Jarvinen H, et al.: Comparison of ciprofloxacin or trimethoprim therapy for venous leg ulcers: results of a pilot study. J Am Acad Dermatol 31: 279, 1994.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Alinovi A, Bassissi P, Pini M. Systemic administration of antibiotics in the management of venous ulcers. A randomized clinical trial. J Am Acad Dermatol 15: 186, 1986.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Armstrong DG, Lavery LA: Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet 366: 1704, 2005.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Blume PA, Walters J, Payne W, et al.: Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care 31: 631, 2008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Saxena V, Hwang CW, Huang S, et al.: Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 114: 1086, 2004.

  • 15

    von Felbert V, Simon D, Braathen LR, et al.: Treatment of linear scleroderma with water-filtered infrared-A irradiation [in German]. Hautarzt 58: 923, 2007.

  • 16

    Mercer JB, Nielsen SP, Hoffmann G: Improvement of wound healing by water-filtered infrared-A (wIRA) in patients with chronic venous stasis ulcers of the lower legs including evaluation using infrared thermography. Ger Med Sci 6: Doc11, 2008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Hartel M, Illing P, Mercer JB, et al.: Therapy of acute wounds with water-filtered infrared-A (wIRA). GMS Krankenhhyg Interdiszip 2: Doc53, 2007.

  • 18

    Radakovic S, Weber M, Tanew A: Dramatic response of chronic ulcerating necrobiosis lipoidica to ultraviolet A1 phototherapy. Photodermatol Photoimmunol Photomed 26: 327, 2010.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Due E, Rossen K, Sorensen LT, et al.: Effect of UV irradiation on cutaneous cicatrices: a randomized, controlled trial with clinical, skin reflectance, histological, immunohistochemical and biochemical evaluations. Acta Derm Venereol 87: 27, 2007.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Brockis JG, Elliott M, Lissiman M: The rate of healing of wounds treated with ultra-violet light. Aust N Z J Surg 35: 108, 1965.

  • 21

    Igarashi N, Onoue S, Tsuda Y: Photoreactivity of amino acids: tryptophan-induced photochemical events via reactive oxygen species generation. Anal Sci 23: 943, 2007.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Huvaere K, Olsen K, Andersen ML, et al.: Riboflavin-sensitized photooxidation of isohumulones and derivatives. Photochem Photobiol Sci 3: 337, 2004.

  • 23

    Li J, Hirota K, Yumoto H, et al.: Enhanced germicidal effects of pulsed UV-LED irradiation on biofilms. J Appl Microbiol 109: 2183, 2010.

  • 24

    Taylor RB: Clinical study of ultraviolet in various skin conditions. Phys Ther 52: 279, 1972.

  • 25

    Thai TP, Houghton PE, Campbell KE, et al.: Ultraviolet light C in the treatment of chronic wounds with MRSA: a case study. Ostomy Wound Manage 48: 52, 2002.

  • 26

    Thai TP, Keast DH, Campbell KE, et al.: Effect of ultraviolet light C on bacterial colonization in chronic wounds. Ostomy Wound Manage 51: 32, 2005.

  • 27

    Sasaki YF, Tsuda S, Izumiyama F, et al.: Detection of chemically induced DNA lesions in multiple mouse organs (liver, lung, spleen, kidney, and bone marrow) using the alkaline single cell gel electrophoresis (Comet) assay. Mutat Res 388: 33, 1977.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Wills EE, Anderson TW, Beattie BL, et al.: A randomized placebo-controlled trial of ultraviolet light in the treatment of superficial pressure sores. J Am Geriatr Soc 31: 131, 1983.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Nussbaum EL, Flett H, Hitzig SL, et al.: Ultraviolet-C irradiation in the management of pressure ulcers in people with spinal cord injury: a randomized, placebo-controlled trial. Arch Phys Med Rehabil 94: 650, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Xu L, McLennan SV, Lo L, et al.: Bacterial load predicts healing rate in neuropathic diabetic foot ulcers. Diabetes Care 30: 378, 2007.

  • 31

    Wright JB, Lam K, Burrell RE: Wound management in an era of increasing bacterial antibiotic resistance: a role for topical silver treatment. Am J Infect Control 26: 572, 1998.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Yin HQ, Langford R, Burrell RE: Comparative evaluation of the antimicrobial activity of ACTICOAT antimicrobial barrier dressing. J Burn Care Rehabil 20: 195, 1999.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Schultz GS, Barillo DJ, Mozingo DW, et al.: Wound bed preparation and a brief history of TIME. Int Wound J 1: 19, 2004.

  • 34

    Warriner R, Burrell R: Infection and the chronic wound: a focus on silver. Adv Skin Wound Care 18(suppl 1): 2, 2005.

  • 35

    Ngo QD, Vickery K, Deva AK: The effect of topical negative pressure on wound biofilms using an in vitro wound model. Wound Repair Regen 20: 83, 2012.

  • 36

    Morykwas MJ, Argenta LC, Shelton-Brown EI, et al.: Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38: 553, 1997.

    • PubMed
    • Search Google Scholar
    • Export Citation

Ultraviolet-A Light and Negative-Pressure Wound Therapy to Accelerate Wound Healing and Reduce Bacterial Proliferation

Kathryn E. Davis Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Kathryn E. Davis in
Current site
Google Scholar
PubMed
Close
 PhD
,
Jessica Bills Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Jessica Bills in
Current site
Google Scholar
PubMed
Close
 BS
,
Debby Noble Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Debby Noble in
Current site
Google Scholar
PubMed
Close
 BS
,
Peter A. Crisologo Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH.

Search for other papers by Peter A. Crisologo in
Current site
Google Scholar
PubMed
Close
 DPM
, and
Lawrence A. Lavery Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

Search for other papers by Lawrence A. Lavery in
Current site
Google Scholar
PubMed
Close
 DPM, MPH

Background: Ultraviolet (UV)-A therapy is a simple, inexpensive, and effective modality for wound healing, with tremendous potential to improve healing and reduce clinical infections in a number of clinical settings. To date, application of UV-A relies on bulky and hard-to-dose lamps that provide inconsistent therapy, thus making it difficult to apply therapy that is appropriate for the patient.

Methods: This study was designed to test the effectiveness of a novel wound therapy device that combines UV-A with traditional negative-pressure wound therapy (NPWT) to promote wound healing. Furthermore, we tested the ability of fiberoptic UV-A delivery to inhibit bacterial proliferation. Finally, we assayed the level of DNA damage that results from UV-A as compared to established UV-C therapies. Wound healing studies were performed in a porcine model using an articulated therapy arm that allows for continued therapy administration over an extended time course. Negative-pressure wound therapy was administered alone or with UV-A fiberoptic therapy for 2 weeks. Dressings were changed twice a week, at which time wound area was assessed.

Results: Data demonstrate that UV-A with NPWT treatment of wounds results in greater healing than NPWT alone. Using the same therapy device, we demonstrate that exposure of Staphylococcus aureus and Pseudomonas aeruginosa to fiberoptic UV-A results in decreased colony area and number of both bacterial strains. Finally, we show that UV-A induces minimal DNA damage in human fibroblasts and no more DNA damage in wound tissue as compare to intact skin.

Conclusions: These data demonstrate that UV-A can decrease bacterial proliferation and promote wound healing when coupled with NPWT.

Corresponding author: Kathryn E. Davis, PhD, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, F4.310A, Dallas, TX 75390-8560. (E-mail: kathryn.davis@utsouthwestern.edu)
Save