Negative Pressure Beats Moist Tx for Foot Ulcers

A greater percentage of diabetic foot ulcers achieved complete closure with negative pressure wound therapy than with advanced moist wound therapy in a randomized controlled study of more than 300 patients.

There were also significantly fewer secondary amputations seen in the group undergoing negative pressure therapy, Dr. Peter A. Blume and colleagues reported.

Diabetic foot ulcers lead to nonhealing chronic wounds that are difficult to treat and are a significant risk factor for nontraumatic amputation.

Several diabetic foot ulcer treatments have been reported. All of them require integration of multiple treatment modalities, with debridement being the foundation for these therapies. Success of any particular form of treatment is dependent on the appropriate match of patient and treatment factors, according to Dr. Blume of the North American Center for Limb Preservation, New Haven, Conn., and colleagues.

The study goal was to determine whether negative pressure wound therapy (NPWT) was a better or equivalent treatment to advanced moist wound therapy (AMWT) in concurrence with debridement for treating foot ulcers in diabetic adults with adequate blood circulation.

Patients were randomly assigned to either NPWT, which used vacuum-assisted closure, or AMWT, which primarily used hydrogels and alginates. The study could not be blinded because of the distinct nature of the two therapies, according to the study investigators.

The multicenter study enrolled 342 patients with a mean age of 58 years over the period of August 2002 to August 2005; 79% of the patients were men. All patients were initially debrided as needed within 2 days of randomization and received standard off-loading therapy as needed after treatment was initiated.

Treatment was continued until ulcer closure, sufficient granulation tissue formation for healing, or until day 112. All patients were examined weekly for the first 4 weeks then every other week until day 112 or ulcer closure. Patients achieving ulcer closure were followed at 3 and 9 months (Diabetes Care 2008;31:631–6).

Complete ulcer closure was defined as skin closure (100% reepithelialization) without a draining or dressing requirement. Closure occurred in 73 of 169 (43%) of the NPWT patients, compared with 48 of 166 (29%) of the AMWT patients. In addition, significantly more NPWT patients achieved 75% closure (105 of 169, 62%), than did AMWT patients (85 of 166, 51%).

The incidence of secondary amputations was also significantly less for NPWT (4%) than for AMWT (10%).

"Although the exact mechanism of the decrease in secondary amputations remains unclear, treatment of DFUs [diabetic foot ulcers] with NPWT appears to promote significant healing," the authors concluded.

Dr. John Lantis (Saint Luke's Roosevelt Hospital, New York), a study coauthor, disclosed receiving honoraria from KCI USA, which provided the vacuum therapy system used and whose global biometrics group provided the data analysis.

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A greater percentage of diabetic foot ulcers achieved complete closure with negative pressure wound therapy than with advanced moist wound therapy in a randomized controlled study of more than 300 patients.

There were also significantly fewer secondary amputations seen in the group undergoing negative pressure therapy, Dr. Peter A. Blume and colleagues reported.

Diabetic foot ulcers lead to nonhealing chronic wounds that are difficult to treat and are a significant risk factor for nontraumatic amputation.

Several diabetic foot ulcer treatments have been reported. All of them require integration of multiple treatment modalities, with debridement being the foundation for these therapies. Success of any particular form of treatment is dependent on the appropriate match of patient and treatment factors, according to Dr. Blume of the North American Center for Limb Preservation, New Haven, Conn., and colleagues.

The study goal was to determine whether negative pressure wound therapy (NPWT) was a better or equivalent treatment to advanced moist wound therapy (AMWT) in concurrence with debridement for treating foot ulcers in diabetic adults with adequate blood circulation.

Patients were randomly assigned to either NPWT, which used vacuum-assisted closure, or AMWT, which primarily used hydrogels and alginates. The study could not be blinded because of the distinct nature of the two therapies, according to the study investigators.

The multicenter study enrolled 342 patients with a mean age of 58 years over the period of August 2002 to August 2005; 79% of the patients were men. All patients were initially debrided as needed within 2 days of randomization and received standard off-loading therapy as needed after treatment was initiated.

Treatment was continued until ulcer closure, sufficient granulation tissue formation for healing, or until day 112. All patients were examined weekly for the first 4 weeks then every other week until day 112 or ulcer closure. Patients achieving ulcer closure were followed at 3 and 9 months (Diabetes Care 2008;31:631–6).

Complete ulcer closure was defined as skin closure (100% reepithelialization) without a draining or dressing requirement. Closure occurred in 73 of 169 (43%) of the NPWT patients, compared with 48 of 166 (29%) of the AMWT patients. In addition, significantly more NPWT patients achieved 75% closure (105 of 169, 62%), than did AMWT patients (85 of 166, 51%).

The incidence of secondary amputations was also significantly less for NPWT (4%) than for AMWT (10%).

"Although the exact mechanism of the decrease in secondary amputations remains unclear, treatment of DFUs [diabetic foot ulcers] with NPWT appears to promote significant healing," the authors concluded.

Dr. John Lantis (Saint Luke's Roosevelt Hospital, New York), a study coauthor, disclosed receiving honoraria from KCI USA, which provided the vacuum therapy system used and whose global biometrics group provided the data analysis.

ELSEVIER GLOBAL MEDICAL NEWS

A greater percentage of diabetic foot ulcers achieved complete closure with negative pressure wound therapy than with advanced moist wound therapy in a randomized controlled study of more than 300 patients.

There were also significantly fewer secondary amputations seen in the group undergoing negative pressure therapy, Dr. Peter A. Blume and colleagues reported.

Diabetic foot ulcers lead to nonhealing chronic wounds that are difficult to treat and are a significant risk factor for nontraumatic amputation.

Several diabetic foot ulcer treatments have been reported. All of them require integration of multiple treatment modalities, with debridement being the foundation for these therapies. Success of any particular form of treatment is dependent on the appropriate match of patient and treatment factors, according to Dr. Blume of the North American Center for Limb Preservation, New Haven, Conn., and colleagues.

The study goal was to determine whether negative pressure wound therapy (NPWT) was a better or equivalent treatment to advanced moist wound therapy (AMWT) in concurrence with debridement for treating foot ulcers in diabetic adults with adequate blood circulation.

Patients were randomly assigned to either NPWT, which used vacuum-assisted closure, or AMWT, which primarily used hydrogels and alginates. The study could not be blinded because of the distinct nature of the two therapies, according to the study investigators.

The multicenter study enrolled 342 patients with a mean age of 58 years over the period of August 2002 to August 2005; 79% of the patients were men. All patients were initially debrided as needed within 2 days of randomization and received standard off-loading therapy as needed after treatment was initiated.

Treatment was continued until ulcer closure, sufficient granulation tissue formation for healing, or until day 112. All patients were examined weekly for the first 4 weeks then every other week until day 112 or ulcer closure. Patients achieving ulcer closure were followed at 3 and 9 months (Diabetes Care 2008;31:631–6).

Complete ulcer closure was defined as skin closure (100% reepithelialization) without a draining or dressing requirement. Closure occurred in 73 of 169 (43%) of the NPWT patients, compared with 48 of 166 (29%) of the AMWT patients. In addition, significantly more NPWT patients achieved 75% closure (105 of 169, 62%), than did AMWT patients (85 of 166, 51%).

The incidence of secondary amputations was also significantly less for NPWT (4%) than for AMWT (10%).

"Although the exact mechanism of the decrease in secondary amputations remains unclear, treatment of DFUs [diabetic foot ulcers] with NPWT appears to promote significant healing," the authors concluded.

Dr. John Lantis (Saint Luke's Roosevelt Hospital, New York), a study coauthor, disclosed receiving honoraria from KCI USA, which provided the vacuum therapy system used and whose global biometrics group provided the data analysis.

ELSEVIER GLOBAL MEDICAL NEWS