Applying NPWT to bleeding open wounds after forefoot amputation in diabetic foot patients - a case report (original) (raw)
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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 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 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.
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%...
Guidelines regarding negative wound therapy (NPWT) in the diabetic foot
Ostomy/wound management
The purpose of these guidelines is to the summarize consensus of a multidisciplinary expert advisory panel convened to determine appropriate use of negative pressure wound therapy (NPWT), also known as Vacuum-Assisted Closure or V.A.C. Therapy, in the treatment of diabetic foot wounds. The Tucson Expert Consensus Conference (TECC) on V.A.C. Therapy was convened in an effort to guide the direction for future research either to confirm or refute current consensus while providing practical guidance to the clinician currently treating diabetic foot wounds. The consensus committee discussed and commented on the following ten key questions regarding NPWT: 1) How long should NPWT be used in the treatment of a diabetic foot wound? 2) Should NPWT be applied to a wound that has not been debrided? 3) How should the patient using NPWT be evaluated on an outpatient basis? 4) When should NPWT be applied following lower-extremity bypass? 5) When should NPWT be applied after incision and drainage o...
Wound healing in forefoot amputations: the predictive value of toe pressure
Annals of vascular surgery, 1994
A retrospective study of 136 men undergoing forefoot amputation was done to test the hypothesis that preoperative toe pressure (TP) could predict the likelihood of wound healing. Demographic data included age, smoking history, diabetes mellitus (DM), hypertension, hyperlipidemia, and coronary artery disease. Clinical data included infection, preoperative arterial Doppler data, TP, wound disposition, concomitant revascularization (REV), and healing outcome. Among diabetics, no primary amputation healed with a preoperative TP < 38 mm Hg. Among REV diabetics, no healing occurred with a TP < 40 mm Hg after bypass, but no failures occurred either with a TP > 68 mm Hg or an increase in TP > or = 30 mm Hg after bypass. Nondiabetic patients exhibited no threshold TP values. Univariate analysis revealed that DM and REV were significantly different in the healed (N = 83) vs. nonhealed (N = 53) populations (p = 0.027 and 0.034). In healed patients mean TP (71.8 +/- 3.5 mm Hg SEM) w...
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 Foot and Ankle Surgery
Foot & Ankle International, 2019
Negative Pressure Wound Therapy (NPWT) is frequently utilized to manage complex wounds, however its mechanisms of healing remain poorly understood. Changes in growth factor expression, micro- and macro-deformation, blood flow, exudate removal, and bacterial concentration within the wound bed are thought to play a role. NPWT is gaining widespread usage in foot and ankle surgery, including the management of traumatic wounds; diabetic and neuropathic ulcers; wounds left open after debridement for infection or dehiscence; high-risk, closed incisions; tissue grafts and free flaps. This article reviews the rationale for NPWT, its proposed mechanisms of action, and the evidence regarding its clinical applications within the field of foot and ankle surgery. Level of Evidence: Level V, expert opinion.
Advantages of Negative Pressure Therapy in Local Diabetic Foot Treatment
Revista de Chimie, 2019
Diabetic foot is a current public health problem and a late consequence of diabetes. Morbidity and mortality are significant, seriously affecting the patient�s quality of life. Treatment of the diabetic foot is a long-lasting, highly resource-consumption process. Using negative pressure therapy leads to shorter hospitalization periods, better functional outcomes, significantly contributes to decreasing the number of amputations and improving patient�s quality of life. 49 year-old patient is hospitalized with necrotizing at right foot and shank, neglected type II diabetes. It is performed amputation of atypical necessity, right leg, transtarsal, open stump. After successive debridements, negative pressure therapy is installed for a period of 24 days. This favors the formation of the granular bed, the remission of the infection, allowing grafting. The graft is partially integrated and plantar reconstruction is performed with sural reversal flap. The local and functional results are sa...