Role of negative pressure wound therapy in the management of surgically treated diabetic foot infections: A randomized controlled trial

Background
Negative pressure wound therapy (NPWT) has been shown to be an effective and safe adjunctive treatment for chronic diabetic foot ulcers, but its role in surgically treated diabetic foot infection (DFI) has not been clearly evaluated yet. The present study aimed at evaluation of effectiveness and safety of NPWT in the treatment of postoperative wounds of DFI compared with conventional wound dressing (CWD).
Patients and methods
This 8-week randomized controlled study enrolled 80 surgically treated patients with DFI randomized to NPWT (=40) or CWD (=40). The study outcomes included changes in wound surface area, time to complete granulation tissue formation (GTF), cessation of wound drainage, wound-related pain, and bleeding. Treatment success was defined as complete healthy GTF without wound drainage.
Results
The wound surface area decreased significantly with NPWT than CWD (39.5 ± 26.5 vs. 14.3 ± 8.9 cm, <0.001) accounting for reduction percentage of 51.0 ± 2.0 versus 19.0 ± 2.0% (<0.001). In the fourth and sixth week of treatment, 75 and 100% of NPWT patients achieved complete healthy GTF versus 30 and 75% of CWD patients, respectively (<0.001), with mean time for complete GTF of 30.45 ± 4.6 versus 38.3 ± 1.67 days (=0.001), respectively. Treatment success was achieved in 100% of NPWT patients versus 75% of CWD (<0.001). Wound drainage ceased in 100% of NPWT patients versus 65% of CWD (<0.001) in the sixth week. The mean VAS score was 4.02 ± 0.83 versus 4.0 ± 0.82 (=0.892) in the first week, and 2.1 ± 0.78 versus 3.0 ± 0.82, (<0.001) in the fourth week, respectively. No major bleeding occurred in the study.
Conclusions
NPWT is an effective and safe treatment for surgically treated DFI in terms of improved reduction of wound size, faster GTF, and cessation of wound drainage, without increased pain or bleeding as compared with conventional moist wound dressing.