Negative Pressure Wound Therapy on Diabetic Foot Ulcers
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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.
Methods
Twenty-four patients with diabetes and nonhealing, lower-extremity wounds were included in the study. Patients were prospectively randomized to the NPWT group or control group. To avoid bias, all patients were prospectively randomized into groups according to the last digit of the hospital protocol numbers that a blinded official had assigned. Odd numbers were assigned to the NPWT group, even numbers to the control group. All patients were properly informed and gave written consent. The Medical Park Hospital Ethics Committee approved the study.
Seventeen of 24 patients (71%) had insulin dependent diabetes and 7 patients (29%) had noninsulin dependent diabetes. Fifteen of 24 patients (62.5%) had peripheral neuropathy of varying intensity. Five patients (21%) had peripheral vascular dysfunction and were revascularized. The patients with vascular dysfunction who lacked pedal pulses were not enrolled in the study. One patient was undergoing treatment for chronic renal failure but was included in the study.
The diabetic foot ulcers were surgically debrided of nonviable tissue prior to application of NPWT or moist gauze dressing. In the control group, traditional moist gauze dressings were used and were changed twice a day. After debridement, the surface area of the wound was measured in the operating room and at the bedside using sterilized millimetric paper and a disposable pen. Since the paper was cut to fit the wound, the template was useful for measuring the surface area of the wounds and for cutting the NPWT wound dressing to facilitate optimal wound coverage.
In the NPWT group, the wounds were covered with the polyurethane ether dressing and a tube was placed underneath the dressing. The tube and dressing were covered with a clean, nonsterile, adhesive drape to create an airtight seal.The tube was then connected to an aspirator pump to create negative pressure. In this group, -125 mmHg continuous negative pressure was used. The NPWT dressing and tube were changed every 48 h in correlation with other studies.2,3,7,8,10
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