Guidelines regarding negative wound therapy (NPWT) in the diabetic foot (original) (raw)
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Ostomy/wound management, 2006
In 2004, a multidisciplinary expert panel convened at the Tucson Expert Consensus Conference (TECC) to determine appropriate use of negative pressure wound therapy as delivered by a Vacuum Assisted Closure device (V.A.C. THERAPY, KCI, San Antonio, Texas) in the treatment of diabetic foot wounds. These guidelines were updated by a second multidisciplinary expert panel at a consensus conference on the use of V.A.C. THERAPY, held in February 2006, in Miami, Florida. This updated version of the guidelines summarizes current clinical evidence, provides practical guidance, offers best practices to clinicians treating diabetic foot wounds, and helps direct future research. The Miami consensus panel discussed the following 12 key questions regarding V.A.C. (1) How long should V.A.C. THERAPY be used in the treatment of a diabetic foot wound? (2) Should V.A.C." THERAPY be applied without debriding the wound? (3) How should the patient using V.A.C. THERAPY be evaluated on an outpatient ba...
Negative pressure wound therapy in patients with diabetic foot
Acta Orthopaedica et Traumatologica Turcica, 2011
In this study our aim was to compare the results of standard dressing treatment to negative pressure wound therapy (NPWT) performed with a vacuum-assisted closure (VAC) device in patients with diabetic foot ulcers. Methods: We assessed the results of 35 patients treated for diabetic foot ulcer between 2006 and 2008. Of these cases, 20 (4 women and 16 men; mean age: 66 years; range: 52-90 years) were treated with standard wet dressings and 16 feet in 15 patients (10 men, 5 women; mean age: 58.9 years; range: 42-83 years) with VAC therapy. The success of treatment was evaluated in terms of hospitalization length and rate of limb salvation. Results: The average hospitalization period with VAC treatment was 32 days compared to 59 days with standard dressing treatment. All patients treated with standard dressings eventually had to undergo amputation. However, the amputation rate was 37% in the VAC treated group and 88% of patients had a functional extremity at the end of treatment. Conclusion: VAC therapy, together with debridement and appropriate antibiotic therapy, enables a higher rate of limb salvage, especially in Wagner Grade 3 and Grade 4 ulcers.
Negative Pressure Wound therapy in Diabetic Foot.
Background Diabetic foot wounds, particularly those secondary to amputation, are very complex and difficult to treat. We investigated whether negative pressure wound therapy (NPWT) improves the proportion and rate of wound healing after partial foot amputation in patients with diabetes.
Negative Pressure Wound Therapy for the Diabetic Foot Treatment: A Literature Review
Diabetes mellitus is one of the most common chronic metabolic diseases. Diabetes mellitus can cause many complications such as obesity, stroke, coronary heart disease, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Studies show that compared to the cost of treating diabetes, more costs are incurred for the treatment of complications of diabetes. One of the most common chronic complications is diabetic foot ulcers (DFU), which are disabling and affect about 15% of diabetic patients which leading to infection, gangrene, and eventually leading to amputation. DFU care requires a cross-disciplinary and systematic approach consisting of blood glucose control, surgical debridement, vascular recanalization, decompression, and supportive treatment. Controlling wound infection and performing tissue repair is very important to prevent or reduce amputation rates. The concept of negative pressure wound therapy (NPWT) was first established and applied in clinical practice by a German physician, Fleischmann, in 1993 and has been recognized for its remarkable effects in increasing perfusion, improving wound drainage, and promoting the growth of granulation tissue. Currently, NPWT is widely used for various acute and chronic wounds, such as DFU and considered effective to reduce limb amputation rates. NPWT is safe for the treatment of neuropathic, nonischemic, and noninfected plantar ulceration in patients with diabetes mellitus. However, special attention should be given to proper patient selection and intraoperative assessment to ensure wound closure and avoid undue complications.
Diabetes Care, 2008
Objective: To evaluate safety and clinical efficacy of Negative Pressure Wound Therapy (NPWT) compared to Advanced Moist Wound Therapy (AMWT) to treat diabetic patients with foot ulcers. Research Design And Methods: This multicenter randomized controlled trial enrolled 342 patients mean age 58 years; 79% male. Complete ulcer closure was defined as skin closure (100% re-epithelization) without drainage or dressing requirements. Patients were randomized to either NPWT (Vacuum-Assisted Closure) or AMWT (predominately hydrogels and alginates) and received standard off-loading therapy as needed. The trial evaluated treatment until Day 112 or ulcer closure by any means. Patients whose wound achieved ulcer closure were followed at 3 and 9 months. Each study visit included closure assessment by wound exam and tracings. Results: A greater proportion of foot ulcers achieved complete ulcer closure with NPWT (73/169, 43.2%) than AMWT (48/166, 28.9%) within the 112-day Active Treatment Phase (p=0.007). Kaplan-Meier median estimate for 100% ulcer closure was 96 days (95% CI: 75.0, 114.0) for NPWT and not determinable for AMWT (p=0.001). NPWT patients experienced significantly (p=0.035) fewer secondary amputations. The proportion of home care therapy days to total therapy days for NPWT was 9471/10579 (89.5%) and 12210/12810 (95.3%) for AMWT. In assessing safety, no significant difference between the groups was observed in treatmentrelated complications such as infection, cellulitis, and osteomyelitis at 6 months. Conclusions: NPWT appears to be as safe as, and more efficacious, than AMWT for the treatment of diabetic foot ulcers. This study was registered with ClinicalTrials.gov as NCT00432965.
Negative-Pressure Wound Therapy and Diabetic Foot Amputations
Journal of the American Podiatric Medical Association, 2007
Background: This study was undertaken to assess the benefits of negative-pressure wound therapy (NPWT) versus traditional wound therapies in reducing the incidence of lower-extremity amputations in patients with diabetic foot ulcers. Methods: Administrative claims data for patients with diabetic foot ulcers from commercial payers (n = 3,524) and Medicare (n = 12,795) were retrospectively analyzed. Patients were divided into NPWT and control/traditional therapy groups on the basis of administrative codes. Risk-adjustment procedures were then performed to match patient risk categories (through total treatment costs) and wound severities (through debridement depth). Results: The incidence of amputations in the NPWT groups was lower than that in the control groups. For the cost-based risk-adjustment analysis, amputation incidences with NPWT versus traditional therapy were 35% lower in the Medicare sample (10.8% versus 16.6%; P = .0077) and 34% lower in the commercial payer sample (14.1%...
Negative pressure wound therapy in treatment of diabetic foot wounds: a marriage of modalities
Ostomy Wound Management, 2004
Introduction: Chylorrhoea is an uncommon but potentially dangerous complication of neck surgery, particularly neck dissection. A periperative thoracic duct suture is performed or fibrin glue, absorbable cellulose or muscle flap may be used. Postoperatively conservative therapy is preferred. Case Report: We present a case of chylorrhoea after a salvage neck dissection persisting even after 2 surgical revisions. Chylorrhoea was successfully managed only after the use of NPWT (negative pressure wound therapy), which is so far relatively rare in otorhinolaryngological surgery. Conclusion: The modern method of local therapy by vacuum assisted closure appears to be useful for the chylous fistula treatment as well as for secondary healing of wounds, especially after oncological salvage surgery performed in the field of post radiation fibrosis.