Negative-pressure wound therapy for diabetic ischemic foot wounds in hemodialysis patients

Background: The evidence-based recommendations in 2011 state that a negative-pressure wound therapy (NPWT) may be considered as an advanced wound care therapy for lower limb ulceration after successful revascularization. Since the grade of recommendation was determined by six articles which did not study patients with similar wound severity to critical limb ischemia (CLI), we investigated the patients with similar one. Methods: Of the 169 cases who were surgically treated for lower extremity wounds due to CLI between January 1, 2007, and December 31, 2013, nine cases satisfied the following criteria in our institute. There were patients on hemodialysis due to diabetic nephropathy among patients with CLI, and percutaneous transluminal angioplasty (PTA) was performed. These patients had foot gangrene, underwent debridement, and then underwent second-stage midfoot wound closure. Their wounds were completely healed. After performing debridement until the second-stage wound closure surgery, the localized wound therapy without NPWT in three patients (group 1) before health insurance covered NPWT in 2010 and using NPWT in six patients (group 2) thereafter. Results: The mean period until wound closure surgery after debridement was 55.7 ± 11.2 days in group 1 and 31.3 ± 6.6 in group 2. Significant difference in the number of days was observed between the two groups (p = 0.002). Conclusions: Period of time from debridement to the time of wound closure surgery was significantly shortened with NPWT after revascularization by means of PTA in CLI patients. Level of Evidence: Level IV, therapeutic study.