Comparison of two wound negative pressure treatment modes in the treatment of diabetic foot ulcer

Abstract

Objective To compare the therapeutic effects of two wound negative pressure treatments on diabetic foot ulcer. Methods Sixteen patients (10 male, 6 female) with diabetic foot ulcer admitted to the Department of Endocrinology of Guangxi Zhuang Autonomous Region People′s Hospital from April to August 2018 were selected. After comprehensive systemic treatment, wound evaluation and debridement, patients with wound bed suitable for wound negative pressure treatment were randomized into this open label cross-over trial. They were divided into the first vacuum assisted closure (VAC) group (8 cases) and the first vacuum sealing drainage (VSD) group (8 cases). The first VAC group received VAC treatment in the first week, then VSD treatment in the second week. The first VSD group was treated with VSD in the first week and VAC in the second week. The foot ulcer wounds of all the patients were photographed before treatment, after 1 week of treatment, and after 2 weeks of treatment. Changes of ulcer area and granulation tissue area were analyzed using Image J software. Meanwhile, the tissue oxygen partial pressure of the two sites around ulcer were measured with Danish Raydo Percutaneous Oxygen Partial Pressure Analyzer. The changes of ulcer area, granulation tissue area and percutaneous partial pressure of oxygen were compared between two treatments during the first and second weeks of treatment using two-stage cross-design analysis of variance. Results (1) Sixteen patients with diabetic foot ulcer were compared with those before treatment. After treatment, there was significant differences observed including decreased area of ulcer [4.61(3.11) vs 9.51(6.55) cm2, Z=3.517], expandedarea of granulation [4.08 (2.49) vs 0.90 (1.12) cm2, Z=-3.516], and increased values of percutaneous oxygen partial pressure [(54.19±6.91) vs (32.16±10.16) mmHg (1 mmHg=0.133 kPa), (56.75±12.95) vs (30.56±11.93) mmHg, t=-11.814,-14.028] (all P<0.05). (2) Two negative pressure treatments of VSD and VAC had statistical significance on the changes of ulcer area, granulation tissue area and percutaneous partial pressure of oxygen in two lesions of subjects (F=5.763-22.090, all P<0.05). The increasesof percutaneous oxygen partial pressure and granulation tissue area, and reduction in ulcer area after VAC treatment were greater than those after VSD treatment (all P<0.05). (3) No matter which negative pressure treatment was adopted, the increase value of percutaneous partial oxygen pressure in the two sites after the first week of treatment was greater than that after the second week of treatment, and the difference was statistically significant (F=13.254,11.205, both P<0.05). Conclusion VAC is superior to VSD in the improvement of diabetic foot ulcerarea, area of granulation tissue on wound surface and oxygen partial pressure of surrounding tissues, indicating that VAC treatment has more advantages in treating diabetic foot ulcer. Key words: Diabetic foot; Foot ulcers; Blood gas monitoring, transcutaneous; Negative-pressure wound therapy