The Use of Negative Pressure Wound Therapy for the Treatment of Diabetic Foot Ulcers

The appropriate referral of diabetic foot ulcer patients to specialized foot care treatment and service in the emergence of a new wound is pivotal to enhancing outcomes. Firms enhance continuity of qualified care in the transition from primary-care environments and hospital interventions if they limit the occurrence of unnecessary delays. Evidence-based practices (EBP) supports multidisciplinary care as the most appropriate in appraising foot salvage rates and absolute healing rates (Seidel et al., 2014). The PICOT paper addresses current reviews on outcomes for diabetic foot ulcers and therapy favoring negative pressure treatment methods.

Diabetic foot ulceration is very common as it affects about 25% of Americans suffering diabetes mellitus (American Diabetes Association, 2014). Evidence-based practices show that medical practitioners achieve desired management outcomes when they assess a patient’s ulceration before treatment followed with collaborated multidisciplinary care. Early assessments and subsequent referrals to a team of multidisciplinary professionals remain crucial for optimized outcomes (Anderson, Hare, & Perdrizet, 2016). The core treatment aspects for diabetes-related foot wounds involve personalized care through debridement and specialized dressing, antibiotic therapy, pressure offloading, as well as, considerations for either orthopedic leg surgery or revascularization (Hasan, Teo, & Nather, 2015). EBP outcomes have strongly supported that timely care allows for conservative lesion healing or limiting of tissue loss for patients previously considered for amputation.

NPTW is essentially noninvasive as it utilizes localized but controlled negative pressure to enable healing of acute or chronic wounds. Generally, a clinician places and seals sterile and latex-free polyurethane on a DFU to generate an airtight wound seal (Hasan et al., 2015). In some instances, polyvinyl alcohol form is used as a dressing. Generally, negative pressure at 80-125mmHg is used continuously or in cycles to allow for regular removal of collected fluid (Brad et al., 2013). This feature is identified as critical in edema removal and chronic exudates; thus, limiting bacterial colonization. EBP literature provides that NPWT restrict bacterial colonization allowing a healthy generation of fresh capillary vessels (Anderson et al., 2016). The application of mild mechanical force enhances ulcer oxygenation and cellular proliferation.

In comparison to the application of standard moist dressings, NPWT has proved to present better outcomes as it allows greater patient self-management. As an adjunctive treatment, it allows for the integration of other therapies especially in instances where no more progression of DFU is noticeable (Brad et al., 2013). These treatments include hyperbaric oxygen therapy, biological dressings, growth factors, platelet rich plasma, and biological skin equivalents. However, given that these are specialized healings, it is imperative that expert clinicians with the requisite anatomical knowledge and skill sets employ critical decision-making (Cole, 2016). Hence, the PICOT question “In diabetic patients with foot ulcers how does negative pressure wound therapy compared to standard moist wound therapy affect overall wound healing?”

The literature search carried out involved a variety of articles sourced from the PubMed, Embase, Cochrane, and CINAHL databases. The keywords employed in PubMed and CINAHL included “negative pressure wound therapy,” “vacuum assisted therapy,” “standard moist wound dressing,” “diabetic foot ulcer,” and “American diabetics with foot ulcerations.” The MeSH terms used in searching through the Embase database were “comparing overall wound healing between NPWT and standard moist wound dressing therapy.” The review comprised English-studies publicized between 2009 and 2015 with diagnosis periods pegged on index dates or time references of the most recent DFU episode. The searches involved randomized controls, meta-analysis, clinical controlled studies, and retrospective studies. Mesh terms resulted in

The first search on PubMed applied the MeSH terms offered a wide array of related articles. The same terms on other medical databases included “foot ulcer patients with diabetes mellitus,”“first-time foot ulceration,” and “NPWT outcomes.” This resulted in 37 articles, which called for exclusion criteria for duplicated studies, those with numerous therapies, and the explorations that had a large time lag between research undertaking and publication. PubMed, Cochrane, and CINAHL search brought forth 12, 13, and 22 articles respectively. Five articles (see appendix A) were found to be of considerable relevance to the PICOT question and set the applied exclusion criteria and search limitations.

References

American Diabetes Association. (2014). National diabetes statistics report, 2014. Estimates of diabetes and its burden in the epidemiologic estimation methods. Natl Diabetes Stat Rep, 2009-2012.

Anderson, C. A., Hare, M. A., & Perdrizet, G. A. (2016). Wound healing devices brief vignettes. Advances in wound care, 5(4), 185-190. Retrieved 22 February 2017 from http://online.liebertpub.com/doi/abs/10.1089/wound.2015.0651

Brad, R. Desai, U., Cummings, A. K., Skornicki, M., Parsons, N., & Birnbaum, P. H. (2013). Medical, drug, and work-loss costs of diabetic foot ulcers. ISPOR 18th Annual International Meeting May 21, 2013 New Orleans, LA.

Cole, W. E. (2016). Use of multiple adjunctive negative pressure wound therapy modalities to manage diabetic lower-extremity wounds. Eplasty,16.

Hasan, M. Y., Teo, R., & Nather, A. (2015). Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments. Diabetic Foot & Ankle, 6.

Seidel, D., Mathes, T., Lefering, R., Storck, M., Lawall, H., & Neugebauer, E. A. M. (2014). Negative pressure wound therapy versus standard wound care in chronic diabetic foot wounds: study protocol for a randomized controlled trial. Trials, 15, 334.