Modulation of Lymphangiogenesis in Incisional Murine Diabetic Wound Healing Using Negative Pressure Wound Therapy

Objective: Despite the significant function of lymphatics in wound healing, and frequent clinical use of Negative Pressure Wound Therapy (NPWT), the effect of mechanical force application on lymphangiogenesis remains to be elucidated. We utilize a murine incisional wound healing model to assess the mechanisms of lymphangiogenesis following NPWT.Approach: Dorsal incisional skin wounds were created on diabetic mice (genetically obese leptin receptor-deficient mice [db/db]; n = 30) and covered with an occlusive dressing (Control, n = 15) or NPWT (-125 mmHg, continuous, 24 h for 7 days; NPWT, n = 15). The wounds were macroscopically assessed for 28 days. Tissue was harvested on day 10 for analysis. Qualitative functional analysis of lymphatic drainage was performed on day 28 using Evans Blue staining (n = 2).Results: NPWT increased lymphatic vessel density (40 +/- 20 vs. 12 +/- 6 podoplanin [PDPN](+) and 25 +/- 9 vs. 14 +/- 8 lymphatic vessel endothelial receptor 1 [LYVE-1](+)) and vessel diameter (28 +/- 9 vs. 12 +/- 2 mu m). Western blotting verified the upregulation of LYVE-1 with NPWT. Leukocyte presence was higher with NPWT (22% +/- 3.7% vs. 9.1% +/- 4.1% lymphocyte common antigen [CD45](+)) and the leukocytes were predominately B cells clustered within vessels (8.8% +/- 2.5% vs. 18% +/- 3.6% B-lymphocyte antigen CD20 [CD20](+)). Macrophage presence was lower in the NPWT group. Lymphatic drainage was increased in the NPWT group, which exhibited greater Evans Blue positivity.Innovation: The lymphangiogenic effects take place independent of macrophage infiltration, appearing to correlate with B cell presence.Conclusion: NPWT promotes lymphangiogenesis in incisional wounds, significantly increasing the lymph vessel density and diameter. This study highlights the potential of NPWT to stimulate lymphatic drainage and wound healing of surgical incisions.