Use of Multiple Adjunctive Negative Pressure Wound Therapy Modalities to Manage Diabetic Lower-Extremity Wounds

Area of Science:

• Podiatry
• Wound Healing
• Diabetic Foot Ulcers

Background:

• Optimal wound healing requires careful patient and wound assessment.
• Negative pressure wound therapy (NPWT) and hyperbaric oxygen therapy (HBOT) are established treatments.
• Managing postsurgical diabetic lower-extremity wounds with high bioburden presents challenges.

Purpose of the Study:

• To evaluate a multistep therapeutic approach for postsurgical diabetic lower-extremity wounds.
• To assess the efficacy of combining NPWT with instillation, standard NPWT, and HBOT.
• To manage complex wounds with significant bioburden.

Main Methods:

• Three diabetic patients with lower-extremity ulcers underwent surgical intervention.
• A multistep therapy included NPWT with saline instillation and dwell time, followed by continuous NPWT, and HBOT.
• Treatment involved specific pressure settings (-150 mm Hg) and durations for NPWT.

Main Results:

• Complete wound closure was achieved within 4 weeks of initiating the multistep therapy.
• All patients regained full limb function without long-term complications.
• The combined therapy demonstrated positive outcomes in managing complex diabetic wounds.

Conclusions:

• A multistep wound therapy approach, including NPWT with instillation and HBOT, shows promise for postsurgical diabetic lower-extremity wounds.
• This pilot study suggests successful outcomes in complex wound cases.
• Larger prospective studies are necessary to confirm the efficacy of this approach.