Srivastava Vivek, Meena Ram Niwas, Pratap Arvind, Verma Awgesh Kumar, Ansari Mumtaz Ahmad, Mishra Shashi Prakash
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
J Family Med Prim Care. 2022 Nov;11(11):7001-7007. doi: 10.4103/jfmpc.jfmpc_72_22. Epub 2022 Dec 16.
Negative pressure wound therapy (NPWT) is the treatment of choice for diabetic foot ulcers (DFUs), and the role of NPWT in the management of DFU is limited. The aim of the study was to compare the effects of NPWT versus conventional dressing (CD) on wound healing in DFU.
A total of 55 patients were included and divided into two groups: 23 patients were treated with NPWT and 32 patients with CD. The NPWT dressings were changed every 7 days, while the CDs were changed daily. Wound culture sensitivity, wound size, granulation tissue, and pain evaluation (assessed by Visual Analog Scale) were all measured at the start and 3 weeks or until the ulcer was healed. The wound margin temperature was measured at four random sites for thermometric evaluation, and normal limb temperature was also measured for comparison. Patients' satisfaction and treatment costs were also compared.
On days 14 and 21, the wound size was reduced significantly in the NPWT group ( < 0.001 and < 0.001, respectively). The percentage reduction in wound size from baseline to days 7, 14, and 21 was significantly higher in the NPWT group ( = 0.013, = 0.001, and = 0.029, respectively). On days 7, 14, and 21, the granulation tissue score was significantly higher in the NPWT group ( = 0.001, = 0.001, and < 0.001, respectively). On days 14 and 21, the mean VAS score was significantly low in the NPWT group ( < 0.001 and < 0.001, respectively). The majority of wounds in the NPWT group were sterile on day 21 compared to those in the CD group ( = 0.008). The majority of patients in the NPWT group had excellent patient satisfaction ( < 0.001). The average material cost was significantly higher in the NPWT group ( = 0.001). The mean wound temperature of the affected limb was significantly higher compared to that of the unaffected limb ( < 0.001).
In terms of early formation of granulation tissue, faster wound size reduction, less discomfort, and patient satisfaction, the study indicated that NPWT appeared to be superior. An initial rise in temperature in a DFU may indicate the presence of a pre-ulcerative lesion.
负压伤口治疗（NPWT）是糖尿病足溃疡（DFU）的首选治疗方法，且NPWT在DFU管理中的作用有限。本研究的目的是比较NPWT与传统敷料（CD）对DFU伤口愈合的影响。
共纳入55例患者，分为两组：23例患者接受NPWT治疗，32例患者接受CD治疗。NPWT敷料每7天更换一次，而CD每天更换。在开始时以及3周或直至溃疡愈合时，均测量伤口培养敏感性、伤口大小、肉芽组织和疼痛评估（通过视觉模拟评分法评估）。在四个随机部位测量伤口边缘温度以进行温度评估，同时也测量正常肢体温度以作比较。还比较了患者满意度和治疗费用。
在第14天和第21天，NPWT组的伤口大小显著减小（分别为P<0.001和P<0.001）。从基线到第7天、第14天和第21天，NPWT组伤口大小的减小百分比显著更高（分别为P = 0.013、P = 0.001和P = 0.029）。在第7天、第14天和第21天，NPWT组的肉芽组织评分显著更高（分别为P = 0.001、P = 0.001和P<0.001）。在第14天和第21天，NPWT组的平均视觉模拟评分（VAS）显著更低（分别为P<0.001和P<0.001）。与CD组相比，NPWT组在第21天时大多数伤口无菌（P = 0.008）。NPWT组的大多数患者具有极佳的患者满意度（P<0.001）。NPWT组的平均材料成本显著更高（P = 0.001）。患侧肢体的平均伤口温度显著高于未受影响肢体（P<0.001）。
在肉芽组织的早期形成、伤口大小更快减小、不适更少以及患者满意度方面，该研究表明NPWT似乎更具优势。DFU中温度的初始升高可能表明存在溃疡前病变。
