Systematic Review of Therapy for Diabetic Foot Ulcers: Negative Pressure Wound Therapy vs Advanced Moist Wound Therapy

This systematic review addresses the issue of the diabetic foot ulcer (DFU) with regards to treatment. Specifically, negative pressure wound treatment (NPWT) as compared to standard wound treatments, most often referred to as advanced moist wound therapy (AMWT).  The population studied is adult patients (age 18 and up) and diagnosed with diabetes mellitus along with the complication of at least one DFU.  Primary outcomes are quantified by duration of wound until healing or extent of healing according to the serial measurements of the depth of the wound deficit. The ultimate goal of therapy is to speed healing and prevent lower extremity amputations.

The population studied is patients with concomitant diagnoses of diabetes mellitus and diabetic foot ulcer (DFU). The intervention of interest is NPWT as compared to standard treatments of AWMT. The outcome measures desired are defined as decreased duration of wound, increased rates of healing, complete healing, and prevention of amputation or  prevention of further amputation. Therefore, the PICO question to be answered: Is there a difference in healing rates and incidence of amputation or further amputation when using NPWT as compared to AMWT?

 In the final analysis, four randomized clinical trials, three retrospective studies, one Cochrane Systematic Review, one Evidence Based Practice report, and one Clinical Guideline was selected for critiquing. At this point in time, it is difficult to reach an unequivocal recommendation for the use of NPWT over AMWT. The consensus of the experts is that the efficacy of NPWT as shown by various studies favors negative pressure under some conditions.

The experts in the field of wound care have demonstrated a willingness to explore NPWT in order to facilitate successful outcomes with DFUs and it is this open-minded approach that allows for gains in the pursuit of best practice and evidence based medicine.