Management of negative pressure wound therapy in the treatment of diabetic foot ulcers

Meloni, Marco; Izzo, Valentina; Vainieri, Erika; Giurato, Laura; Ruotolo, Valeria; Uccioli, Luigi

doi:10.5312/wjo.v6.i4.387

Cited by 64 publications

(41 citation statements)

References 41 publications

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“…NPWT is a non-invasive therapy system with controlled negative pressure. It uses a vacuum device to promote wound healing by removing fluid from open wounds through a sealed dressing or a foam dressing connected to a collection container using sub-atmospheric pressure (9). There are several NPWT mechanisms of action: macrodeformation, microdeformation, fluid removal and environmental control of the wound (10).…”

Section: Discussionmentioning

confidence: 99%

“…There are several NPWT mechanisms of action: macrodeformation, microdeformation, fluid removal and environmental control of the wound (10). NPWT promotes a moist environment, reduces edema, creates a positive wound environment by removing healing inhibitors, increases blood flow, stimulates angiogenesis and granulation tissue and causes mechanical stress in the bed of the wound promoting cell proliferation (9). The effects of NPWT can deliver different treatment goals: managing and protecting the wound, prepare the wound for surgical closure/to progress the wound by secondary intention, to improve outcomes after split-thickness skin graft, to improve patient comfort and reduce costs (11).…”

Section: Discussionmentioning

confidence: 99%

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Modern Approaches for Treatment of Patients with Chronic Wounds in Ambulatory Setting in General Hospital Dr. "Jože Potrč", Ptuj.

Veliu

Kröpfl

Vrbnjak

2019

AJTES

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Chronic wounds represent an enormous health, social and economic burden in modern society. With the increasing incidence of diabetes and obesity as well as the ageing of the population, we correspondingly expect a rise in the incidence of chronic wounds. The latter will reflect in an even heavier burden for individuals, their families and the society. At the General Hospital Dr. Jože Potrč Ptuj we devote a lot of time dealing with this issue, because we are aware of the impact that the chronic wounds have on the quality of life of affected patients. We have been taking care of patients with chronic wounds for several years in the ambulatory and hospital setting. In the article we present our organizational model in the treatment of patients with chronic wounds at General Hospital Dr. Jože Potrč Ptuj. We present the modern approaches in the treatment of chronic wounds at our hospital, our results in the treatment of chronic wounds supported with clinical cases. The key to successful management of patients with chronic wounds are good knowledge, team work and an individual approach to each patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modern Approaches for Treatment of Patients with Chronic Wounds in Ambulatory Setting in General Hospital Dr. "Jože Potrč", Ptuj.

Veliu

Kröpfl

Vrbnjak

2019

AJTES

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“…This is also the protocol recommended by some authors. 19,20 The standard method for the achievement of hemostasis is electrocoagulation. However, in cases of diabetic foot, this creates multiple new thermal necrosis sites, which is undesirable, particularly if infection exists.…”

Section: Discussionmentioning

confidence: 99%

Applying NPWT to bleeding open wounds after forefoot amputation in diabetic foot patients - a case report

Białecki¹,

Pyda²,

Kołodziejska³

et al. 2018

NPWTJ

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NPWT is increasingly used in patients with diabetic foot. The protocol for performing NPWT is subject to debate. Main concerns regard the type of suction to use (continuous, intermittent, or variable), the wound-packing material, or the exact pressure to apply. Typically, an optimum pressure range of -80 to -125 mmHg is indicated. Following bone resection in diabetic foot patients, the surgical wound is left open, which often entails bleeding from the resection site. In these cases, the start of NPWT was typically delayed by 24-48 hours -during that time a pressure dressing was applied -and NPWT was only started once bleeding had ceased. In order to initiate NPWT as soon as possible, we decided to start it at a higher negative pressure than usual, i.e. -180 mmHg, expecting that this would stop the bleeding. Only then would we reduce the negative pressure. This paper presents the course of NPWT with high negative pressure values after an amputation in 2 diabetic foot patients. In both cases, our assumptions were confirmed. The patients did not bleed, the drained volume did not exceed 30 ml (which seems clinically insignificant) in the first 40 minutes of treatment. Later, with negative pressure at -120 mmHg, no bleeding into the dressing was observed. Following the treatment (which lasted for 9 days), the wounds granulated normally, with no signs of inflammation. Applying VAC dressing using high negative pressure values to bleeding wounds immediately after surgery may stop the bleeding, enabling immediate initiation of NPWT.

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“…[29][30][31][32][33][34] Nevertheless only few articles described the NPT influence on MMPs activity. [22][23][24][25] Greene et al described the reduction in MMP-9/ neutrophil gelatinase-associated lipocalin, MMP-9, latent, and active MMP-2 activity by 15% to 76% determined by zymography in three patients (1 DFU) after 2 weeks of NPT.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Negative Pressure Therapy in Diabetic Foot Ulcers with Elevated Protease Activity: A Case Series

IzzoValentina

MeloniMarco

GiuratoLaura

et al. 2017

Advances in Wound Care

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Objective: Despite several works have described the usefulness of negative pressure therapy (NPT) in the treatment of diabetic foot ulcers (DFUs), no studies have reported its ability in the proteases modulation in DFUs. The aim of this work was to evaluate the role of NPT as a protease-modulating treatment in DFUs. Approach: We conducted a prospective study of a series of diabetic patients affected by chronic DFUs. Each ulcer was assessed for matrix metalloproteinases (MMPs) activity with a protease status diagnostic test at the baseline and after 2 weeks of NPT. Results: Four patients were included. All patients had type 2 diabetes with a disease duration of &20 years. A1c was 79.5 -15.3 mmol/mol. Ulcer area was >5 cm 2 in all cases. All wounds showed elevated protease activity (EPA) at the baseline. After 2 weeks, all patients showed a normalization of MMPs activity. Innovation: NPT showed its effectiveness in the reduction of EPA in chronic DFUs. Conclusion: This study confirms the role of NPT in the positive modulation of protease activity also in chronic DFUs.

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Management of negative pressure wound therapy in the treatment of diabetic foot ulcers

Cited by 64 publications

References 41 publications

Modern Approaches for Treatment of Patients with Chronic Wounds in Ambulatory Setting in General Hospital Dr. "Jože Potrč", Ptuj.

Modern Approaches for Treatment of Patients with Chronic Wounds in Ambulatory Setting in General Hospital Dr. "Jože Potrč", Ptuj.

Applying NPWT to bleeding open wounds after forefoot amputation in diabetic foot patients - a case report

The Effectiveness of Negative Pressure Therapy in Diabetic Foot Ulcers with Elevated Protease Activity: A Case Series

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