Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds

Abstract

The management of complex diabetic foot wounds with large skin defects poses a challenge for surgeons. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 and October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm2 (range, 4.71–66.76 cm2).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm2/day, ranging from 0.29 cm2/day to 8.35 cm2/day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistical difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach to complex diabetic foot wounds. Nevertheless, more attention should be paid to the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.

Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage—Clinical Outcome of 34 Patients

“…Krticka et al 29 also concluded that VSD combined with a dynamic method could be very effective for fasciotomy wound closure in comparison with traditional techniques. Wu et al 30 and Ji et al 31 shared their successful experience about the application of VSD and skin stretching technique in the treatment of diabetic foot wounds. All of the above reports support our hypothesis that the combination of these 2 techniques is advantageous.…”

Evidence for the benefits of negative pressure therapy in the treatment of diabetic foot in adults: a comprehensive approach to improved health

“…11 Intermittent negative pressure has been shown 12 to accelerate the formation of granulation tissue more efficiently than if negative pressure is applied continuously. 13…”