Monday, December 28, 2009

Negative pressure wound therapy shows a 97.8% limb-salvage rate for diabetic feet

Of the salvaged limbs, the investigators found that 31% healed without undergoing any amputation.
By Gina Brockenbrough
Negative pressure wound therapy used in combination with debridement and/or partial foot amputation may lead to successful limb salvage in patients with severe diabetic foot infections.
“Our results indicate that negative pressure wound therapy (NPWT) can be a useful adjunct to the management of limb threatening diabetic infections and presents an excellent limb-salvage rate and few complications,” Bom Soo Kim, MD, said during his presentation at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society.

Study demographics

Kim and his colleagues retrospectively reviewed 45 diabetic feet with limb-threatening infections that underwent debridement and/or partial amputation and NPWT using a VAC system (Kinetic Concepts, Inc.). Patients with a continued poor prognosis had a repeat debridement and VAC application and/or underwent a subsequent major amputation.

The patients had a mean age of 59.9 years and were followed for 17 months after wound healing.
They found that the VAC system was applied for a mean of 26 days and that the median time to greater than 75% wound area granulation was 23 days, and the mean time to complete wound healing was 104 days.
They noted one failure which occurred in a patient who had pneumonia and was bedridden for 7 months. During this time, the patient experienced wound deterioration, a mixed infection and a gangrenous change on his heel. The patient subsequently underwent a below-the-knee amputation.
“Overall, successful limb salvage was achieved in 97.8% of cases,” Kim said. “After removing the VAC therapy system, 43% of cases healed without further operations, and 35% of cases required further partial amputations.” Overall, patients had an average of 2.4 operations per limb.

Cost effectiveness

W. Brett Smith, DO, noted that vacuum-assisted closure dressings are helpful for complex wounds, but questioned the cost effectiveness of using these systems.
“We have this explosion of disease and there is no real emphasis right now into what is the best cost-effective way of treating diabetic patients,” he said.
Kim responded, “If you think about the total duration of the treatment until the complete healing, it is more cost effective using the VAC [to] heal the wounds faster.”
For more information:
  • Bom Soo Kim, MD, can be reached at Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-gu, Seoul, 120-752, South Korea; 02-2228-2204;
  • W. Bret Smith, DO, can be reached at Moore Orthopaedics, 104 Saluda Pointe Dr., Lexington, SC, 29072; 803-227-8178. Neither source has any direct financial interest in any products or companies mentioned in this article.
  • Kim BS, Lee JW, Choi WJ, et al. Limb salvage in severe diabetic foot infection using negative pressure wound therapy. Presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 15-18, 2009. Vancouver, British Columbia.