Negative-Pressure Wound Therapy Using Modified Vacuum-Assisted Closure in Patients with Diabetic Foot Ulcers

Bong Jae Kim; Ji Hye Suk; A Ra Jo; Jong Kun Ha; Chan Woo Jung; Seong Oh Park; Hyung Taek Park; Mi Kyung Kim

doi:10.4093/jkd.2011.12.2.122

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Kim, Suk, Jo, Ha, Jung, Park, Park, and Kim: Negative-Pressure Wound Therapy Using Modified Vacuum-Assisted Closure in Patients with Diabetic Foot Ulcers

Original Articles & Case Reports

J Korean Diabetes 2011;12(2):122-127.

Published online: 22 January 2011

DOI: https://doi.org/10.4093/jkd.2011.12.2.122

Negative-Pressure Wound Therapy Using Modified Vacuum-Assisted Closure in Patients with Diabetic Foot Ulcers

Bong Jae Kim¹, Ji Hye Suk¹, A Ra Jo¹, Jong Kun Ha¹, Chan Woo Jung¹, Seong Oh Park¹, Hyung Taek Park², Mi Kyung Kim¹

¹Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea

²Department of Orthopedic Surgery, Maryknoll Medical Center, Busan, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetic foot ulcers (DFU) are common and serious complications of diabetes mellitus. The prognosis of DFU may be very poor even during early stages depending on the general conditions of patients, and amputation is often required to manage DFU. Various therapeutic approaches to DFU have been introduced, and among these negative-pressure wound therapy using vacuum-assisted closure (VAC-NPWT) is particularly noteworthy. We performed VAC-NPWT in three patients with complicated DFU. We used a modified VAC-NPWT protocol, which used wall suction and curaVAC^®. Dressing changes were performed every week, which was longer than standard method. All of our cases improved with granulating wound beds and were cleared of bacterial infection by the end of modified VAC therapy. These modifications reduced the costs of VAC-NPWT without introducing associated side effects. We recommend the active application of VAC-NPWT for complicated DFU, although this recommendation should be confirmed by large randomized controlled studies.

Keywords: Diabetic foot ulcer, Negative-pressure wound therapy, Vacuum-assisted closure

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Fig. 1.

Wound status of patient no.2. (A) Pre-debridement. (B) Post-debridement. (C) Post-vacuum-assisted closure therapy, after 5 weeks.

Fig. 2.

Materials used in the application of vacuum-assisted closure therapy include a polyurethane foam (1), suction head (2) and non-collapsible tube (3).

Table 1.

Summary of clinical characteristics, wound states and VAC-NPWT settings of patients

Patient number		1	2	3
Age (yr)		27	76	47
Gender		Male	Female	Female
History of smoking		Never	Never	Never
HbA1c (%)		13.2	14.5	9
Type of diabetes mellitus		1	2	2
Duration of diabetes mellitus (yr)		10	23	10
Diabetic complication	Autonomic neuropathy	Present	Present	Present
	Peripheral neuropathy	Present	Absent	Present
	Nephropathy	Microalbuminuria	Microalbuminuria	Azotemia
	Retinopathy	Moderate NPDR	PDR	Severe NPDR
Site of ulcer		Left dorsum	Left dorsum	Left dorsum
Grade of foot ulcer (Wagner)		3	3	3
Inflammatory markers	WBC (/mm³)	10,100	12,000	38,800
	hsCRP (mg/L)	87.7	140.6	66
	ESR (mm/hr)	60	53	2
Ankle-Brachial	Right side	1.04	NA	0.99
Index	Left side	1.00	NA	0.92
Patency of peripheral artery evaluated by CT angiography		NA	No obstruction	NA
Cuture results from wound swab		MSSA, S. agalactiae	MSSA, S. agalactiae	S. agalactiae (MRCNS)
Interval of VAC dressing change (day)		7	7	7
Length of treatment (day)		65	98	73
Length of VAC dressing used (day)		42	49	63
Wound area	Before treatment (cm²)	2.9	26.5	10.6
	After treatment (cm²)	0.4	7.9	3.3
Decrease of wound area (%)		86.7	70.3	68.9

VAC, vacuum-assisted closure; NPWT, negative-pressure wound therapy; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy; WBC, white blood cell; hsCRP, high-sensitivity C-reactive protein; ESR, erythrocyte sedimentation rate; NA, non-assessment; MSSA, methicillin-sensitive stapylococcus aureus; MRCNS, methicillin-resistant coagulase negative staphylococci.

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