Efficacy of negative pressure wound therapy using vacuum-assisted closure combined with photon therapy for management of diabetic foot ulcers

Xiaoxiao Hu, Weishuai Lian, Xiaojun Zhang, Xue Yang, Jinxia Jiang, Maoquan Li, Xiaoxiao Hu, Weishuai Lian, Xiaojun Zhang, Xue Yang, Jinxia Jiang, Maoquan Li

Abstract

Background: Diabetes mellitus, one of the most prevalent chronic metabolic diseases, causes many complications. Among the complications, one of the most common chronic complications is diabetic foot ulcers (DFUs).

Objective: This study was conducted to investigate the efficacy of negative pressure wound therapy using vacuum-assisted closure (VAC) combined with photon therapy for the management of DFUs.

Patients and methods: The study included a total of 69 patients with DFUs during the period from January 2014 to December 2015. All patients were diagnosed with DFUs with Wagner's stage 2 or 3 and were divided into two groups - the VAC group in which patients received only VAC and the combined group in which patients received both VAC and photon therapy. Data on duration of the treatment, pre- and postoperative wound surface areas, dressing changing times, pain conditions assessed using visual analog scale scores, recurrence rate and amputation rate were collected.

Results: Among all patients, 35 patients were divided into the VAC group and 34 patients into the combined group. Areas of foot ulcers for all patients ranged from 5 to 100 cm2. The treatment duration, dressing changing times and the peak value of visual analog scale scores were all significantly lower in the combined group compared with the VAC group (P < 0.05). However, the reduced area for wound surface showed no significant difference between the two groups. Both recurrence and amputation rates showed no significant difference between the two groups of patients.

Conclusion: Both VAC and VAC combined with photon therapy were effective and safe in the treatment of DFUs, while the combined therapy might have accelerated wound healing, but did not influence the long-term efficacy.

Keywords: diabetic foot ulcer; photon therapy; vacuum-assisted closure.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
A male patient aged 62 years with subcutaneous abscess on the right side of the foot for 1 month; lateral ulcer, dry scab and nonunion for 2 months; and bipedal swelling and pain for 1 month. Notes: (A) Before treatment; (B) debridement surgery; (C) VAC combined with photon therapy; (D) 56 days after treatment. Abbreviation: VaC, vacuum-assisted closure.

References

    1. Diet MJE. Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women – NEJM. New England Journal of Medicine. 2001;345(11):790–797.
    1. Gr J. Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus – NEJM. New England Journal of Medicine. 2010;362(17):1563–1574.
    1. Wu T, Xie G, Ni Y, et al. Serum metabolite signatures of type 2 diabetes mellitus complications. J Proteome Res. 2015;14(1):447–456.
    1. Alvarez CA, Lingvay I, Vuylsteke V, Koffarnus RL, Mcguire DK. Cardiovascular Risk in Diabetes Mellitus: Complication of the Disease or of Antihyperglycemic Medications. Clin Pharmacol Ther. 2015;98(2):145–161.
    1. Yigit S, Karakus N, Inanir A. Association of MTHFR gene C677T mutation with diabetic peripheral neuropathy and diabetic retinopathy. Mol Vis. 2013;19(30):1626–1630.
    1. Bao X, Yang C, Fang K, Shi M, Yu G, Hu Y. Hospitalization costs and complications in hospitalized patients with type 2 diabetes mellitus in Beijing, China. J Diabetes. 2017;9(4):405–411.
    1. Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers. J Am Acad Dermatol. 2014;21(1):e21–e24.
    1. Chin YF, Liang J, Wang WS, Hsu BR, Huang TT. The role of foot self-care behavior on developing foot ulcers in diabetic patients with peripheral neuropathy: a prospective study. Int J Nurs Stud. 2014;51(12):1568–1574.
    1. Hingorani A, Lamuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;633S(2 Suppl):3S–21S.
    1. Moura LI, Dias AM, Carvalho E, de Sousa HC. Recent advances on the development of wound dressings for diabetic foot ulcer treatment – a review. Acta Biomater. 2013;9(7):7093–7114.
    1. Shojaiefard A, Khorgami Z, Larijani B. Independent risk factors for amputation in diabetic foot. Int J Diabetes Dev Ctries. 2008;28(2):32.
    1. Cychosz CC, Phisitkul P, Belatti DA, Wukich DK. Current Concepts Review: Preventive and Therapeutic Strategies for Diabetic Foot Ulcers. Foot & Ankle International. 2015;37(3):334.
    1. Widgerow AD. Bioengineered skin substitute considerations in the diabetic foot ulcer. Ann Plast Surg. 2014;73(2):239.
    1. Dumantepe M, Fazliogullari O, Seren M, Uyar I, Basar F. Efficacy of intralesional recombinant human epidermal growth factor in chronic diabetic foot ulcers. Growth Factors. 2015;33(2):128–132.
    1. Kwan RL, Cheing GL, Vong SK, Lo SK, Sk L. Electrophysical therapy for managing diabetic foot ulcers: a systematic review. Int Wound J. 2013;10(2):121–131.
    1. Isaac AL, Armstrong DG. Negative pressure wound therapy and other new therapies for diabetic foot ulceration: the current state of play. Med Clin North Am. 2013;97(5):899–909.
    1. Ulusal AE, Sahin MS, Ulusal B, Cakmak G, Tuncay C. Negative pressure wound therapy in patients with diabetic foot. Acta Orthop Traumatol Turc. 2011;45(4):254–260.
    1. Venturi ML, Attinger CE, Mesbahi AN, Hess CL, Graw KS. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) Device: a review. Am J Clin Dermatol. 2005;6(3):185–194.
    1. Simone CB, II, Kramer K, O’Meara WP, et al. Comparison of Predicted Excess Secondary Malignancies Between Proton and Photon Radiation Therapy for Treatment of Stage I Seminoma. International Journal of Radiation Oncology Biology Physics. 2012;82(1):242.
    1. Gupta A, Telfer J, Filonenko N, Salansky N, Sauder D. The use of low-energy photon therapy in the treatment of leg ulcers – a preliminary study. Journal of Dermatological Treatment. 1997;8(2):103–108.
    1. Leite SN, Andrade TA, Masson-Meyers DS, Leite MN, Enwemeka CS, Frade MA. Phototherapy promotes healing of cutaneous wounds in undernourished rats. An Bras Dermatol. 2014;89(6):899–904.
    1. Nagoba BS, Gandhi RC, Wadher BJ, Rao A, Hartalkar AR, Selkar SP. A simple and effective approach for the treatment of diabetic foot ulcers with different Wagner grades. Int Wound J. 2010;7(3):153–158.
    1. Rice JB, Desai U, Cummings AK, Birnbaum HG, Skornicki M, Parsons NB. Burden of diabetic foot ulcers for medicare and private insurers. Diabetes Care. 2014;37(3):651–658.
    1. Günal Ö, Tuncel U, Turan A, Barut S, Kostakoglu N. The Use of Vacuum-Assisted Closure and GranuFoam Silver® Dressing in the Management of Diabetic Foot Ulcer. Surg Infect. 2015;16(5):558.
    1. Armenio A, Cutrignelli DA, Nardulli ML, et al. Bio-Engineering tissue and V. A. C. therapy: A new method for the treatment of extensive necrotizing infection in the diabetic foot. Annali Italiani Di Chirurgia. 2017;88:268–274.

Source: PubMed

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