The efficacy of negative pressure wound therapy for diabetic foot ulcers: A systematised review

Wynn, Matthew; Freeman, Samantha

doi:10.1016/j.jtv.2019.04.001

Cited by 47 publications

(27 citation statements)

References 25 publications

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“…On the other hand, Liu Z et al [4] and Matthew Wynn [21] et al both in their review concluded that comparing with other wound dressings, it remained unclear whether NPWT could increase the proportion of diabetic foot wounds healed and reduce the time to heal the wounds of DFUs. Likewise, there is no obvious advantage in reduction of wound area by application of NPWT alone in our opinion.…”

Section: Discussionmentioning

confidence: 99%

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

Chen

et al. 2021

Preprint

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Management of complex diabetic foot wounds with large skin defects poses a challenge for surgeon. 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 to 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 days to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm² per day, ranging from 0.29 cm² per day to 8.35 cm² per 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 statistically 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 for complex diabetic foot wounds. Nevertheless, more attentions should be paid for the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.

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Section: Discussionmentioning

confidence: 99%

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

Chen

et al. 2021

Preprint

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“…Findings from our study highlight the importance of full, independent appraisal of NPWT, in hospital and community settings, in the form of large randomised controlled trials incorporating full economic evaluation. Results from rigorous studies, including systematic reviews (NICE, 2016; Wynn & Freeman, 2019; Chetter et al, In press), also indicate that there is insufficient good quality evidence to assist clinicians in making choices between different types of dressings for use in the management and treatment of open surgical wounds and further research is required.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ and surgeons’ views and experiences of surgical wounds healing by secondary intention: A qualitative study

McCaughan

Sheard

Cullum

et al. 2020

Journal of Clinical Nursing

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Aims and Objectives To explore surgeons’ and nurses’ perspectives of managing surgical wounds healing by secondary intention. Background Every year, more than 10 million surgical operations are performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as “healing by secondary intention.” These wounds are often slow to heal, prone to infection and complex to manage. Design A qualitative, descriptive approach, using semi‐structured interviews. Methods Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of “Framework” approach. Consolidated criteria for reporting qualitative research guided the study report. Results Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option. Conclusions Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost‐effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation. Relevance for clinical practice Clinical decision‐making in wound care could be optimised through further robust studies to inform practitioners about the cost‐effectiveness of available treatments.

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“…10 NPWT could facilitate wound healing by promoting tissue perfusion and providing a moist local environment for wound coverage. 31,32 Additionally, wound healing is not the ultimate goal of DFU management. How to prevent ulcer recurrence is an important issue for clinicians and patients.…”

Section: Discussionmentioning

confidence: 99%

<p>Limb Salvage and Prevention of Ulcer Recurrence in a Chronic Refractory Diabetic Foot Osteomyelitis</p>

Jiang

et al. 2020

DMSO

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Biomechanical changes caused by structural foot deformities predispose patients to plantar ulceration. Plantar ulcer recurrence often leads to osteomyelitis, which is more commonly observed in patients with diabetes. Once the infection of diabetic foot ulcer (DFU) spreads and is complicated by osteomyelitis, treatment becomes more complicated and difficult. Osteomyelitis treatment remains challenging because of low drug concentration within the tissue caused by poor circulation and inadequate localized nutrition. Moreover, tissues around plantar ulcers are fewer and are thin, making the formation of granulation tissues difficult due to elevated plantar pressure. Furthermore, the skin around the wound is excessively keratinized, and the epidermis is hard to regenerate. Meanwhile, skin grafting at that site is often not successful due to poor blood circulation. Therefore, it is technically challenging to manage diabetic pressure plantar ulcer with osteomyelitis and prevent its recurrence. Here, we present a case of chronic DFU complicated by osteomyelitis due to foot deformity. The ulcer was successfully healed using advanced wound repair technology comprising of surgical bone resection, vancomycin-loaded bone cement implant, negativepressure wound therapy, and autologous platelet-rich gel. Subsequently, preventive foot care with custom-made offloading footwear was prescribed. The plantar ulcer did not recur and improvement in biomechanical parameters was observed after the intervention. This case represents an effective and comprehensive management strategy for limb salvage and prevention in patients with complicated foot conditions.

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The efficacy of negative pressure wound therapy for diabetic foot ulcers: A systematised review

Cited by 47 publications

References 25 publications

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

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

Nurses’ and surgeons’ views and experiences of surgical wounds healing by secondary intention: A qualitative study

<p>Limb Salvage and Prevention of Ulcer Recurrence in a Chronic Refractory Diabetic Foot Osteomyelitis</p>

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