Introduction: PICOT Question
Diabetic foot wounds result from insufficient or impaired blood circulation in the legs. In diabetic patients, this occurs often, and it takes much longer to heal wounds and ulcers. Various causes contribute to this, and treatment options aim to prevent the adverse effects of diabetes. Negative Pressure Wound Therapy and Conventional Dressing are the primary treatment modalities for diabetic foot wounds. The level of effectiveness varies, and an evaluation of the methods is necessary to select the most effective one.
(P) is the Diabetic patients with foot wounds at MU hospital on medical surgery unit (I) does the use of Negative pressure wound therapy (O) result in a higher healing rate, lower infection rate, and a 30% reduction in pain management (C) compared to Moberly hospital on medical surgery unit using Conventional standard (moist) wound dressing during the same period (T) from October-Dec 2023.
Background
Diabetic foot is a complex of pathophysiologic ulcerative changes in the foot that is a severe complication for the patient. It is noted that this complication is the most frequent cause of amputations in diabetes mellitus, and hence, prevention measures are required. The complication manifests as the rapid development of dry skin of the feet, and sensitivity is drastically reduced. As a result, patients suffer even minor injuries, and due to high sugar, they cannot pass on their own. Diabetic foot manifests as an ulcer, which can quickly become infected and cause discomfort to the patient.
Methods of Treatment
There are various treatment methods for diabetic foot: in cases of infections, systemic antibiotics, surgical debridement of ulcers, and amputation, as well as local treatment with bandages. Moist wound care (MWC) is a traditional treatment method that involves applying dressings to the diabetic foot. The method involves applying a moist dressing at regular intervals to relieve swelling, prevent infection, and promote slow healing of the skin. The method’s advantages are considered scarless, easy to use, and can be applied independently with proper training.
Negative Pressure Wound Therapy (NPWT) is a relatively innovative way of treating wounds. Due to the negative pressure created, the technique allows fluid/exudate to be suctioned out using an aspiration pump. NPWT is the tight dressing of the wound and the creation of a vacuum in which blood is more active in rushing to the wound and expelling fluid. As a result, the rate of wound healing is expected to be more significant, and healing is less traumatic and prone to recurrence. The method’s primary advantage is its positive impact on inflammatory processes and reduced wound swelling, thereby facilitating the healing process.
Results
MWC and NPWT have some advantages over each other in treating diabetic foot ulcers, and each method can be rationally used in therapeutic tactics. However, when comparing these modalities, significant differences lead to an ambiguous conclusion. According to the research for this paper, NPWT has greater efficacy than MWC in several key indicators. It should be noted that NWPT and MWC report the same data regarding patient pain, with no significant differences reported. Diabetic foot is no longer a sentence to amputation precisely because of the high efficacy of the NPWT method.
The first vital indicator to compare is the healing rate of diabetic foot ulcers. It has been observed that the use of NPWT results in a higher rate of wound healing than MWC (Chen et al., 2021). However, some studies have shown no statistically significant difference, possibly due to the varying levels of negative pressure in the system (Wang et al., 2022).
The general trends of NPWT applications indicate that their effectiveness in treating wounds of various etiologies is higher than that of standard techniques (Liu et al., 2018). Seidel et al. (2020) suggest that inflammatory processes in subcutaneous tissue heal more quickly under negative pressure due to secondary tissue tension. Consequently, NPWT technology, as a treatment modality, has the potential to accelerate the wound tightening process and thereby reduce wound swelling, thereby accelerating healing.
Another important aspect of diabetic foot treatment that should be considered during granulation tissue formation is. Granulation tissue is the primary type of tissue that replaces the affected areas. Chen et al. (2021) note that the difference in tissue formation time was statistically significant. This means that NPWT shows a greater speed in granulation tissue formation.
Wang et al. (2022) also arrive at the same conclusion, indicating that the rate of granular tissue formation was increased. In addition, they found that the rate of wound discharge disappearance was also lower for the NPWT method. Hence, negative pressure is more effective than standard dressing in adequate repair and healing through granulation tissue formation.
Finally, any technique should consider all possible risks and be prepared to address them. Within standard wet dressings, there are risks of contamination and the potential for inflammation to spread over large areas. The use of NPWT can potentially lead to additional trauma, excessive granulation tissue overgrowth (such as infiltration of the dressing itself), and pain. Therefore, the risk management potential of each technique needs to be determined.
According to Seidel et al. (2020), adverse pressure conditions were more established and confirmed, with no recurrences observed in any of the comparison groups. In contrast, Wang et al. (2022) found no significant differences in amputation risks or adverse outcomes. Therefore, MWC and NPWT do not demonstrate statistically significant differences in randomized controlled trials and require further study.
Recommendations for the Use of NPWT
Doctors and nurses positively endorse the perception of treatment with innovative methods. However, there is always a chance that the discomfort of NPWT treatment for patients may be too great, so that the wet dressing method may be the only indicated option. There is a trend of increasing positive attitudes towards NPWT despite disadvantages such as pump noise and generally having the device close to the body (Miyanaga et al., 2022). Patients’ perceptions should be evaluated in the same way as the impact of the techniques on the disease, as practical cooperation with patients is one of the tasks of healthcare providers. Consequently, the integration of NPWT into practice should be gradual and as comfortable as possible for patients, with clear explanations of the reasons for use.
Conclusion
The study confirmed that negative pressure wound therapy has several advantages over the standard wet dressing technique. First, the rate of healing and wound repair is significantly higher with NPWT treatment. Second, tissue regeneration, tissue tightening, and granulation tissue formation are faster with NPWT.
At the same time, MWC does not demonstrate rapid efficacy and is economically costly. The associated risks and pain scales were found to be nearly identical for both treatment modalities, indicating that further data collection and refinement are required. Thus, NPWT can be used in the treatment of diabetic foot wounds with greater efficacy than MWC to achieve rapid tissue repair and resolution of inflammation.
References
Chen, L., Zhang, S., Da, J., Wu, W., Ma, F., Tang, C., Li, G., Zhong, D., & Liao, B. (2021). A systematic review and meta-analysis of efficacy and safety of negative pressure wound therapy in the treatment of diabetic foot ulcer. Annals of palliative medicine, 10(10), 10830–10839.
Liu, X., Zhang, H., Cen, S., & Huang, F. (2018). Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: A systematic review and meta-analysis. International journal of surgery (London, England), 53, 72–79.
Miyanaga, A., Miyanaga, T., Sakai, K., Konya, C, Asano, K., & Shimada, K. (2022). Patient experience of negative pressure wound therapy: A qualitative study. Nursing Open, 10(3), 1415-1425.
Seidel, D., Diedrich, S., Herrle, F., Thielemann, H., Marusch, F., Schirren, R., Talaulicar, R., Gehrig, T., Lehwald-Tywuschik, N., Glanemann, M., Bunse, J., Hüttemann, M., Braumann, C., Heizmann, O., Miserez, M., Krönert, T., Gretschel, S., & Lefering, R. (2020). Negative Pressure Wound Therapy vs Conventional Wound Treatment in Subcutaneous Abdominal Wound Healing Impairment: The SAWHI Randomized Clinical Trial. JAMA Surgery, 155(6), 469–478.
Wang, N., Li, S. S., Liu, Y. P., Peng, Y. Y., & Wang, P. F. (2022). Comparison of negative pressure wound therapy and moist wound care in patients with diabetic foot ulcers: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine, 101(31), e29537.