Use of Vacuum Assisted Closure Therapy in the Treatment of Diabetic Foot Wounds

Diabetic foot disease is a major health problem, which affects up to 15% of the more than 200 million patients with diabetes worldwide and is associated with an increased risk of amputation. VacuumAssisted Closure (V.A.C.®) Therapy has been shown to be effective in the treatment of diabetic foot wounds. In two parallel randomized controlled trials we have evaluated the effectiveness of VAC Therapy in enhancing skin-graft take of diabetic foot wounds (study I) and the effectiveness in treatment of infected open minor amputations (study II). In study I, 70 patients were randomly assigned to either VAC Therapy (V1 group) or coverage of the grafts with non adherent gauze (C1 group). In study II, 130 diabetic subjects were randomized to either surgical debridement and VAC Therapy (V2 group) or surgical debridement and semi-occlusive silver dressing (C2 group). In study I the take rate was 80% in the V1 group versus 68% in the C1 group (p = 0.05). In study II a more rapid development of granulation tissue covering the exposed bone was shown in the V2 group when compared to the C2 group (41±8 vs 59±18 days, p = 0.03). Also a better and more rapid control of the infections (10±8 days in V2 group vs 19±13 days in C2 group; p = 0.05) and reduced time to complete closure of the wound was found with VAC Therapy (65±16 days in V2 group vs 98±45 days in C2 group, p = 0.005). Total time required for surgical procedures was reduced in the VAC group ( 2.5 hours versus 6 hours in the control group, p = 0.02). In conclusion, this study demonstrates that treating diabetic wounds with VAC Therapy can result in a faster wound bed preparation, a faster closure, and in a better graft take rate when compared to standard wound care.