The efficacy of negative pressure wound therapy compared with conventional dressing in treating infected diabetic foot ulcers: a randomized controlled trial
Tóm tắt
Despite advances made in diagnosing and controlling diabetes mellitus (DM), treatment of diabetic foot ulcers (DFUs) is still among challenges faced by physicians. Negative pressure wound therapy (NPWT) is one of newer modalities proposed in the treatment of DFUs. However, there is lack of evidence to support its mileage in this regard. This study was conducted with the aim of assessing the efficacy of NPWT in healing process of DFUs. Sixty patients with DM were randomly allocated into two groups consisting of 30 patients each: the intervention group received sub-atmospheric pressure of − 75 to − 100 mmHg (5 min on, 2 min off) with dressings changed every 48 h, and the control group was treated with silver sulfadiazine dressings, changed twice daily. Patients were followed up until complete closure of ulcers, with a mean duration of 3 months. Of the total 60 patients, 27 patients (45%) were females. Most of the patients in both groups had DFUs of grade 2 according to Wegner’s classification. Rate of healing of the ulcers was significantly higher by using NPWT (p-value 0.01). NPWT also caused a significant reduction in ulcer surface area, depth, size, major and minor amputations, and disability duration (p-values 0.008, 0.002, 0.02, 0.03, and 0.01, respectively). No significant decrease in occurrence of complications was seen with NPWT. NPWT seems to be more efficacious than conventional dressing in treating infected DFUs.
Tài liệu tham khảo
Khanolkar MP, Bain SC, Stephens JW. The diabetic foot. QJM Int J Med. 2008;101(9):685–95.
Hunt NA, Liu GT, Lavery LA. The economics of limb salvage in diabetes. Plast Reconstr Surg. 2011;127:289S–95S.
Ulbrecht JS, Cavanagh PR, Caputo GM. Foot problems in diabetes: an overview. Clin Infect Dis. 2004;39(Supplement_2):S73–82.
Argenta LC, Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience.
Hanneman SK. Design, analysis, and interpretation of method-comparison studies. AACN Adv Crit Care. 2008;19(2):223–34.
Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2(2):64–122.
Venturi ML, Attinger CE, Mesbahi AN, Hess CL, Graw KS. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device: a review. Am J Clin Dermatol. 2005;6(3):185–94.
Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematic review of topical negative pressure therapy for acute and chronic wounds. Br J Surg. 2008;95(6):685–92.
Söylemez MS, Özkan K, Kılıç B, Erinç S. Intermittent negative pressure wound therapy with instillation for the treatment of persistent periprosthetic hip infections: a report of two cases. Ther Clin Risk Manag. 2016;12:161–6.
Wang T, He R, Zhao J, Mei JC, Shao MZ, Pan Y, Zhang J, Wu HS, Yu M, Yan WC, Liu LM, Liu F, Jia WP. Negative pressure wound therapy inhibits inflammation and upregulates activating transcription factor-3 and downregulates nuclear factor-κB in diabetic patients with foot ulcerations. Diabetes Metab Res Rev. 2017;33(4).
Armstrong DG, Lavery LA, Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet. 2005;366(9498):1704–10.
Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care. 2008;31(4):631–6.
Karatepe O, Eken I, Acet E, Unal O, Mert M, Koc B, et al. Vacuum assisted closure improves the quality of life in patients with diabetic foot. Acta Chir Belg. 2011;111(5):298–302.
Eginton MT, Brown KR, Seabrook GR, Towne JB, Cambria RA. A prospective randomized evaluation of negative-pressure wound dressings for diabetic foot wounds. Ann Vasc Surg. 2003;17(6):645–9.
Jian-wei S, Jian-hui S, Chun-cai Z. Vacuum assisted closure technique for repairing diabetic foot ulcers: analysis of variance by using a randomized and double-stage crossover design. ZHONGGUO ZUZHI GONGCHENG YANJIU YU LINCHUANG KANGFU. 2007;11(44):8908.
Sepúlveda G, Espíndola M, Maureira M, Sepúlveda E, Ignacio Fernández J, Oliva C, et al. Negative-pressure wound therapy versus standard wound dressing in the treatment of diabetic foot amputation. A randomised controlled trial [Abstract]. Cir Esp. 2009;86(3):171–7.
Vaidhya N, Panchal A, Anchalia MM. A new cost-effective method of NPWT in diabetic foot wound. Indian J Surg. 2015;77(Suppl 2):525–9.
Nain PS, Uppal SK, Garg R, Bajaj K, Garg S. Role of negative pressure wound therapy in healing of diabetic foot ulcers. J Surg Tech Case Rep. 2011;3(1):17–22.
Ravari H, Modaghegh MH, Kazemzadeh GH, Johari HG, Vatanchi AM, Sangaki A, et al. Comparison of vacuum-assisted closure and moist wound dressing in the treatment of diabetic foot ulcers. J Cutan Aesthet Surg. 2013;6(1):17–20.
Sajid MT, Mustafa Q, Shaheen N, Hussain SM, Shukr I, Ahmed M. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers. J Coll Physicians Surg Pak. 2015;25(11):789–93.
McCallon SK, Knight CA, Valiulus JP, Cunningham MW, McCulloch JM, Farinas LP. Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage. 2000;46(8):28–32.
Zhang J, Hu ZC, Chen D, Guo D, Zhu JY, Tang B. Effectiveness and safety of negative-pressure wound therapy for diabetic foot ulcers: a meta-analysis. Plast Reconstr Surg. 2014;134(1):141–51.
Liu S, He CZ, Cai YT, Xing QP, Guo YZ, Chen ZL, et al. Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis. Ther Clin Risk Manag. 2017;13:533–44.
Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers: part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014;70(1):1–e1.