Technology in wound management : is negative pressure wound therapy efficient and safe in treating the diabetic foot.

Abstract

Background: Negative Pressure Wound Therapy (NPWT) is a new technology in the management of wounds that is gaining popularity and challenging Advanced Moist Wound therapy (AMWT) as the preferred treatment of this condition. Although there is to date insufficient evidence to support this innovative therapy in local hospitals it is regularly employed to treat various wounds. Moreover, it has generated great interest among practitioners, especially Tissue Viability Teams. Aims and Objectives: This dissertation evaluates the safety and efficacy of NPWT compared to AMWT in the treatment of the diabetic foot through a systematic evaluation of relevant randomised control trials (RCTs) and systematic reviews (SRs). Methods: PubMed, CINAHL, Cochrane databases, Google Scholar and Google search engine were searched. Search was restricted between the year 2000 and 2011. Out of 826 citations, thirteen publications were identified for the final analysis. These consisted of five RCTs, six SRs, one Case Series study and a Consensus study. The tool used for critical appraisal was the Critical Appraisal Skills Programme (CASP). The trials that compared NPWT to AMWT and evaluated safety and efficacy were included. Cost effectiveness and economic evaluation were excluded. Results: All five RCTs compared NPWT to AMWT and reported positive outcomes. However, the heterogeneity in the methodology of the studies and the diversity in endpoints made their analysis and comparison difficult, thus affecting the results. Data on factors such as the quality of life and the infection rate lacked details or was not reported at all. Four of the studies used the VAC industrial machine by KCI, the manufacturers of the same VAC machine. These might be precluded by sponsorship issues. One RCT used the central suctioning of the hospital. The six SRs were homogenous in their results and all conclude that further research is needed. Conclusion: Whereas NPWT demonstrates positive effects, especially on the post-amputated foot, there is no clear evidence to date that finds that NPWT is safer and more efficacious than AMWT. Considering this lack of evidence, NPWT should be administered with great caution. Moreover, it is recommended that the Central suctioning system of the hospital should be avoided.