Comparative Assessment of Negative Pressure Wound Therapy Versus Standard Treatment in Diabetic Foot Ulcers

PURPOSE: The purpose of this systematic and metanalysis was to compare wound healing-related outcomes of negative pressure wound therapy (NPWT) to conventional therapy outcomes (time to granulation tissue formulation, ulcer depth, adverse effects amputation, pain, infection, and bleeding, along with hospital length of stay) for treatment of diabetic foot ulcers (DFU) in adults. METHODS: Systematic review and meta-analysis of pooled data. SEARCH STRATEGY: The electronic databases PubMed, Scopus, Web of Science, and Embase were searched. An artificial intelligence powered (Rayyan), proprietary software was used to retrieve, remove duplicates, and cite studies identified in our search. Two researchers and a conflict referee screened the studies in 2 phases; a title/abstract review, followed by reading all articles in full before identifying 12 studies included in this systematic review and metanalysis. RESULTS: Twelve studies were included in our metanalysis; 8 were clinical trials and 4 were observational studies. The pooled sample in the 8 clinical trials comprised 760 participants; 373 were managed with NPWT and 387 were managed with conventional therapy. No significant difference was observed for ulcer depth (P = .16). However, significant differences were found in mean difference in time to granulation tissue formation (P = .03), rate of amputation, pain (P = .01), infection rates (P = .005), and hospital length of stay (P < .001). The pooled sample evaluated in the 4 observational studies was 222; 100 were managed with NPWT and 122 with CT. Significant differences were found in time to granulation tissue formation (P < .001), amputation rates (P = .04), infection rate (P = .04), and hospital length of stay (P < .001). CONCLUSIONS: NPWT improves time to granulation tissue formation, reduces hospital stay, and the risk of secondary amputations, infections, and pain. Based on these findings we recommend incorporating NPWT as a standard component of DFU management.