Diabetes mellitus (DM) is a chronic condition caused by impaired regulation of blood glucose levels. Normally the hormone insulin regulates blood glucose, but in people with type 1DM, production of insulin no longer occurs. Type 2DM is characterized by cellular
insensitivity to insulin and reduced insulin secretion. In the UK approximately 90%of people with DM have type 2. The severity of foot ulcers in people with DM can be graded using several systems. The Wagner wound classification system was one of the first described and has, historically, been widely used, although it is now rarely used in clinical practice.
Wagner wound classification assesses ulcer depth and the presence of osteomyelitis (bone infection) or gangrene and grades ulcers as: grade 0 (pre- or post-ulcerative lesion), grade 1 (partial/full-thickness ulcer), grade 2 (probing to tendon or capsule), grade 3 (deep with osteitis (inflammation of the bone)), grade 4 (partial foot gangrene) and grade 5 (whole foot gangrene).
Foot ulcers in people with DM have a serious impact on health, related with the quality of life, particularly with respect to physical functioning and role-limitations due to physical and emotional issues. Any intervention that promotes healing, or reduces amputation rates, or both, in foot wounds in people with DM would make an important difference, and several health technologies are marketed as impacting on these outcomes.
In January 2018, for this first Cochrane review was done, searching the Wounds Specialized Register Published or unpublished randomized controlled trials (RCTs) that evaluated the effects of any brand of NPWT in the treatment of foot wounds in people with DM.
There is low-certainty evidence to suggest that NPWT may be effective in healing ulcers compared with wound dressings in terms of the proportion of wounds healed and time to healing. 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. There is low-certainty evidence suggesting NPWT may reduce the risk of amputation, but that there is no clear difference in the number of wounds closed or covered with surgery between the treatment groups.
Authors: Zhenmi Liu and coll.
Newspaper: Cochrane Database Syst Rev. 2018 Oct 17;10(10):CD010318.