Negative pressure therapy (vacuum) for wound bed preparation among diabetic patients
case series
Keywords:
Diabetic foot, Skin transplantation, Surgical flaps, Negative-pressure wound therapy, Wound healingAbstract
CONTEXT: Complications from diabetes mellitus affecting the lower limbs occur in 40 to 70% of such patients. Neuropathy is the main cause of ulceration and may be associated with vascular impairment. The wound evolves with necrosis and infection, and if not properly treated, amputation may be the end result. Surgical treatment is preferred in complex wounds without spontaneous healing. After debridement of the necrotic tissue, the wound bed needs to be prepared to receive a transplant of either a graft or a flap. Dressings can be used to prepare the wound bed, but this usually leads to longer duration of hospitalization. Negative pressure using a vacuum system has been proposed for speeding up the treatment. This paper had the objective of analyzing the effects of this therapy on wound bed preparation among diabetic patients. CASE SERIES: Eighty-four diabetic patients with wounds in their lower limbs were studied. A commercially available vacuum system was used for all patients after adequate debridement of necrotic tissues. For 65 patients, skin grafts completed the treatment and for the other 19, skin flaps were used. Wound bed preparation was achieved over an average time of 7.51 days for 65 patients and 10 days for 12 patients, and in only one case was not achieved. CONCLUSIONS: This experience suggests that negative pressure therapy may have an important role in wound bed preparation and as part of the treatment for wounds in the lower limbs of diabetic patients.
Downloads
References
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30-69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence. Diabetes Care. 1992; 15(11):1509-16.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28.
Jeffcoate WJ, Price P, Harding KG; International Working Group on Wound Healing and Treat- ments for People with Diabetic Foot Ulcers. Wound healing and treatments for people with diabetic foot ulcers. Diabetes Metab Res Rev. 2004;20(Suppl 1):S78-89.
Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical manage- ment. Int Wound J. 2004;1(2):123-32.
Miyajima S, Shirai A, Yamamoto S, Okada N, Matsushita T. Risk factors for major limb ampu- tations in diabetic foot gangrene patients. Diabetes Res Clin Pract. 2006;71(3):272-9.
Abbott CA, Carrington AL, Ashe H, et al. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002;19(5):377-84.
Dellon AL. From there to here: a personal viewpoint after three decades of neuropathy research. Clin Podiatr Med Surg. 2006;23(3):497-508.
Valdivia JM, Dellon AL, Weinand ME, Maloney CT Jr. Surgical treatment of peripheral neuropathy: outcomes from 100 consecutive decompressions. J Am Podiatr Med Assoc. 2005;95(5):451-4.
Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: in- cidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg. 2004;53(6):517-22.
Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM; American Diabetes Association.Preventive foot care in diabetes. Diabetes Care. 2004;27(Suppl 1):S63-4.
Ferreira MC, Tuma P Jr, Carvalho VF, Kamamoto F. Complex wounds. Clinics (Sao Paulo). 2006;61(6):571-8.
Schultz GS, Sibbald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11(Suppl 1):S1-28.
Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D; International Wound Bed Preparation Advisory Board; Canadian Chronic Wound Advisory Board. Preparing the wound bed 2003: focus on infection and inflammation. Ostomy Wound Manage. 2003;49(11):23-51.
Falanga V. Wound healing and its impairment in the diabetic foot. Lancet. 2005; 366(9498):1736-43.
Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563-76; discussion 577.
Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38(6):553-62.
Ferreira MC, Wada A, Tuma Júnior P. The vacuum assisted closure of complex wounds: report of 3 cases. Rev Hosp Clin Fac Med Univ São Paulo. 2003;58(4):227-30.
Wada A, Ferreira MC, Tuma Júnior P, Arrunátegui G. Experience with local negative pressure (vacuum method) in the treatment of complex wounds. Sao Paulo Med J. 2006;124(3):150-3.
DeFranzo AJ, Marks MW, Argenta LC, Genecov DG. Vacuum-assisted closure for the treatment of degloving injuries. Plast reconstr surg. 1999;104(7):2145-8.
Lambert KV, Hayes P, McCarthy M. Vacuum assisted closure: a review of development and current applications. Eur J Vasc Endovasc Surg. 2005;29(3):219-26.
Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: mi- crodeformations of wounds and cell proliferation. Plast Reconstr Surg. 2004;114(5):1086- 96; discussion 1097-8.
Chen KD, Li YS, Kim M, et al. Mechanotransduction in response to shear stress. Roles of receptor tyrosine kinases, integrins, and Shc. J Biol Chem. 1999;274(26):18393-400.
Yager DR, Nwomeh BC. The proteolytic environment of chronic wounds. Wound Repair Regen. 1999;7(6):433-41.
Chen SZ, Li J, Li XY, Xu LS. Effects of vacuum-assisted closure on wound microcirculation: an experimental study. Asian J Surg. 2005;28(3):211-7.
Krizek TJ, Robson MC. Evolution of quantitative bacteriology in wound management. Am J Surg. 1975;130(5):579-84.
