To investigate the effect and mechanism of vacuum sealing drainage combined with alprostadil in promoting wound healing of diabetic foot ulcer.

Fourty three patients with diabetic foot ulcer treated with vacuum sealing drainage from January 2017 to December 2018 in the Department of Burns, Guangzhou First People′s Hospital were divided into observation group (n=23) and control group (n=20) according to the random number table method. Both groups were treated with vacuum sealing drainage, and the observation group combined with intravenous infusion of alprostadil. Before and on the 7th and 14th day of treatment, 3 mL of morning fasting venous blood was collected from the two groups of patients. On the 7th and 14th day of treatment, 5 mL of drainage fluid from the patient′s drainage bag was collected, the supernatant was centrifuged, and transferred to the sterilized Eppendorf tube and sealed, frozen in -80 ℃ low-temperature refrigerator. When the patients changed the negative pressure material, some granulation tissue was taken, fixed with 10% formaldehyde, and the paraffin sections was made. The levels of procalcitonin and serum albumin in the blood of the observation group and the control group were detected before, on the 7th and 14th day of treatment. The nitric oxide and vascular endothelial growth factor (VEGF) in the drainage fluid on the 7th and 14th day of treatment, and the granulation tissue receptor for advanced glycation end products (RAGE) and putrescine content were detected. Data were compared with t test and χ² test.

There was no significant difference in the content of procalcitonin and serum albumin between the two groups before treatment (with P values above 0.05). On the 7th and 14th day of treatment, the procalcitonin in the observation group was (0.61±0.46) and (0.30±0.28) ng/mL, lower than those in the control group [(0.93±0.47) and (0.49±0.29) ng/mL], the differences were statistically significant (t=-2.21, -2.15; P=0.03, 0.04). The serum albumin was (27.13±2.13) and (28.78±1.90) g/L in the observation group, which were significantly higher than those in the control group [(25.48±2.66) and (25.48±2.66) g/L], the differences were statistically significant (t=2.17, 3.18; P=0.04, <0.01). The content of nitric oxide in the drainage fluid of the observation group on the 7th and 14th day of treatment was (86.30±5.82), (106.97±6.44) μmol/L, and the concentrations were higher than those in the control group [(65.64±5.76), (84.80±9.19) μmol/L], the differences were statistically significant (t=11.67, 9.25; with P values below 0.05); the content of VEGF was (123.04±11.76) and (240.15±38.85) pg/mL, respectively, the concentration were higher than those of the control group [(85.09±6.72) and (129.57±17.28) pg/mL], the differences were statistically significant (t=12.72, 11.74; with P values below 0.05). On the 7th and 14th day of treatment in the observation group, the putrescine concentration in the drainage solution was (0.63±0.08) and (0.22±0.08) mg/L, which were lower than those of the control group [(0.81±0.09) and (0.41±0.08) mg/L], the differences were statistically significant (t=-6.74, -12.15; with P values below 0.05). RAGE in the granulation tissues taken were 37.1±6.76, 17.17±5.54, and the expression were lower than those of the control group 52.94±8.72, 38.00±5.69, the differences were statistical significance (t=-6.90, -7.95; with P values below 0.05); the total effective rate was 95.70% in the observation group and 60.00% in the control group, the difference was statistically significant (χ²=9.00, P=0.029).

Vacuum sealing drainage combined with alprostadil can promote wound healing of diabetic foot uler and the mechanism is related to alprostadil promoting endothelial secretion of nitric oxide and VEGF, accelerating the removal of putrescine, promoting wound granulation growth and inhibiting RAGE expression.