Diabetic wound healing : a comparison of negative pressure therapy and standard dressing

Abstract

Diabetic foot Ulcers (DFU) are one of the main serious complications of Diabetes. This project analysed Negative Pressure Wound Therapy (NPWT) compared with standard dressing (SD) treatment to heal DFU. The project 'PICO' question is; 'Is NPWT more effective to treat diabetic foot ulcers than standard dressings?' The population being investigated was composed of adults older than 40 years, suffering from diabetes mellitus and having a DFU. The intervention being NPWT compared with SD treatment (hydrocolloids and moistened gauze dressings). The outcome investigated was wound healing by size reduction. The inclusion criteria were; studies in English, with a sample of participants being adults with DFU older than 40 years. The exclusion criteria were; case reports, posters, abstracts and case studies of less than 5 patients. Studies on animals and published before the year 2000, were also excluded. The papers selected were: eight randomised controlled trials and four systematic reviews. These papers were critically appraised via the Critical Appraisal Skills Program. Findings: All the studies except one found that NPWT was more efficient and effective than SD treatment, since NPWT had a faster rate of wound closure, reduced bacterial colonisation and increased blood flow to the extremities. NPWT is recommended to be utilised on stage 2 and 3 DFUs of the Texas grading scale system. DFUs should be prevented by good blood glucose monitoring, good footwear and physical exercise. In practice, if NPWT is not applied correctly, adverse effects may occur, therefore nurses should be educated on how to apply NPWT and how to assess the patient regularly. Moreover, NPWT is contraindicated for patients having osteomyelitis, fistula present, exposure to large blood vessels and malignant wounds. Nowadays light and small negative pressure devices are available and these can be utilised in the outpatient setting.