Use of Multiple Adjunctive Negative Pressure Wound Therapies Across the Continuum of Care in Deep, Complex Wounds of Diabetic Patients
Complications of diabetes mellitus type II involve numerous factors, including poor wound healing, chronic ulceration, and ensuing limb amputation.1 Impaired wound healing in diabetic patients is caused by multiple local and systemic factors that require a multi-disciplinary treatment approach for effective wound management. Wounds with deep tissue loss are often further complicated by soft tissue infection and osteomyelitis. In addition to debridement, systemic antibiotics, and addressing underlying wound causes, adjunctive use of negative pressure wound therapy (NPWT) with and without instillation has been used successfully to treat deep, complex wounds of diabetic patients.2-4 We describe our experience in managing non-healing post-amputation foot wounds and extensive Fournier’s gangrene gluteal/scrotal wounds in three diabetic patients with multiple comorbidities. The amputation wounds displayed exposed muscle, tendon and bone, as well as osteomyelitis. Patients received antibiotics and debridement, when appropriate, and wounds were treated with several advanced wound care modalities, including NPWT* with and without instillation of normal saline (10-minute dwell times and 2-3 hours of NPWT)Ɨ, oxidized regenerated cellulose (ORC)/collagen/ORC-silver dressings Ɨ Ɨ, and hyperbaric oxygen therapy, throughout the continuum of care in inpatient and outpatient settings. All patients were male, and the average age was 56. In cases of adequate glucose control of the patient and offloading of the wound, use of NPWT resulted in enhanced granulation tissue formation and wound volume reduction. Negative pressure wound therapy modalities may be considered an important tool in the holistic care of difficult wounds in diabetic patients.
*V.A.C.® Therapy (KCI, now part of 3M Company, San Antonio, TX)
Ɨ V.A.C. VERAFLO™ Therapy (KCI, now part of 3M Company, San Antonio, TX)
Ɨ Ɨ PROMOGRAN™ Matrix Wound Dressing (KCI, an ACELITY company, San Antonio, TX)
1. Okonkwo UA, DiPietro LA. Diabetes and Wound Angiogenesis. Int J Mol Sci. 2017 Jul 3;18(7).
2. Cole WE. Use of Multiple Adjunctive Negative Pressure Wound Therapy Modalities to Manage Diabetic Lower-Extremity Wounds. Eplasty. 2016 Dec 20;16:e34. eCollection 2016.
3. Armstrong DG, Lavery LA; Diabetic Foot Study Consortium. Negative pressure wound therapy after partial diabetic footamputation: a multicentre, randomised controlled trial. Lancet. 2005 Nov 12;366(9498):1704-10.
4. McElroy EF. Use of negative pressure wound therapy with instillation and a reticulated open cell foam dressing with through holes in the acute care setting. Int Wound J. 2019 Jun;16(3):781-787.