Negative-pressure wound therapy for management of chronic neuropathic noninfected diabetic foot ulcerations – short-term efficacy and long-term outcomes

• Published in: Endocrine Vol. 62; no. 3; pp. 611 - 616
• Main Authors: Borys, S, Hohendorff, J, Koblik, T, Witek, P, Ludwig-Slomczynska, AH, Frankfurter, C, Kiec-Wilk, B, Malecki, MT
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2018; Springer Nature B.V
• Subjects: Aged; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetic Foot - therapy; Endocrinology; Feet; Female; Foot diseases; Humanities and Social Sciences; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; multidisciplinary; Negative-Pressure Wound Therapy; Original; Original Article; Patients; Pressure; Science; Treatment Outcome; Ulcers; Wound Healing; Wounds; Type 2 diabetes; Diabetic foot syndrome; Negative-pressure wound therapy
• ISSN: 1355-008X; 1559-0100
• DOI: 10.1007/s12020-018-1707-0

Purpose
Negative pressure wound therapy (NPWT) is an adjunct method used in the treatment of diabetic foot ulceration (DFU). Real world data on its effectiveness and safety is scarce. In this prospective observational study, we assessed the short-term efficacy, safety, and long-term outcomes of NPWT in patients with type 2 diabetes (T2DM) and neuropathic, noninfected DFUs.
Methods
Based on wound characteristics, mainly area (>1 vs. ≤1 cm
2
), 75 patients with DFUs treated in an outpatient clinic were assigned to NPWT (
n
 = 53) or standard therapy (
n
 = 22). Wound area reduction was evaluated after 8 ± 1 days. Long-term outcomes assessed included complete ulceration closure and recurrence rate.
Results
Patients assigned to NPWT were characterized by greater wound area (15.7 vs. 2.9 cm
2
). Reduction in wound area was found in both the NPWT (−1.1 cm
2
, −10.2%,
p
 = 0.0001) and comparator group (−0.3 cm
2
, −18.0%,
p
 = 0.0038). No serious adverse events related to NPWT were noted. Within 1 year, 55.1% (27/49) of DFUs were closed in the NPWT group and 73.7% (14/19) in the comparator group (
p
 = 0.15). In the logistic regression, wound duration and smaller initial area, but not treatment mode, were associated with closure. One-year follow-up after DFU resolution revealed an ~30.0% recurrence rate in both groups (
p
 = 0.88).
Conclusions
NPWT is a safe treatment for neuropathic, nonischemic, and noninfected DFU in patients with T2DM, although this observational study did not prove its effectiveness over standard therapy. Additionally, we report a high rate of both closure and recurrence of ulcers, the latter irrespective of initial ulcer area.