To investigate the effectiveness of the closed negative pressure closure (VAC) technique in the treatment of diabetic foot. Methods Systemic treatment such as anti-infection, hypoglycemia and local debridement were applied, and the wound was treated with VAC until the granulation was filled and the wound healed. Results: In 12 patients with diabetic foot of Wagner grade 2-4, after 1-4 courses of VSD treatment, the wound granulation tissue was fresh and flat, without infection, edema and exudation, and the exposed bones and tendons were covered by granulation tissue, and the average healing time of the wound was (20.8±5.3)d, which was significantly shorter than the average healing time of conventional dressing change [(29.6±6.3)d]. Conclusion VAC treatment of diabetic foot can shorten the wound healing time and reduce the treatment cost.
The diabetic foot is a diabetic patient with a combination of neuropathy and various degrees of peripheral vasculopathy resulting in lower extremity infection, ulcer formation, and/or deep tissue destruction. Diabetic foot is one of the major chronic complications of diabetes mellitus, with high incidence and amputation rate up to 40%, and its amputation rate is 25 times more than other causes, often occurring in patients with long duration and long-term uncontrolled disease, difficult to treat, huge medical expenses, poor prognosis, and the resulting social and economic burden is heavy. It is of great clinical importance to actively explore some simple and easy techniques to promote diabetic foot healing and improve the outcome. We used VAC to treat 12 patients with diabetic foot from 2009 to May 2011 and achieved good results, and the treatment methods and results are reported below.
Data and Methods
I. General information
There were 14 cases in this group, 8 males and 6 females; age ranged from 50 to 79 years old, with an average of 61 years old. All of them had a history of diabetes mellitus for more than 8 years, and all 14 cases met the diagnosis of diabetic foot according to the Diagnostic Criteria for the Diagnosis and Treatment of Diabetic Foot and Related Complications.
Inclusion criteria: patients who met all of the following conditions.
(1) Age ≥ 18 years.
(2) Suffered from diabetic foot ulcers, all graded as grade 2 or above according to the 1981 Wagner grading method.
(3) Good blood supply to the affected foot. Ankle-brachial index ≥ 0.7 and < 1.2. Exclusion criteria: Patients with one of the following.
(1) Foot ulcers due to trauma, venous insufficiency, or vascular disease.
(2) Cancerous ulcers or ulcer malignancy.
(3) Untreated cellulitis or osteomyelitis.
(4) Those who are receiving corticosteroids, immunosuppressants and chemotherapy.
(5) Difficult to control hyperglycemia (glycosylated hemoglobin HbA1c>12%).
(6) Those who are receiving dialysis treatment. Using 12 other patients with similar site trauma admitted to our department in 2009 as the control group, routine dressing changes were made once a day, and gauze impregnated with scopolamine, insulin and sensitive antibiotics was applied externally to the trauma surface.
II. Medical materials
Medical foam material: Vacuseal (Polymedics, NV, Belgium), the main component is polyvinyl alcohol, shaped like sponge foam, with 0.3-0.6 mm microporous, white, non-toxic, non-immunoactive, corrosion-resistant, with strong adsorption and water permeability, soft and strong resistance to tension, can be trimmed according to the size of the wound. Multilaterally perforated rigid silicone drainage tube: 8 mm in diameter, embedded in polyvinyl alcohol sponge.
Negative pressure drainage device: ward center negative pressure drainage device with a negative pressure of 125 mm Hg (1 mm Hg = 0.133 kPa) or self-contained negative pressure drainage device (B. Braun, Germany), capable of generating a maximum negative pressure of 80 kPa, easy to carry and does not interfere with the patient’s bedside activities. Bio-permeable film (3M, USA), which is larger than Vacuseal and completely covers the surface of Vacuseal, has good oxygen and moisture permeability, can waterproof and prevent bacterial invasion, and observe the sponge foam drainage.
III. Treatment method
Thorough local debridement, along with cleaning the skin around the ulcer to ensure it is free of grease and dirt. Cover the skin around the ulcer with a protective patch or gel. A foam dressing is cut to the size of the ulcer and a flat, laterally perforated drainage tube is placed in the center. The foam dressing is placed inside the ulcer. Place dressings on all wounds, leaving no dead space, especially fistulas and sinus tracts. For fistulas, the inner opening should be closed and then treated, and the dressing drainage tube should be extended to the end of the sinus tract.
Cover the dressing surface with a biological patch. It is important to ensure that there is no air leakage. Then connect the drainage tube, connecting tube, drainage bottle, and filter to the negative pressure pump. Set the negative pressure parameters to ensure that there are no air leaks and then turn on the machine. The negative pressure is set at 80-100mmHg below the air pressure. common cycle setting: start for 5min, stop for 2min. intermittent negative pressure allows the tissue to relax one after another, which can maintain good blood flow for a long time and achieve better results. Time of dressing change: if the ulcer is covered with sponge, the dressing is changed once in 5-7 days; chronic non-infected wounds are changed once in 5-7 days, and those with obvious infection and much exudation are changed once in 3-4 days.