Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus

• Published in: Cochrane database of systematic reviews 2018-10, Vol.10 (10), p.CD010318-CD010318
• Main Authors: Liu, Zhenmi, Dumville, Jo C, Hinchliffe, Robert J, Cullum, Nicky, Game, Fran, Stubbs, Nikki, Sweeting, Michael, Peinemann, Frank
• Format: Article
• Language: English
• Subjects: Amputation; Bandages - statistics & numerical data; Debridement; Diabetic Foot - surgery; DIABETIC FOOT ULCERS; Endocrine & metabolic; Humans; Negative-Pressure Wound Therapy - adverse effects; Negative-Pressure Wound Therapy - methods; Negative-Pressure Wound Therapy - statistics & numerical data; Randomized Controlled Trials as Topic; Skin disorders; Wound Healing; Wounds
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD010318.pub3

Foot wounds in people with diabetes mellitus (DM) are a common and serious global health issue. People with DM are prone to developing foot ulcers and, if these do not heal, they may also undergo foot amputation surgery resulting in postoperative wounds. Negative pressure wound therapy (NPWT) is a technology that is currently used widely in wound care. NPWT involves the application of a wound dressing attached to a vacuum suction machine. A carefully controlled negative pressure (or vacuum) sucks wound and tissue fluid away from the treated area into a canister. A clear and current overview of current evidence is required to facilitate decision-making regarding its use. To assess the effects of negative pressure wound therapy compared with standard care or other therapies in the treatment of foot wounds in people with DM in any care setting. In January 2018, for this first update of this review, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. We identified six additional studies for inclusion in the review. Published or unpublished randomised controlled trials (RCTs) that evaluated the effects of any brand of NPWT in the treatment of foot wounds in people with DM, irrespective of date or language of publication. Particular effort was made to identify unpublished studies. Two review authors independently performed study selection, risk of bias assessment and data extraction. Initial disagreements were resolved by discussion, or by including a third review author when necessary. We presented and analysed data separately for foot ulcers and postoperative wounds. Eleven RCTs (972 participants) met the inclusion criteria. Study sample sizes ranged from 15 to 341 participants. One study had three arms, which were all included in the review. The remaining 10 studies had two arms. Two studies focused on postamputation wounds and all other studies included foot ulcers in people with DM. Ten studies compared NPWT with dressings; and one study compared NPWT delivered at 75 mmHg with NPWT del