Negative pressure wound therapy use in diabetic foot syndrome—from mechanisms of action to clinical practice

Borys, Sebastian; Hohendorff, Jerzy; Frankfurter, Claudia; Kieć‐Wilk, Beata; Małecki, Maciej

doi:10.1111/eci.13067

Cited by 53 publications

(41 citation statements)

References 59 publications

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“…190 Some evidence demonstrates that NPWT results in more pro-angiogenic and antiinflammatory molecular conditions in wounds. 191 NPWT with instillation (NPWTi) is a system incorporating both instillation (using one of various types of sterile fluids) and aspiration that is intended to cleanse, and possibly disinfect, wounds. 192 While many published studies have demonstrated the safety and wound healing efficacy of NPWT/NPWTi, the quality of most is relatively low, few have addressed diabetic foot complications, 193 and none have specifically addressed if there was benefit in resolving evidence of wound infection.…”

Section: Recommendation 27mentioning

confidence: 99%

“…NPWT involves the application of a special wound dressing attached to a vacuum suction machine that aspirates wound and tissue fluid from the treated area into a canister . Some evidence demonstrates that NPWT results in more pro‐angiogenic and anti‐inflammatory molecular conditions in wounds . NPWT with instillation (NPWTi) is a system incorporating both instillation (using one of various types of sterile fluids) and aspiration that is intended to cleanse, and possibly disinfect, wounds .…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

Lipsky

Senneville

Abbas

et al. 2020

Diabetes Metabolism Res

501

729

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients.

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Section: Recommendation 27mentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

Lipsky

Senneville

Abbas

et al. 2020

Diabetes Metabolism Res

501

729

View full text Add to dashboard Cite

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“…Whether it constitutes a novel mechanism of NPWT action requires further research. NPWT's local mechanism of action at the tissue level has been well documented in a recent review [26]. NPWT results in the promotion of wound contraction, tissue granulation, vessel proliferation, neoangiogenesis, epithelialization, and removal of excess extracellular fluid [26].…”

Section: Discussionmentioning

confidence: 99%

“…They were assigned either to the standard therapy (ST) group or to the combined standard therapy with NPWT group, with each treatment time lasting 8 ± 1 days. Patients were nonrandomly assigned to the NPWT group but rather chosen based on local and international research and clinical practices, as well as the guidelines concerning NPWT use in DFU, most of which take wound area into account [26, 27]. In short, patients with ulcerations ≤ 1.0 cm 2 were allocated to the ST group, and the remaining patients were assigned to the NPWT group.…”

Section: Methodsmentioning

confidence: 99%

Effects of Negative Pressure Wound Therapy on Levels of Angiopoetin-2 and Other Selected Circulating Signaling Molecules in Patients with Diabetic Foot Ulcer

Hohendorff

Drożdż

Borys

et al. 2019

Journal of Diabetes Research

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Background and Aims Diabetic foot ulcers (DFUs) are linked to amputations and premature deaths. Negative pressure wound therapy (NPWT) has been used for DFUs. The mechanism of NPWT's action may be associated with its influence on circulating molecules. We assessed NPWT's effect on the plasma levels of angiopoietin-2 (Ang2), a key regulator of angiogenesis, and its microvesicular receptors (Tie2) as well as the microvesicles (MVs) themselves in DFU patients. Materials and Methods We included 69 patients with type 2 diabetes mellitus (T2DM) and neuropathic, noninfected DFUs—49 were treated with NPWT and 20 were treated with standard therapy (ST). Assigning patients to the NPWT group was not random but based on DFU characteristics, especially wound area. Ang2 was measured by ELISA in the entire group, while in a subgroup of 19 individuals on NPWT and 10 on ST, flow cytometry was used to measure Tie2+ and the corresponding isotype control (Iso+) and annexin V (AnnV+) as well as total MVs. Measurements were performed at the beginning and after 8 ± 1 days of therapy. Results Treatment groups were similar for basic characteristics but differed by their median DFU areas (10.3 (4.2-18.9) vs. 1.3 (0.9-3.4) cm2, p = 0.0001). At day 0, no difference was observed in Ang2 levels, total MVs, MV Tie+, and MV AnnV+ between the groups. Ang2 decreased after 8 days in the NPWT group, unlike in the ST group (3.54 (2.40-5.40) vs. 3.32 (2.33-4.61), p = 0.02, and 3.19 ± 1.11 vs. 3.19 ± 1.29 ng/mL, p = 0.98, respectively). No other parameters were identified that may have been influenced by the NPWT treatment. Conclusion NPWT in T2DM patients with neuropathic, noninfected DFU seems to lead to reduction of the Ang2 level. Influencing the level of Ang2 may constitute one of NPWT-related mechanisms to accelerate wound healing.

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“…Diabetes mellitus is a devastating disease with more than 400 million people affected globally 1. Chronic ulcers with deep tissue damage in patients with diabetes leads to a high rate of amputation and mortality.…”

Section: Introductionmentioning

confidence: 99%

<p>CTGF Loaded Electrospun Dual Porous Core-Shell Membrane For Diabetic Wound Healing</p>

Augustine

Zahid

Wang

et al. 2019

IJN

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PurposeImpairment of wound healing is a major issue in type-2 diabetes that often causes chronic infections, eventually leading to limb and/or organ amputation. Connective tissue growth factor (CTGF) is a signaling molecule with several roles in tissue repair and regeneration including promoting cell adhesion, cell migration, cell proliferation and angiogenesis. Incorporation of CTGF in a biodegradable core-shell fiber to facilitate its sustained release is a novel approach to promote angiogenesis, cell migration and facilitate wound healing. In this paper, we report the development of CTGF encapsulated electrospun dual porous PLA-PVA core-shell fiber based membranes for diabetic wound healing applications.MethodsThe membranes were fabricated by a core-shell electrospinning technique. CTGF was entrapped within the PVA core which was coated by a thin layer of PLA. The developed membranes were characterized by techniques such as Scanning Electron Microscopy (SEM), Fourier Transform Infrared Spectroscopy (FTIR) and X-Ray Diffraction (XRD) analysis. In vitro cell culture studies using fibroblasts, keratinocytes and endothelial cells were performed to understand the effect of CTGF loaded membranes on cell proliferation, cell viability and cell migration. A chicken chorioallantoic membrane (CAM) assay was performed to determine the angiogenic potential of the membranes.ResultsResults showed that the developed membranes were highly porous in morphology with secondary pore formation on the surface of individual fibers. In vitro cell culture studies demonstrated that CTGF loaded core-shell membranes improved cell viability, cell proliferation and cell migration. A sustained release of CTGF from the core-shell fibers was observed for an extended time period. Moreover, the CAM assay showed that core-shell membranes incorporated with CTGF can enhance angiogenesis.ConclusionOwing to the excellent cell proliferation, migration and angiogenic potential of CTGF loaded core-shell PLA-PVA fibrous membranes, they can be used as an excellent wound dressing membrane for treating diabetic wounds and other chronic ulcers.

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Negative pressure wound therapy use in diabetic foot syndrome—from mechanisms of action to clinical practice

Cited by 53 publications

References 59 publications

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

Effects of Negative Pressure Wound Therapy on Levels of Angiopoetin-2 and Other Selected Circulating Signaling Molecules in Patients with Diabetic Foot Ulcer

<p>CTGF Loaded Electrospun Dual Porous Core-Shell Membrane For Diabetic Wound Healing</p>

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