Guidelines regarding negative wound therapy (NPWT) in the diabetic foot.

The purpose of these guidelines is to the summarize consensus of a multidisciplinary expert advisory panel convened to determine appropriate use of negative pressure wound therapy (NPWT), also known as Vacuum-Assisted Closure or V.A.C. Therapy, in the treatment of diabetic foot wounds. The Tucson Expert Consensus Conference (TECC) on V.A.C. Therapy was convened in an effort to guide the direction for future research either to confirm or refute current consensus while providing practical guidance to the clinician currently treating diabetic foot wounds. The consensus committee discussed and commented on the following ten key questions regarding NPWT: 1) How long should NPWT be used in the treatment of a diabetic foot wound? 2) Should NPWT be applied to a wound that has not been debrided? 3) How should the patient using NPWT be evaluated on an outpatient basis? 4) When should NPWT be applied following lower-extremity bypass? 5) When should NPWT be applied after incision and drainage of infection? 6) How should NPWT be used in patients with osteomyelitis? 7) How should nonadherence (i.e., noncompliance) be defined in the patient on NPWT? When should NPWT be discontinued in this population? 8) How should NPWT be used in combination with other modalities? 9) Should small, superficial, noninfected wounds be considered for NPWT? 10) How should we define success in future studies of NPWT?