Novel home use of mechanical negative pressure wound therapy in diabetic foot ulcers

2021 ◽  
Vol 30 (12) ◽  
pp. 1006-1010
Author(s):  
Xuxin Lim ◽  
Li Zhang ◽  
Qiantai Hong ◽  
Enming Yong ◽  
Shufen Neo ◽  
...  
Keyword(s):  
Wound Healing ◽  
Limb Salvage ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Length Of Hospital Stay ◽  
Wound Therapy ◽  
Primary Wound Closure ◽  
Mean Cost

Objective: Mechanical negative pressure wound therapy is an ultraportable, light weight and disposable single-use device that has been shown to promote wound healing. This study evaluated home use of a mechanically powered negative pressure wound therapy (NPWT) in diabetic foot wounds. Methods: Patients underwent revascularisation and/or debridement or amputation before starting mechanical NPWT. Wound outcomes and images of the wounds were recorded at each follow-up visit by the wound nurse. Patients were followed up until wound closure or end of therapy. Results: A total of 12 patients (each with one wound) were included in the study. Of the 12 wounds, 33.3% (n=4) of wounds achieved primary wound closure while the remaining 66.6% (n=8) of wounds demonstrated a mean wound size reduction of 37.5±0.13%. Of the closed wounds, mean time to healing was 4.75±2.50 weeks. There was 100% limb salvage with no further debridement or amputations, and no 30-day unplanned readmissions. Mean length of hospital stay before starting home NPWT was 9.75±6.31 days. Mean number of NPWT changes was 8.33±2.67 sessions, while mean duration of therapy was 4.0±1.54 weeks. Mean cost of home NWPT therapy was US$1904±731 per patient. Conclusion: The home use of mechanically powered NPWT in diabetic foot wounds demonstrated excellent wound healing rates and 100% limb salvage, with no complications.

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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yaojun Wu ◽  
Liang Chen ◽  
Shaokun Wu ◽  
Liying Yu ◽  
Mimi Chen ◽  
...  
Keyword(s):  
Median Time ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Defect Size ◽  
Wound Therapy ◽  
Skin Stretching ◽  
Safe Approach ◽  
Large Skin

AbstractThe 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.

scholarly journals A Case of a Patient Who Successfully Achieved Early Wound Closure by Local Negative Pressure Wound Therapy (NPWT) against Compromised Wound Healing after Arterio-Venous Graft Infection

2021 ◽  
Vol 1 (1) ◽  
pp. 14-19
Author(s):  
Risa Kusuta ◽  
Keiji Shimazu ◽  
Kazuhiro Mizoguchi ◽  
Kazumasa Komura ◽  
Atsuo Tanaka
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Present Report ◽  
Graft Infection ◽  
Severe Bleeding ◽  
Wound Therapy ◽  
Venous Graft ◽  
Early Wound

The primary treatment strategy for arterio-venous graft (AVG) infection includes appropriate antibiotic use and removal of the infected graft. It is well known that patients with hemodialysis are likely to experience compromised wound healing, which often leads to various postoperative complications. Negative pressure wound therapy (NPWT) is a non-invasive procedure that promotes wound healing by sealing the wound under negative pressure. Although NPWT is practically accepted in general surgery, there are only a few reports of this strategy to the vascular access operation for patients with hemodialysis due to the possibility of severe bleeding. In the present report, we report a case of a patient who successfully achieved safe and early wound closure by NPWT against compromised wound healing after AVG infection.

scholarly journals A Comparative Study between the Use of Negative Pressure Wound Therapy and Silver-Releasing Foam Dressings in the Management of Diabetic Ulcers

2021 ◽  
Author(s):  
George Taliat ◽  
Clement D’Souza
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Treatment Modalities ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Therapy ◽  
Diabetic Ulcers ◽  
Surgical Department

Abstract Introduction Diabetic foot ulcers are one among the most commonly encountered complication of diabetes mellitus tackled by the surgical department worldwide. Negative pressure wound therapy (NPWT) and silver-releasing foam dressings are effective modalities for the treatment of ulcers. This study compares the two treatment modalities. Methods Sixty adult patients admitted with diabetic foot ulcers undergoing NPWT (vacuum-assisted closure [VAC]) or silver-releasing foam dressing (Biatain Ag) treatment were included in the study. Patients undergoing either of the treatment modalities were observed and followed up on a weekly basis prospectively. Wounds were routinely examined for the size of ulcer in area (cm2) and time taken for wound healing. Patients were also assessed qualitatively by means of a questionnaire to find out patient satisfaction and compliance. Results Time taken for wound healing among Biatain Ag group was found to be 24±9.483 days compared with only 19.73±7.575 days in the VAC group. Decrease in size ulcer measured in area was found to be 38.79% in Biatain Ag group, whereas in the VAC group it was found to be 26.56%. Patients were satisfied with both modalities of treatment; however, patient compliance was better for the Biatain Ag Group due to decrease in restriction of mobility and decrease in cost. Conclusion Overall, both modalities of treatment were found to be comparable and can be used with similar efficacy. It can be concluded that silver-releasing foam dressing can act as a beneficial alternative to NPWT in the treatment of diabetic ulcers.

Benefits of negative pressure wound therapy with instillation in the treatment of hard-to-heal wounds: a case series

2020 ◽  
Vol 29 (4) ◽  
pp. 248-253 ◽  
Author(s):  
Valérie Latouche ◽  
Hervé Devillers
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Dwell Time ◽  
Negative Pressure Wound Therapy ◽  
Early Stage ◽  
Case Series ◽  
Wound Therapy ◽  
Impaired Wound Healing ◽  
The Mean ◽  
Mean Cost

Objective: Impaired wound healing can lead to hard-to-heal wounds, which impact on patients, clinicians and healthcare systems. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) was developed to manage wounds through early-stage cleansing. This study describes the use of NPWTi-d to help manage hard-to-heal wounds in patients with risk factors for impaired wound healing. Method: In this case series, patients were treated between October 2015 and March 2018 at a community hospital in western France. Normal saline solution was instilled into wounds with a dwell time of 10 minutes, followed by the application of negative pressure at −75 mmHg to −125 mmHg for 2–3 hours. If needed, patients were given appropriate oral or intravenous antibiotic treatment in conjunction with NPWTi-d and subsequent wound therapies. Results: A total of 15 patients participated in the study. Mean age was 81±13 years, and 12 (80%) patients were malnourished with blood albumin levels of 30.1±5.7g/l, and 12 (80%) patients were given antibiotic therapy. The mean duration of NPWTi-d was 19.4±20.8 days, with a mean number of dressing changes of 6.6±6.8; the duration of NPWTi-d and the number of dressing changes for pressure ulcers was three times that of the other wound types. The mean cost of NPWTi-d in this study was €1643.40±€1709.13. Overall, NPWTi-d provided early-stage wound cleansing and helped achieve adequate granulation tissue formation and progression to the next phase of wound healing. Conclusion: In these cases, NPWTi-d was a beneficial and effective method of treating hard-to-heal wounds that were resistant to traditional treatments, yielding favourable clinical outcomes.

scholarly journals Prophylactic negative-pressure wound therapy after ileostomy reversal for the prevention of wound healing complications in colorectal cancer patients: a randomized controlled trial

2020 ◽  
Author(s):  
M. Wierdak ◽  
M. Pisarska-Adamczyk ◽  
M. Wysocki ◽  
P. Major ◽  
K. Kołodziejska ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Wound Healing ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Ileostomy Closure ◽  
Control Group ◽  
Diverting Ileostomy ◽  
Wound Therapy ◽  
Primary Wound Closure ◽  
Colorectal Cancer Patients

Abstract Background The aim of this study was to assess the usefulness of protective negative-pressure wound therapy (NPWT) in the reduction of wound healing complications (WHC) and surgical site infections (SSI) after diverting ileostomy closure in patients who underwent surgery for colorectal cancer. Methods In this prospective randomized clinical trial in a tertiary academic surgical center, patients who had colorectal cancer surgery with protective loop ileostomy and were scheduled to undergo ileostomy closure with primary wound closure from January 2016 to December 2018 were randomized to be treated with or without NPWT. The primary endpoint was the incidence of WHC. Secondary endpoints were incidence of SSI, length of postoperative hospital stay (LOS), and length of complete wound healing (CWH) time. Results We enrolled 35 patients NPWT (24 males [68.6%]; mean age 61.6 ± 11.3 years), with NPWT and 36 patients (20 males [55.6%]; mean age 62.4 ± 11.3 years) with only primary wound closure (control group). WHC was observed in 11 patients (30.6%) in the control group and 3 (8.57%) in the NPWT group (p = 0.020). Patients in the NPWT group had a significantly lower incidence of SSI (2 [5.71%] vs. 8 [22.2%] in the control group; p = 0.046) as well as significantly shorter median CWH (7 [7–7] days vs. 7 [7–15.5] days, p = 0.030). There was no difference in median LOS between groups (3 [2.5–5] days in the control group vs. 4 [2–4] days in the NPWT group; p = 0.072). Conclusions Prophylactic postoperative NPWT after diverting ileostomy closure in colorectal cancer patients reduces the incidence of WRC and SSI. Clinical trial registration clinicaltrials.gov (NCT04088162).

scholarly journals Preliminary evidence using negative pressure wound therapy to achieve limb salvage for the ischemic diabetic foot

2016 ◽  
Vol 3 (12) ◽  
pp. 378
Author(s):  
Joe Chi-Cheng Fang ◽  
Yu-Tsung Chen ◽  
Yin-Shuo Chang ◽  
Jen-Hsiang Shen ◽  
Min-Ling Chen ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Preliminary Evidence ◽  
Wound Therapy

Evaluation of Wound Care and Health-Care Use Costs in Patients with Diabetic Foot Ulcers Treated with Negative Pressure Wound Therapy versus Advanced Moist Wound Therapy

2014 ◽  
Vol 104 (2) ◽  
pp. 147-153 ◽  
Author(s):  
Vickie R. Driver ◽  
Peter A. Blume
Keyword(s):  
Health Care ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Patient Records ◽  
Median Cost ◽  
Wound Therapy ◽  
The Mean

Background We conducted a post-hoc retrospective analysis of patients enrolled in a randomized controlled trial to evaluate overall costs of negative pressure wound therapy (NPWT; V.A.C. Therapy; KCI USA, Inc, San Antonio, Texas) versus advanced moist wound therapy (AMWT) in treating grade 2 and 3 diabetic foot wounds during a 12-week therapy course. Methods Data from two study arms (NPWT [n = 169] or AMWT [n = 166]) originating from Protocol VAC2001-08 were collected from patient records and used as the basis of the calculations performed in our cost analysis. Results A total of 324 patient records (NPWT = 162; AMWT = 162) were analyzed. There was a median wound area reduction of 85.0% from baseline in patients treated with NPWT compared to a 61.8% reduction in those treated with AMWT. The total cost for all patients, regardless of closure, was $1,941,472.07 in the NPWT group compared to $2,196,315.86 in the AMWT group. In patients who achieved complete wound closure, the mean cost per patient in the NPWT group was $10,172 compared to $9,505 in the AMWT group; the median cost per 1 cm2 of closure was $1,227 with NPWT and $1,695 with AMWT. In patients who did not achieve complete wound closure, the mean total wound care cost per patient in the NPWT group was $13,262, compared to $15,069 in the AMWT group. The median cost to close 1 cm2 in wounds that didn't heal using NPWT was $1,633, compared to $2,927 with AMWT. Conclusions Our results show greater cost effectiveness with NPWT versus AMWT in recalcitrant wounds that didn't close during a 12-week period, due to lower expenditures on procedures and use of health-care resources.

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

2021 ◽  
Author(s):  
Yaojun Wu ◽  
Liang Chen ◽  
Shaokun Wu ◽  
Liying Yu ◽  
Mimi Chen ◽  
...  
Keyword(s):  
Median Time ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Defect Size ◽  
Wound Therapy ◽  
Skin Stretching ◽  
Safe Approach ◽  
Large Skin

Abstract 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.

scholarly journals Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: results of the German DiaFu-RCT

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e026345 ◽  
Author(s):  
Dörthe Seidel ◽  
Martin Storck ◽  
Holger Lawall ◽  
Gernold Wozniak ◽  
Peter Mauckner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Secondary Outcome ◽  
National Study ◽  
Wound Therapy ◽  
Closure Rate

ObjectivesThe aim of the DiaFu study was to evaluate effectiveness and safety of negative pressure wound therapy (NPWT) in patients with diabetic foot wounds in clinical practice.DesignIn this controlled clinical superiority trial with blinded outcome assessment patients were randomised in a 1:1 ratio stratified by study site and ulcer severity grade using a web-based-tool.SettingThis German national study was conducted in 40 surgical and internal medicine inpatient and outpatient facilities specialised in diabetes foot care.Participants368 patients were randomised and 345 participants were included in the modified intention-to-treat (ITT) population. Adult patients suffering from a diabetic foot ulcer at least for 4 weeks and without contraindication for NPWT were allowed to be included.InterventionsNPWT was compared with standard moist wound care (SMWC) according to local standards and guidelines.Primary and secondary outcome measuresPrimary outcome was wound closure within 16 weeks. Secondary outcomes were wound-related and treatment-related adverse events (AEs), amputations, time until optimal wound bed preparation, wound size and wound tissue composition, pain and quality of life (QoL) within 16 weeks, and recurrences and wound closure within 6 months.ResultsIn the ITT population, neither the wound closure rate (difference: n=4 (2.5% (95% CI−4.7% – 9.7%); p=0.53)) nor the time to wound closure (p=0.244) was significantly different between the treatment arms. 191 participants (NPWT 127; SMWC 64) had missing endpoint documentations, premature therapy ends or unauthorised treatment changes. 96 participants in the NPWT arm and 72 participants in the SMWC arm had at least one AE (p=0.007), but only 16 AEs were related to NPWT.ConclusionsNPWT was not superior to SMWC in diabetic foot wounds in German clinical practice. Overall, wound closure rate was low. Documentation deficits and deviations from treatment guidelines negatively impacted the outcome wound closure.Trial registration numbersNCT01480362and DRKS00003347.

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