Negative Pressure Wound Therapy in the Treatment of Complicated Wounds of the Foot and Lower Limb in Diabetic Patients: Case Series and Literature Review

Diabetic foot related diseases represent a global health problem because of the complications, risk of amputation and not at least because the economic burden on the health systems. Diabetic foot related diseases are often chronic and infected wounds that need a multidisciplinary approach. Negative pressure wound therapy (NPWT) is a technique that uses sub-atmospheric pressure to help promote the wound healing by reducing the inflammatory exudate keeping the wound moist, inhibit bacterial growth and promoting the granulation tissue. The aim of this paper was to appreciate the role of NPWT to avoid a major amputation in diabetic patients with foot lesions of soft tissue infection of the lower limb and comparing with the existing literature. We analyzed retrospectively the patients with diabetic foot related disease treated by negative pressure wound therapy by a single teem in the last 15 years. 30 patients treated by NPWT were identified of which 27 had lesions of the foot and 3 had soft tissue extensive infections of the lower limb. Major amputations were performed in 5 (16,6%) cases because of failure of the primary lesion treatment, one patient died and 24 (80%) had a favorable outcome. Reviewing the literature, we found that many studies favor the NPWT to standard wound care due to higher and faster healing rates, but when they were analyzed to-gether, in meta-analyses studies, multiple factors of errors were found which confer only a low-certainty evidences of NPWT efficiency. In conclusion even is still very hard to obtain an undeniable statistical proof of the effi-ciency of NPWT in diabetic foot lesions it remains a very useful tool for these patients. A correct use combined with ethological treatment may offer a maximum chance to avoid a major amputation for the patients with diabetic related foot diseases.