COMPARISON BETWEEN NEGATIVE PRESSURE WOUND THERAPY VERSUS STANDARD WOUND CARE IN DIABETIC FOOT PATIENTS AT A TERTIARY CARE HOSPITAL

Main Article Content

Rashid Zahid Ali
Khurram Bajwa
Bilal Elahi
Qaiser Haral
Arwah Mansoor
Shakeel Akbar

Keywords

diabetic ulcer, Negative Pressure Wound Therapy, Standard Wound Care, Diabetic foot ulcer

Abstract

Background: Diabetic foot ulcers (DFUs) are one of the most common and disabling diabetes mellitus related complications which result in significant morbidity and even amputation.


Objective: The purpose of this research is to establish the effectiveness of NPWT with that of SWC in the management of DFUs in a tertiary care hospital.


Study Design: This is a randomized controlled trial.


Duration and Place of the Study: This study was undertaken in Department of General Surgery, Combined Military Hospital, Peshawar, Pakistan over a period of Six Months from 01st Dec 2022 to 30th, May 2023.


Material and Methods: A total 92 diabetic foot patients with DFUs were included in the study. Patients were divided into two groups, NPWT and SWC, by a simple random technique. The main assessment tools were the time to complete wound healing, the rate of wound healing, the decrease in the size of the wound, and the occurrence of complications. Secondary end points focused on the satisfaction of the patient and the quality of life.


Results: A total of 92 patients with diabetic foot ulcers were enrolled and randomized into two groups: The number of patients in the NPWT group was 46 and in the SWC group 46. The mean age was 58.4 ± 10.3 years for the NPWT group and 58.8 ± 10.1 years for the SWC group (p= 0.78). Gender distribution was also similar with 60.9% males in the NPWT group and 58.7% in the SWC group (p= 0.84). The duration of diabetes was 15.2 ± 5.6 years for NPWT and 15.4 ± 5.4 years for SWC (p=0.89).


Conclusion: NPWT is superior to SWC in the diabetic foot patients as it facilitates the healing process and shortens the time taken to heal the wound. It also leads to improved satisfaction levels among the patients and better quality of life of the patients as well.

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References

1. Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Diabetic foot ulcers and their recurrence. New England Journal of Medicine, 376(24), 2367-2375. doi:10.1056/NEJMra1615439
2. Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D., & Bi, Y. (2017). Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Annals of Medicine, 49(2), 106-116. doi:10.1080/07853890.2016.1231932
3. Prompers, L., Huijberts, M., Apelqvist, J., Jude, E., Piaggesi, A., Bakker, K., ... & Schaper, N. (2007). High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Diabetologia, 50(1), 18-25. doi:10.1007/s00125-006-0491-1
4. Singh, N., Armstrong, D. G., & Lipsky, B. A. (2005). Preventing foot ulcers in patients with diabetes. JAMA, 293(2), 217-228. doi:10.1001/jama.293.2.217
5. Lavery, L. A., Davis, K. E., Berriman, S. J., Braun, L., Nichols, A., & Walters, J. L. (2016). WHS guidelines update: Diabetic foot ulcer treatment guidelines. Wound Repair and Regeneration, 24(1), 112-126. doi:10.1111/wrr.12391
6. Jeffcoate, W. J., & Harding, K. G. (2003). Diabetic foot ulcers. The Lancet, 361(9368), 1545-1551. doi:10.1016/S0140-6736(03)13169-8
7. Lipsky, B. A., Berendt, A. R., Cornia, P. B., Pile, J. C., Peters, E. J., Armstrong, D. G., ... & Warren, S. (2012). 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clinical Infectious Diseases, 54(12), e132-e173. doi:10.1093/cid/cis346
8. Norman, G., Dumville, J. C., Mohapatra, D. P., Owens, G. L., & Crosbie, E. J. (2018). Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database of Systematic Reviews, (4). doi:10.1002/14651858.CD009261.pub4
9. Orgill, D. P., & Bayer, L. R. (2013). Negative pressure wound therapy: past, present and future. International Wound Journal, 10(S1), 15-19. doi:10.1111/iwj.12145
10. Li, X., Xu, Y., & Liu, J. (2022). Advances in the application of negative pressure wound therapy in wound healing: a review. Journal of Clinical Medicine, 11(4), 905. doi:10.3390/jcm11040905
11. Dumville, J. C., Munson, C., & Christie, J. (2018). Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database of Systematic Reviews, (10). doi:10.1002/14651858.CD010318.pub3
12. Armstrong, D. G., Lavery, L. A., & Diabetic Foot Study Consortium. (2005). Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. The Lancet, 366(9498), 1704-1710. doi:10.1016/S0140-6736(05)67695-7
13. Liu, S., He, C. Z., Cai, Y. T., Xing, Q., Guo, Y. Z., Hu, C. H., & Yi, C. (2017). Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis. Therapeutics and Clinical Risk Management, 13, 533-544. doi:10.2147/TCRM.S127849
14. Mouës, C. M., van den Bemd, G. J., Meerding, W. J., Hovius, S. E. (2007). An economic evaluation of the use of TNP on full-thickness wounds. Journal of Wound Care, 16(9), 369-372. doi:10.12968/jowc.2007.16.9.28073
15. Vikatmaa, P., Juutilainen, V., Kuukasjärvi, P., & Malmivaara, A. (2008). Negative pressure wound therapy: a systematic review on effectiveness and safety. European Journal of Vascular and Endovascular Surgery, 36(4), 438-448. doi:10.1016/j.ejvs.2008.06.022
16. Bolton, L., Fowler, E., & Smith, E. (2004). Treating pressure ulcers with negative pressure wound therapy (NPWT): a case series. Ostomy Wound Management, 50(10), 36-46. doi:10.25270/owm.2004.50.10.36