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      Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study

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          Abstract

          Objective

          To compare the effectiveness of vacuum-assisted closure (VAC) versus conventional dressings in the healing of diabetic foot ulcerations (DFUs) in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery), safety, and patient satisfaction.

          Methods

          Randomized case–control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC) and Group B (patients treated with conventional dressings), with an equal number of patients in each group. DFUs were treated until wound closure, either spontaneously, surgically, or until completion of the 8-week period.

          Results

          Granulation tissue appeared in 26 (92.85%) patients by the end of Week 2 in Group A, while it appeared in 15 (53.57%) patients by that time in Group B. 100% granulation was achieved in 21 (77.78%) patients by the end of Week 5 in Group A as compared to only 10 (40%) patients by that time in Group B. Patients in Group A had fewer number of positive blood cultures, secondary amputations and were satisfied with treatment as compared to Group B.

          Conclusion

          VAC appears to be more effective, safe, and patient satisfactory compared to conventional dressings for the treatment of DFUs.

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          Most cited references22

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          The dysvascular foot: a system for diagnosis and treatment.

          Allison F Wagner (1981)
          Article 0 comments Cited 172 times – based on 0 reviews     Review now
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            Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial.

            David Armstrong, Lawrence A. Lavery (2005)
            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. We enrolled 162 patients into a 16-week, 18-centre, randomised clinical trial in the USA. Inclusion criteria consisted of partial foot amputation wounds up to the transmetatarsal level and evidence of adequate perfusion. Patients who were randomly assigned to NPWT (n=77) received treatment with dressing changes every 48 h. Control patients (n=85) received standard moist wound care according to consensus guidelines. NPWT was delivered through the Vacuum Assisted Closure (VAC) Therapy System. Wounds were treated until healing or completion of the 112-day period of active treatment. Analysis was by intention to treat. This study has been registered with , number NCT00224796. More patients healed in the NPWT group than in the control group (43 [56%] vs 33 [39%], p=0.040). The rate of wound healing, based on the time to complete closure, was faster in the NPWT group than in controls (p=0.005). The rate of granulation tissue formation, based on the time to 76-100% formation in the wound bed, was faster in the NPWT group than in controls (p=0.002). The frequency and severity of adverse events (of which the most common was wound infection) were similar in both treatment groups. NPWT delivered by the VAC Therapy System seems to be a safe and effective treatment for complex diabetic foot wounds, and could lead to a higher proportion of healed wounds, faster healing rates, and potentially fewer re-amputations than standard care.
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              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.

              Peter Blume, Jodi Walters, Wyatt Payne … (2008)
              The purpose of this study was to evaluate safety and clinical efficacy of negative pressure wound therapy (NPWT) compared with advanced moist wound therapy (AMWT) to treat foot ulcers in diabetic patients. This multicenter randomized controlled trial enrolled 342 patients with a mean age of 58 years; 79% were male. Complete ulcer closure was defined as skin closure (100% reepithelization) without drainage or dressing requirements. Patients were randomly assigned 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 wounds achieved ulcer closure were followed at 3 and 9 months. Each study visit included closure assessment by wound examination and tracings. A greater proportion of foot ulcers achieved complete ulcer closure with NPWT (73 of 169, 43.2%) than with AMWT (48 of 166, 28.9%) within the 112-day active treatment phase (P = 0.007). The 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 9,471 of 10,579 (89.5%) and 12,210 of 12,810 (95.3%) for AMWT. In assessing safety, no significant difference between the groups was observed in treatment-related complications such as infection, cellulitis, and osteomyelitis at 6 months. NPWT appears to be as safe as and more efficacious than AMWT for the treatment of diabetic foot ulcers.
              Article 0 comments Cited 125 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diabet Foot Ankle
                Journal ID (iso-abbrev): Diabet Foot Ankle
                Journal ID (publisher-id): DFA
                Title: Diabetic Foot & Ankle
                Publisher: Co-Action Publishing
                ISSN (Electronic): 2000-625X
                Publication date (Electronic): 08 April 2014
                Publication date Collection: 2014
                Volume: 5
                Electronic Location Identifier: 10.3402/dfa.v5.23345
                Affiliations
                [1 ]Department of Plastic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar India
                [2 ]Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
                Author notes
                [* ]Correspondence to: Bashir A. Laway, Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India, Email: drlaway@ 123456gmail.com
                Article
                Publisher ID: 23345
                DOI: 10.3402/dfa.v5.23345
                PMC ID: 3982118
                PubMed ID: 24765245
                SO-VID: f1b008ef-2017-4819-a0b8-7d6649a417bb
                Copyright © © 2014 Ali M. Lone et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 13 November 2013
                Date revision received : 07 February 2014
                Date accepted : 10 February 2014
                Categories
                Subject: Clinical Research Article

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: diabetic foot ulcer,infections,conventional dressings,vacuum-assisted closure,wound closure
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: diabetic foot ulcer, infections, conventional dressings, vacuum-assisted closure, wound closure

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