Tissue Response to Fuzzy Wale Elastic Compression Therapy includes Cell Micro Deformation, Optimizing Cell Mechano Transduction Signaling to Nuclear DNA to Upregulate Gene Expression and Synthesis of Proteins 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. Argenta observed a remarkable triad of NPWT effects:  ...“96% of the wounds responded favourably stating that the technique led to the removal of chronic oedema, increased blood flow and increased granulation tissue.”(Argenta ‘97)  In NPWT, individual oval polyurethane foam cells act as a tiny physiologic mandril delivering static Newtonian force to small volumes of granulation tissue that experience compression under the oval polyurethane cell wall edge and tension in the center of each open foam cell as a result of being sucked into the foam sphere resulting in Cell Micro Deformation of wound surface tissue. This tissue transmits effective mechano transduction signals to the local Cell 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 Wound Bed Preparation and healing outcomes in two real world cases of nonhealing refractory VLU/mixed leg wounds outliers treated with fuzzy wale compression stockinet in intimate contact with the peri wound skin and ulcer granulation tissue. Results:Photos reveal early wound epiboly resolution, exuberant inflammatory granulation tissue abatement, peri wound stasis dermatitis clearing, and reepithelization along cornrow furrows 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 common to both NPWT and to fuzzy elastic textile compression therapy delivers the Argenta triad, "removal of chronic oedema, increased blood flow and increased granulation tissue.” (Argenta ’97) Unique to fuzzy wale textile compression is rapid clearing of peri wound stasis dermatitis (recall NPWT foam disrupts intact skin) and healing of chronic mixed wounds, prompting the term PPWT. (Ehmann) (Winkler). Is Aristotle smiling; further study is underway.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, September 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 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 5 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 5 30 23 https://compressiondynamics.com/wp-content/uploads/2023/02/PosterThree-Dimensional-Elastic-Compression-Therapy-Positive-Pressure-Wound-Therapy.pdf