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Evidence summaries

Negative Pressure Wound Therapy for Treating Foot Wounds in People with Diabetes Mellitus

Negative pressure wound therapy may be more effective in healing post-operative foot wounds and ulcers of the foot in people with diabetes mellitus compared with wound dressings. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 11 studies with a total of 972 subjects with diabetes. Two studies focused on postamputation wounds and all other studies included foot ulcers. Ten studies compared negative pressure wound therapy (NPWT) with dressings, and 1 study compared NPWT delivered at 75 mmHg with NPWT delivered at 125 mmHg.

NPWT compared with dressings for postoperative wounds:There was an increased number of healed wounds in the NPWT group compared with the dressings group, and a 21 days shorter median time to healing. No dignificant difference in amputation risk was observed (table T1).NPWT compared with dressings for foot ulcers: NPWT increased the number of healed wounds, reduced the risk of amputation (table T2), and reduced the time to healing compared with dressings (HR 1.82, 95% CI 1.27 to 2.60; 1 study, n=341).Low-pressure 75 mmHg compared with high-pressure 125 mmHg NPWT for foot ulcers: There was no clear difference in the number of wounds closed or covered with surgery (RR 0.83, 95% CI 0.47 to 1.47) or in adverse events (RR 1.50, 95% CI 0.28 to 8.04) between groups during 4 weeks follow-up time (1 study, n=40).

Negative pressure wound therapy (NPWT) compared to dressings for healing post-operative wounds in people with diabetes

OutcomeParticipants (studies)Assumed risk (dressings)Corresponding risk (NPWT)Relative effect (95% CI)
Proportion of wounds healed (mean follow-up 16 weeks)162 (1)388 per 1000559 per 1000(400 to 780)RR 1.44 (1.03 to 2.01)
Time to healing (mean follow-up 16 weeks)162 (1)388 per 1000609 per 1000(448 to 770)HR 1.91(1.21 to 2.99)
Amputation (mean follow-up 16 weeks or unspecified)292 (2)60 per 100023 per 1000(8 to 61)RR 0.38 (0.14 to 1.02)

NPWT compared to dressings for foot ulcers in people with diabetes

OutcomeParticipants (studies)Assumed risk (dressings)Corresponding risk (NPWT)Relative effect (95% CI)
Proportion of wounds healed486 (5)406 per 1000540 per 1000(475 to 617)RR 1.40 (1.14 to 1.72)
Amputation441 (3)114 per 100038 per 1000(17 to 80)RR 0.33 (0.15 to 0.70)

Clinical comments

Note

Date of latest search: 2024-01-15

References

  • Liu Z, Dumville JC, Hinchliffe RJ et al. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev 2018;(10):CD010318. [PubMed]

Primary/Secondary Keywords