![]() 42.8☓2.5 days for the control group)ĭiabetic foot ulcers treated with NPWT were prospectively studiedġ00% granulation and bacterial clearance at the end of therapy. Wound healing faster in NPWT group (22.8☑7.4 days vs. NPWT resulted in a greater wound size reduction compared to moist dressings Adverse effects were similar in both groupsĪssigned to receive moist gauze dressings or NPWT treatments for 2 weeks, after which subjects crossed over The rate of healing was also faster in the NPWT group, p =0.005. NPWT group had increased healing (56% vs. Partial foot amputation wounds assigned to NPWT or moist dressings 28.9%) with fewer secondary amputations, p =0.035 NPWT group achieved higher wound closure rates (43.2% vs. NPWT therapy more effective than conventional dressings with increased granulation and healing ratesĪssigned to either NPWT or moist dressings (predominately hydrogels and alginates) Systematic review of 4 randomized controlled trial examining NPWT effectiveness 98 days) p =0.005 and more rapid infection clearance (10 days vs. NPWT group had faster granulation (65 days vs. Greater proportion of complete skin-graft uptake in NPWT group (80%) compared to moist dressings (68%), p =0.05Īfter debridement, patients assigned to NPWT or moist dressings Skin-graft wounds assigned to NPWT or moist dressings NPWT is more effective in healing diabetic postoperative foot wounds and ulcers compared with moist wound dressings Systematic review of 5 RCTs examining NPWT effectiveness Currently, this mode is mainly limited to research with limited evidence of its use in clinical practice. Variable mode is a recent introduction and involves cycling between two negative pressure levels (10–80 mmHg). It can also result in granulation ingrowth into the foam causing additional pain during foam removal. In clinical application, intermittent mode has shown an increased potential for pain due to repeated wound filler contraction and expansion ( 33). Though preclinical studies show higher granulation under intermittent and variable pressures, continuous delivery is the established normal setting in clinical practice ( 33). Pressure modes can be changed between continuous, intermittent, and variable delivery. Pressures can also be lowered if the patient experiences pain or excessive amount of blood is seen in the canister despite hemostasis. However, it is recommended to avoid using higher NPWT pressures in wounds with compromised vascularity or risk of ischemia ( 9). ![]() Bridge modification enables the suction pad to be placed outside weight-bearing area of the foot allowing patients to wear protective shoes and offloading gear while on NPWT. Higher pressures can be used when there is high exudate and wound fluids ( 32) or in instances such as application of a bridge NPWT dressing. In clinical practice, 125 mmHg is the normal setting though levels can vary between 50 and 150 mmHg depending on the wound type ( 31). In vitro studies showed that at subatmospheric pressures of 125 mmHg, there is a fourfold increase in blood flow ( 4). The NPWT pump delivers the desired negative pressure to the entire system. Pressure setting: what pressure level and whether Although underlying wound deformation by foam and gauze are different, studies show no differences in the time to complete healing between the two filler types ( 30). Similar to white foam, gauze is also useful in wounds where post-debridement soft tissue structures such as tendons and bone are exposed. ![]() Gauze is alternate filler and is useful for irregular wounds because of its conformability and ease of application ( 27). silver) impregnated foam is also available to provide antibacterial cover during NPWT ( 28, 29). It is also beneficial for use on exposed tendons and bones. Its higher tensile strength and less adherent properties are typically indicated for use in tunnels and shallow undermining. The polyvinyl ‘white’ foam is hydrophilic or moisture retaining. Foam-induced scarring further aids in wound contracture and size reduction. This foam results in thick and rapid granulation ( 27) and is ideal for wounds with large defects after radical debridement. The conventional ‘black’ PU foam is hydrophobic or water repelling and enables the dressing to conform to the wound bed providing the foam–tissue interface. Commonly used fillers in diabetic wounds are polyurethane (PU), polyvinyl alcohol foam, and saline-moistened gauze. Wound filler characteristics determine most of the effects of NPWT on the wound bed. Wound filler type: black foam, white foam, or gauze? ![]()
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