LiteratureSynthesis on the Effectiveness of NPWT
LiteratureSynthesis on the Effectiveness of NPWT
American Diabetes Association(2014) posit that nearly approximately 30 million Americans sufferfrom diabetes accounting to close to 10% of the country’s entirepopulace. Individuals with diabetes generally suffer from a host ofco-morbidities that put them at risk for complications such as nervedamage, poor circulation, and infection all of which contribute tothe formation of a DFU. Diabetic foot ulcers (DFU’s) negativelyaffect the welfare of diabetic patients and increase infection,mortality, management expenses and healthcare budgets (Acker, Léger,Hartemann, Chawla, & Siddiqui, 2014). DFU’s present a 70%recurrence rate within five years and result in about 85% of alldiabetic-related amputations (Brad et al., 2013).New incidences imply increasing prevalence rates of diabetesmellitus, which have necessitated the healthcare sector to considerDFU’s as a critical health concern (Armijo, 2014).
At present, standardized care forDFU’s involves glucose control, re-vascularizing ischemic limbs,infection treatment, appropriate debridement, and moist dressingchanges (Seidel et al.,2014). Standard moistdressings are typically the preferred intervention technique formanaging diabetic-related foot lacerations. However, it is believedthat negative pressure wound therapy (NPWT) can result in bettertreatment outcomes as it calls for lower frequency of dressingchanges, induces macro deformation translating to a reduction inlesion size, encourages angiogenesis and granulation, and eliminatesexcess fluid which reduces edema and bacterial colonization rates(Torbrand et al., 2010). Uncontrolled diabetes results in situationswhere standard moist dressings are ineffective due to the bodyfailing to generate desired proteins to promote the healing process(Anderson, Hare, & Perdrizet, 2016).The gravity of this issue has compelled healthcare practitioners aswell as researchers to support NPWT as a technique appropriate formanaging difficult injuries, for instance, surgical, trauma, and footwounds (Brad et al., 2013).Given that the country exhibits a huge diabetic prevalence, it isinherently prudent that effective treatment of DFU’s is availableto patients. Therefore, the PICOT question is,” In diabeticpatients with foot ulcers, how does negative pressure wound therapycompared to standard moist wound therapy affect overall woundhealing?”
The review of literature evidence was obtained from randomizedcontrol trials (RCT) and meta-analysis with a common participantpopulace of adult people with DFU involving those with eitherdiabetes I and II, chronic foot wound or foot ulceration, andpostoperative wounds. Randomized control trials included studies byAkbari et al. (2007), Blume et al. (2008), and Ravari et al. (2013)while the research by Zhang et al. (2014) employed a meta-analysis,which included details of the literature search and a quality ratingscale consistent with the standards of the International CochraneCollaboration. All the fourarticles utilized consisted of explorations that compared theeffectiveness of NPWT to standard moist dressings.
In the evaluation, NPWT wasfound to be more effective, safe, and appropriate in treating DFUthan moist dressings were, as Akbari et al. (2007), Blume etal. (2008), Ravari et al. (2013), and Zhang et al. (2014) assert.Blume et al. (2008) illustrated that NPWT was considerably moreeffective in managing DFU than standard dressing since a great numberof patients (P = 0.001) attained full ulcerative wound closure andgranulation tissue formation than moist dressing participants.Moreover, the median time taken to achieve closure in NPWT wasroughly 96 days, but the researcher failed to estimate properly thetime it took to achieve the same in standard dressings. Akbari et al.(2007) compared the decrease in the DFU using standard and NPWTmethods and realized that the surface area reduced from 46.88cm to35.09 and 46.62 to 42.89 respectively for the experiment group andcontrol group. In this regards, the utilization of NPWT significantlyincreased the curing of non-healing wounds and DFU than conventionaltherapies (Akbari et al., 2007). Ravari et al. (2013) found out thatthe standard dressing did not attain a considerable difference in thesize of the wound (P = 0.1), compared to NPWT, which wasstatistically significant (P = 0.02 surface area decreased from 39.5cm2 to 28.8 cm2).Thus, the variance between the size of the wound in the NPWT andstandard dressing was highly significant (P = 0.03). On the otherhand, Zhang et al. (2014) concluded that NPWT was more effective thanmoist dressing in reducing DFU, took less time to treat, contributedto fewer amputations, and left the patients more satisfied thannon-negative pressure methods. The evidence provided in theliterature reveals that the utilization of NPWT in treating DFU iseffective.
Regarding the GRADE criteria,the RCT studies cultivated strong quality rating with correctintention-to-treat analysis (ITT), dependable research, and directresearch problem. However, explorations by Akbari et al. (2007) andRavari et al. (2013) used inadequate sample size, which meant theyhad a moderate quality scale. It is imperative to note that Ravari etal. (2013) study had imprecision elements, which might have createdhuman errors while Zhang et al. (2014) research lacked homogeneity inevaluating studies. However, the review did not have any other flaws,bias, inconsistency, or indirectness and the existing publicationbias was addressed by Begg’s rank assessment.
From the conclusions made in the studies, it is evident that NPWTshould be applied in treating DFU. Some organizations and policyguidelines, for example, WHO, Cochrane Collaboration, and MedicareDME MAC standards back the usage of NPWT in treating DFU. Theexplorations demonstrate that negative pressure wound method attainsgreat improvements in managing wound ulcers, reduces thehospitalization period, increased patients’ satisfaction, andreduces the chance of amputations thus, it is considerablyeffective. For example, NPWT attained full granulation tissueformation and regeneration quickly and safely (Acker et al., 2014Anderson et al., 2016). This means that the method should be used tosupplement standard moist dressing or as an adjunct to ensureeffective, safe, and quick management of DFU. Although furtherresearch may be needed in evaluating the implications of negativepressure wound therapy on other elements or its effectiveness inmanaging refractory or large wounds, the satisfaction attained bypatients in the studies explored reveal that NPWT is an effectivetherapy in treating DFU. Considering the recommendations presented inthe studies as well as the findings of in assessing control andexperiment groups, it is critical to point out that NPWT should beextensively utilized in non-healing wounds, limb perseveration, andmanaging DFU.
Acker, K., Léger, P., Hartemann, A., Chawla, A., & Siddiqui, M.K. (2014). Burden of diabetic foot disorders, guidelines formanagement and disparities in implementation in Europe: a systematicliterature review. Diabetes/Metabolism Research andReviews, 30(8), 635-645.
Akbari, A., Moodi, H., Ghiasi, F., Sagheb, H. M., & Rashidi, H.(2007). Effects of vacuum-compression therapy on healing of diabeticfoot ulcers: Randomized controlled trial. The Journal ofRehabilitation Research and Development, 44(5), 631.doi:10.1682/jrrd.2007.01.0002
American Diabetes Association. (2014). National diabetes statisticsreport, 2014. Estimates of diabetes and its burden in theepidemiologic estimation methods. NatlDiabetes Stat Rep, 2009-2012.
Anderson, C. A., Hare, M. A., & Perdrizet, G.A. (2016). Wound healing devices brief vignettes. Advancesin Wound Care, 5(4), 185-190. Retrieved 22 February2017 fromhttp://online.liebertpub.com/doi/abs/10.1089/wound.2015.0651.
Armijo, H. (2015). Negative pressure wound therapy versus advancedmoist dressing therapy for treatment of diabetic foot ulcer.University of New Mexico School of Medicine. Retrieved 17September 2017 fromhttps://repository.unm.edu/bitstream/handle/1928/27602/Armijo%20Capstone.pdf?seque
Blume, P. A., Walters, J., Payne, W., Ayala, J., & Lantis, J.(2008). Comparison of negative pressure wound therapy usingvacuum-assisted closure with advanced moist wound therapy in thetreatment of diabetic foot ulcers: A multicenter randomizedcontrolled trial. Diabetes Care, 31(4), 631-636.doi:10.2337/dc07-2196
Brad, R. Desai, U., Cummings, A.K., Skornicki, M., Parsons, N., & Birnbaum, P. H. (2013).Medical, drug, and work-loss costs of diabetic foot ulcers. ISPOR18th Annual International Meeting May 21,2013 New Orleans, LA.
Ravari, H., Modaghegh, M., Kazemzadeh, G., Johari, H., Vatanchi, A.,Sangaki, A., & Shahrodi, M. (2013). Comparison of vacuum-assistedclosure and moist wound dressing in the treatment of diabetic footulcers. Journal of Cutaneous and Aesthetic Surgery, 6(1),17-20. doi:10.4103/0974-2077.110091
Seidel, D., Mathes, T., Lefering, R., Storck, M., Lawall, H., &Neugebauer, E. A. M. (2014). Negative pressure wound therapy versusstandard wound care in chronic diabetic foot wounds: study protocolfor a randomized controlled trial. Trials, 15,334.
Torbrand, C., Ugander, M., Engblom, H., Arheden, H., Ingemansson, R.,& Malmsjö, M. (2010). Wound contraction and macro-deformationduring negative pressure therapy of sternotomy wounds. Journalof Cardiothoracic Surgery, 5(1), 75.
Zhang, J., Hu, Z., Chen, D., Guo, D., Zhu, J., & Tang, B. (2014).Effectiveness and safety of negative-pressure wound therapy fordiabetic foot ulcers. Plastic and Reconstructive Surgery,134(1), 141-151. doi:10.1097/prs.0000000000000275