Article Type : Research Article
Authors : Saida FB and Jaber C
Keywords : Diabetic Foot Ulcers; NPWT
Diabetic foot ulcers are a common complication for diabetic
patients and it constitutes a major health problem. It leads to amputations
when not treated properly. That's why an effective management strategy has to
be initiated. Negative pressure wound therapy is a technique that can replace
conventional dressing when the wound healing is not obtained. In this
prospective review, we reported the use of NPWT in six of our diabetic patients
with foot ulcers.
Diabetes mellitus is an important public health
concern. Its prevalence in Tunisia is 19.8% and is in perpetual increase.
Diabetic complications are a major health burden due to its important
socioeconomic cost and its consequence on the patient’s daily life. Foot ulcer
is a common complication in patients with diabetes. It occurs in 15% of cases. Negative pressure wound therapy NPWT is used to heal
different types of wounds including foot ulcers. In this prospective review, we
reported the use of NPWT in patients with diabetic foot ulcers.
The six patients included have had for their foot ulcer a previous treatment based on antibiotherapy and classic dressing but with delay in healing. We decided to hospitalize each one of them and initiate the NPW. They were 5 male patients and only one female patient. All of them had diabetes on insulin. Four have Hypertension and dyslipidemia. Four of our six patients had limb revascularization. The healing was good even in patients who did not have a vascular operation. They had an average use of 4 packs of vacuum system for an average total period of use of 20 days (Figure 1-3).
Figure 1: THE NPWT system
NPWT is used in several surgeries. The process of healing includes the removal of excessive edema fluid with increase in tissue blood flow. In fact, vacuum-assisted closure allows open drainage that continuously absorbs exudate; it also decreases the amount of bacteria and finally stimulates angiogenesis. The use of NPWT has shown an accelerating healing process compared to conventional dressings which has an important impact in the length of hospital stay and consequently an impact in the socio-economic cost.
Figure 2: Sex of our included patients.
Figure 3: Results of NPWT in foot ulcers.
Furthermore, NPWT increases the antibiotic
concentration in damaged tissue which helps controlling the infection thus
accelerates healing. In another hand, long-term follow-up did not show recourse
to amputation in our patients. In fact, the fear of diabetic foot ulcers is the
evolution towards amputation because it’s known that diabetic foot ulcers leads
in 12% of cases to amputation. Studies have
proven a reduction in amputation for patients with foot ulcers receiving NPWT.
Diabetic foot ulcers are common. Their major
complication is amputation that’s why the management strategy should be initiated
rapidly. The NPWT has been widely used in wound therapies. It can be used in
different surgical wounds and in unhealed ones. The application of NPWT in
diabetic foot ulcers have shown promising results. The remarkable effects of
this therapy were the improvement of healing, the reduction of reoperations and
in particular for some patient’s reduction of major amputations.
The
authors listed certify that they have NO affiliations with or involvement in
any organization or entity with any financial interest.