Negative Pressure Wound Therapy on Diabetic Foot Ulcers - Alternative Medicine for Diabetic Foot Ulcers

Negative Pressure Wound Therapy on Diabetic Foot Ulcers
Posted 11/08/2007
Abdullah Etoz, MD; Ramazan Kahveci, MD
Medscape

The effects of negative pressure wound therapy ([NPWT], V.A.C.® Therapy, KCI, San Antonio, Tex) were compared with standard dressings in 45 patients with diabetic foot ulcers who were admitted to the Department of Plastic and Reconstructive Surgery, Medical Park Hospital, Bursa, Turkey. Twenty-four patients were randomly divided into 2 groups—NPWT group and control group. Initially, the mean surface area of wounds in the NPWT group was 109 cm2, the control group 94.8 cm2. The mean duration of open wound care was 11.25 days in the NPWT group and 15.75 days in the control group (P =0.05). After wound management, mean surface area of the diabetic wounds was 88.6 cm2 in the NPWT group, and 85.3 cm2 in the control group (P < 0.05). The use of NPWT may be an effective initial wound therapy to achieve faster wound bed granulation in diabetic foot ulcers. Further studies are needed to clarify the effects and indications and to modify the technique of this alternative treatment for use on nonhealing wounds.
Introduction

Reconstruction of diabetic foot ulcers is often a challenging problem. The impairments involved with the healing process, along with the lack of resistance against infection in patients with diabetes, represent a familiar clinical problem.[1] High treatment costs and unsatisfactory results are common.

The surgical treatment of the diabetic wounds with loss of soft tissue continuity usually consists of closure using a split-thickness skin graft or transposition flap. However, immediate surgical closure often fails because surgical closure is not always appropriate given the general condition of the patient and the wound.Therefore, initial treatment begins with open wound care.

The NPWT wound dressing (V.A.C.® GranuFoam™, KCI, San Antonio,Tex), developed by Argenta and Morykwas,[2] assists in healing open wounds. In clinical and experimental studies, the effects of NPWT that accelerate wound healing are reported as increased local blood flow, formation of granulation tissue, and decreased bacterial colonization.[2,3] Faster wound healing results in an overall decrease in hospitalization and avoids the additionalmorbidity of chronic wounds.[4-6] Successful results with the NPWT system are reported in other studies.[7-9]

The study aim was to promote healing through the use of NPWT on problematic diabetic foot ulcers and to compare the results with use of conventional moist gauze dressings.

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