How Negative-pressure Wound Therapy Has Changed Diabetic Foot Care

Diabetic foot ulcers can form quickly when a patient gets a cut on their foot and doesn’t realize it. The culprit often is neuropathy, a diabetes-related condition that deadens nerve sensation. If the cut is severe or gets infected, it can extend beyond the surface of the skin to form a deep wound, or ulcer.

If left untreated, diabetic foot ulcers can cause severe illness that results in the need for intense therapy, surgery or even amputation. However, an advanced treatment we use called vacuum-assisted closure wound therapy (VAC or negative-pressure wound therapy) has proven effective for treating these ulcers. Data from a May 2015 study in the World Journal of Orthopedics suggest that the therapy is more effective than traditional moist wound treatments.

This therapy has changed how we approach diabetic wound care. It’s given doctors and patients another pathway for healing. While simple in theory, negative-pressure wound therapy is a sophisticated treatment that can help people with severe diabetic sores avoid amputation. But when I tell patients they’re good candidates for this therapy, they sometimes look at me like I’m crazy, saying, “You’re going to put a vacuum on me?” Essentially—yes!

LISTEN: Dr. Elmarsafi discusses negative-pressure wound therapy in the Medical Intel podcast.

How negative-pressure therapy works

The therapy starts with applying a sealed dressing to the wound. Then, we attach an external pump that creates a gentle vacuum effect. This negative pressure increases blood flow to the wound and decreases excess fluid to help the wound heal. We’re also able to use different solutions depending on the type of bacteria that’s growing.

VAC devices are designed to clean wounds and, at the same time, provide an opportunity for deep wounds to fill in with healthy tissue. This process is essential to prevent reinfection and preserve the affected part of the foot. While negative-pressure therapy can help patients avoid amputation, we often perform some minor surgery to thoroughly clean and inspect the wound, especially if we think the bone beneath might be infected.

There are many different types of VAC devices—some are designed specifically for in-hospital use, and others are portable for longer-term use. For the most part, most patients can get around while wearing a device by using crutches, a walker or a knee scooter.

MedStar Washington Hospital Center's Limb Salvage and Wound Care team includes experts in customizing therapies. Patients with complex diabetic ulcers come to us from other centers that have maxed out their abilities and resources to provide advanced care. For example, we saw a patient in 2017 who was told by two hospitals in the D.C. area that he needed a below-knee amputation. Our team not only was able to save his leg but also got him back to work in just two months with negative-pressure wound therapy.

Things to remember during diabetic ulcer treatment

Treatment discussions are never one-size-fits-all. Everyone heals differently, and the location of a wound affects how easily and quickly it can heal. During treatment, we constantly evaluate and tweak the therapy to improve healing. Your doctor will ask you a lot of questions and may recommend lifestyle changes during recovery. It’s important to speak up if you are concerned or if you have questions about your condition or treatment.

One thing that often surprises patients is that negative-pressure wound therapy devices make noise. The devices are made with sophisticated sensors, and these noises are from the device adjusting as it cleans and closes the wound. The devices are relatively quiet, but the noises can change as the wound changes or as the patient moves around. New sounds don’t mean that something isn’t working. The devices also have alarms, so if something does go wrong, you’ll know!

Another important aspect of recovery is self-care. People who have well-controlled diabetes tend to have better outcomes with VAC therapy. These are patients who carefully monitor their blood sugar and routinely examine their feet to look for cuts or wounds so we can prevent them from getting infected.

Related reading: Prevent diabetic foot problems with these easy care practices

With diabetes, nutrition is a delicate balance. We have to be careful with calorie intake, and we have to manage needs related to heart and kidney health. Many of our patients have trouble with all three, so we work as a team with a nutritionist and the patient’s endocrinologist. Regaining limb strength and mobility also is very important for long-term outcomes and quality of life, and our patients see a physical therapist and/or occupational therapist for rehabilitation.

I view my job as being able to provide the patient with the ability to be mobile for as long and as independently as possible. Sometimes that means amputation. But my job also is to prevent amputations, and negative-pressure wound therapy is an effective treatment that helps me do just that for my patients.