The effectiveness of negative pressure wound therapy using vacuum-assisted closure vs calcium alginate dressings in the treatment of arterial diabetic foot ulcer

Abstract

Background: The prevalence of chronic, non-communicable diseases such as diabetes mellitus are very common (12% prevalence in Malta). One of the major complications of diabetes mellitus (4-10% of this population) is foot ulceration. Such complications take up 10% of the total health care budget. Different local wound procedures to manage foot ulcers exist including various dressings but little consensus exists on which dressing, antiseptic agent or therapy would be the ideal choice. The choice of dressing depends on a plethora of wound factors; the amount and type of drainage, size, depth, type of ulcer and the condition of the surrounding skin Aim: The aim of this study was to analyse the effectiveness of negative pressure wound therapy using vacuum-assisted closure versus calcium alginate dressings in the treatment of arterial diabetic foot ulcers. Research design and method: A single-centre quasi-experimental, matched subject clinical trial was conducted at the Tissue Viability Unit. Thirty patients living with type 2 diabetes and presenting with a newly diagnosed arterial foot ulcer were recruited. Subjects were divided into 2 groups. Group A (n=15) underwent negative pressure wound therapy and Group B (n=15) underwent calcium alginate dressing treatment. Patients were assessed in the clinic and there ulcers were measured for their surface area and depth. Following application of treatment, the patients were reviewed every 3/4 days and assessed accordingly. Ulcers were measured at the end of treatment to assess the change. Results: Both negative pressure therapy and calcium alginate dressings were effective in reducing the surface area and depth of ulcers (p=0.00). However, negative pressure was 3.2 times more effective in reducing surface area of the ulcer and 3.78 times in reducing ulcers depth when compared to calcium alginate (p=0.000) Conclusion: Negative pressure wound therapy by the vacum-assisted closure therapy system could be considered as an effective treatment for complex arterial diabetic foot ulcers and is more effective than calcium alginate dressings. Improved care could result in improved quality of life to all those living with type 2 diabetes, improved health outcomes, lesser diabetes related complications and less expenditure from the Maltese health care budget.