Comparison of Negative Pressure Wound Therapy with Conventional dressing in the Treatment of Diabetic Foot Ulcers with Non-Revascularisable Peripheral Vascular Disease

Introduction: Over the past several years? negative pressure wound therapy (NPWT) using vacuum- assisted closure has emerged as the treatment of complex wounds of the diabetic foot. Many reports on the use of Vacuum Assisted Closure (VAC) therapy after failed revascularization have found increased chances of success. Clinicians should consider negative pressure wound therapy as an adjunct to other modalities in an effort to avoid complications. Aims and Objectives: This study has been taken upto identify the efficacy of newer technique in diabetic wounds with non-revascularisable PVD management in comparison to advanced conventional dressing. Material and Methods: Total of 30 patients were included in this prospective study, who have a non revascularisable peripheral vascular disease for whom on performing peripheral angiography, the distal runoff vessel is less than 10cm, not suitable for intervention. They were randomly divided into two groups, negative pressure wound therapy (NPWT) group (15 patients) and control group (15 patients) who were treated with regular dressings. Transcutaneous oxygen pressure was recorded in all the patients and each patient followed up based on their granulation tissue development and need for amputation in each group. Results: After wound management, mean surface area of the diabetic wounds was 39.08cm2 in the NPWT group (P=0.019), and 38.63cm2 in the control group (P=0.327). The use of NPWT may be an effective initial wound therapy to achieve faster wound bed granulation showing signs of healing in 11 among 15 patients (76%) compared to control group 4 showed granulation among 15 patients (26%) (P=0.001). The incidence of secondary higher amputation in NPWT group is 4/15 (24%), the control group 10/15 (65%) (P=0.003), suggesting reduced incidence of secondary higher amputations in NPWT group. After treatment, the experimental group significantly improved in measures of foot ulcer surface area compared with the control group. Conclusion: NPWT-treated patients reached a successful wound treatment endpoint more rapidly, and the benefit was apparent in all wound sizes. NPWT appears to be a safer and efficacious method, than conventional dressing for the treatment of diabetic foot ulcers with non-revascularisable PVD.