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Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments.

Hasan MY, Teo R, Nather A - Diabet Foot Ankle (2015)

Bottom Line: However, a successful outcome in this subgroup of diabetic patients requires a multidisciplinary approach with careful patient selection, appropriate surgical debridement, targeted antibiotic therapy, and optimization of healing markers.Evolving NPWT technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications.This review article summarizes current knowledge about the role of NPWT in the management of the diabetic foot and its mode of action, clinical applications, and recent developments.

View Article: PubMed Central - PubMed

Affiliation: Division of Foot and Ankle, Department of Orthopaedic Surgery, National University Hospital, Singapore.

ABSTRACT
Negative-pressure wound therapy (NPWT) plays an important role in the treatment of complex wounds. Its effect on limb salvage in the management of the diabetic foot is well described in the literature. However, a successful outcome in this subgroup of diabetic patients requires a multidisciplinary approach with careful patient selection, appropriate surgical debridement, targeted antibiotic therapy, and optimization of healing markers. Evolving NPWT technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications. This review article summarizes current knowledge about the role of NPWT in the management of the diabetic foot and its mode of action, clinical applications, and recent developments.

No MeSH data available.


Related in: MedlinePlus

(a) Wound after surgical debridement. (b) Wound after 2 weeks of NPWT. (c) Healed wound at 6 weeks post-surgery.
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Figure 0003: (a) Wound after surgical debridement. (b) Wound after 2 weeks of NPWT. (c) Healed wound at 6 weeks post-surgery.

Mentions: A 62-year-old female with a 10-year history of diabetes mellitus presented with a dorsal forefoot abscess involving the second toe with pus tracking towards the sole. Upon examination, both dorsalis pedis and posterior tibial pulses were palpable. Infection markers on initial presentation were as follows: WBC count of 16×109/L, ESR of 80 mm/h, and CRP of 102 mg/L. Markers of wound healing included 12.5% for HbA1c, 12 g/dL for Hb, and 30 g/L for albumin. Patient underwent a second ray (metatarsal and toe) amputation and radical surgical debridement (Fig. 3a). Wound cultures grew Pseudomonas aeruginosa and Enterococcus faecalis, which were both sensitive to ceftazidime. Intravenous ceftazidime was thus started after infectious disease consultation.


Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments.

Hasan MY, Teo R, Nather A - Diabet Foot Ankle (2015)

(a) Wound after surgical debridement. (b) Wound after 2 weeks of NPWT. (c) Healed wound at 6 weeks post-surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4490797&req=5

Figure 0003: (a) Wound after surgical debridement. (b) Wound after 2 weeks of NPWT. (c) Healed wound at 6 weeks post-surgery.
Mentions: A 62-year-old female with a 10-year history of diabetes mellitus presented with a dorsal forefoot abscess involving the second toe with pus tracking towards the sole. Upon examination, both dorsalis pedis and posterior tibial pulses were palpable. Infection markers on initial presentation were as follows: WBC count of 16×109/L, ESR of 80 mm/h, and CRP of 102 mg/L. Markers of wound healing included 12.5% for HbA1c, 12 g/dL for Hb, and 30 g/L for albumin. Patient underwent a second ray (metatarsal and toe) amputation and radical surgical debridement (Fig. 3a). Wound cultures grew Pseudomonas aeruginosa and Enterococcus faecalis, which were both sensitive to ceftazidime. Intravenous ceftazidime was thus started after infectious disease consultation.

Bottom Line: However, a successful outcome in this subgroup of diabetic patients requires a multidisciplinary approach with careful patient selection, appropriate surgical debridement, targeted antibiotic therapy, and optimization of healing markers.Evolving NPWT technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications.This review article summarizes current knowledge about the role of NPWT in the management of the diabetic foot and its mode of action, clinical applications, and recent developments.

View Article: PubMed Central - PubMed

Affiliation: Division of Foot and Ankle, Department of Orthopaedic Surgery, National University Hospital, Singapore.

ABSTRACT
Negative-pressure wound therapy (NPWT) plays an important role in the treatment of complex wounds. Its effect on limb salvage in the management of the diabetic foot is well described in the literature. However, a successful outcome in this subgroup of diabetic patients requires a multidisciplinary approach with careful patient selection, appropriate surgical debridement, targeted antibiotic therapy, and optimization of healing markers. Evolving NPWT technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications. This review article summarizes current knowledge about the role of NPWT in the management of the diabetic foot and its mode of action, clinical applications, and recent developments.

No MeSH data available.


Related in: MedlinePlus