Negative pressure wound therapy for the management of foot wounds in the diabetic population: a review of the literature

Diabetes-related foot complications place a significant burden on the National Health Service (NHS) and the economy. The most common and costly sequelae of the disease includes ulceration, gangrene, infection, and ultimately amputation. Research suggests that these complications often have detrimental psychosocial effects on individuals who suffer with them. The management of diabetic foot wounds is a continuing battle for health services and therefore any intervention that promotes healing and possibly prevents the need for amputation could be extremely valuable.

One such intervention currently being used throughout the NHS and globally is Negative Pressure Wound Therapy (NPWT), a technique that uses negative pressure to remove fluid from open wounds through a specialised sealed dressing placed into the wound cavity. The mechanism by which NPWT works is not yet fully understood but it is thought to be associated with the removal of exudate, increased blood supply to the area, and reduction of cytokines and matrix metalloproteinases.

Aim

The objective of this review was to ascertain the effectiveness of NPWT as a treatment for diabetic foot wounds and consider the cost effectiveness of this intervention.

Methods

A systematic search of the literature was carried out using a set of relevant key words to identify available literature published between January 2005 and January 2015. Ten primary research studies were identified as suitable for inclusion following critical assessment using the Critical Appraisal Skills Program (CASP) appraisal tools, the CONSORT statement, and other appropriate frameworks.

Relevance/impact

Despite the increasing use of NPWT there is an apparent lack of relevant and robust Randomised Controlled Trials (RCTs) to justify this. There is a large volume of literature regarding the use of NPWT for various wound types, but very few studies specific to foot wounds in the diabetic population. Furthermore, most of the studies that do exist include case studies, small cohort studies, and poor quality RCTs. Due to the promising results seen in the widespread use of NPWT by health services it seems that the gap in relevant research regarding this technology should be considered further.

Results

The findings of this review indicate that NPWT has a positive effect on wound healing including reducing time to healing. However, the studies currently available are few and of varying quality, many with methodological flaws. Despite increased material costs compared to traditional wound care methods, research suggests that NPWT has the potential to lower care costs overall due to a reduced need for in-patient care.

Discussion and conclusion

The need for further quality RCTs to assess the effectiveness of NPWT for the management of diabetic foot wounds is highlighted. The onus should be on large numbers of participants, robust patient relevant outcome measures, and mid to long term studies with objective outcome measures to provide evidence of clinical effectiveness. It is proposed that future research should focus on developing a set of national guidelines for the use of NPWT in diabetic wound management.