Ganapathy, N (2020) To Compare the Effectiveness of Continuous Versus Intermittent Negative Pressure Wound Therapy in the Healing of Diabetic Foot Ulcerations. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND: Diabetes mellitus, characterised by hyperglycemia either due to absolute insulin deficiency or relative insulin deficiency is the most common metabolic disorder in general population. There is a total loss of functions of beta cells of pancreas in absolute deficiency that leads to low insulin level resulting in hyperglycemia. The most important complication of diabetes that leads to major mortality and morbidity is diabetic foot ulcer. The metabolic abnormalities that characterise diabetes mellitus particularly hyperglycemia, free fatty acids and insulin resistance provoke macrovascular and microvascular complications which may lead even a trivial trauma in foot to end in major amputation. Nearly 25% of diabetic patients are prone to develop foot ulcer during their lifetime wherein the etiologies may be either arterial, neuropathy, pressure sore and foot deformity. The mainstay of diabetic foot ulcer therapy is debridement of all necrotic tisues, callus and fibrous tissue with a primary goal to obtain wound closure. Negative pressure wound therapy (NPWT) is a newer noninvasive system that uses controlled negative pressure using vacuum assisted closure (VAC) devices to help promote wound healing by macro – deformation and microdeformation of tissues, reducing edema, promoting formation and perfusion of granulation tissue and stabilisation of wound environment.This study aims at comparing the effectiveness of continuous versus intermittent negative pressure wound therapy in the healing of diabetic foot ulcerations in terms of wound assessment by Bates-Jensen wound assessment scale at Madras Medical College and Ragiv Gandhi Government General Hospital. MATERIALS AND METHODS: This is a randomized control study to compare the effectiveness of continuous versus intermittent negative pressure wound therapy in the healing of diabetic foot ulcerations in terms of wound assessment by Bates Jensen wound assessment scale. Totally 60 patients are taken up in the study,Continuous NPWT (control) Even IP no. 30 patients and Intermittent NPWT (cases) Odd IP no. 30 patients. INCLUSION CRITERIA: All diabetic foot ulcers with Patients aged between 20 years and 70 years Grade 1 or 2 ulcers (as defined by Wagner’s classification Ulcer area ranging between 25cm and 200cm EXCLUSION CRITERIA: Age < 20 years or > 70 years An obvious septicaemia Osteomyelitis Wounds resulting from venous insufficiency Malignant disease in a wound Patients being treated with corticosteroids, immunosuppressive drugs or chemotherapy Any other serious pre existing cardiovascular, pulmonary and immunological disease • SUMMARY Diabetes incidence is increasing worldwide, particularly in India. Diabetes foot ulcer is one of the preventable disease with proper foot care, hygiene and footwears. Though ulcers occurs it can be healed by newer modalities like NPWT.Present study conducted at MMC/RGGGH concluded that NPWT (continuous and intermittent) has a definite role in management of diabetic foot ulcers.DFS is more common in males between 50-60yrs.Males to female ratio is 3:1. Wound closure rates are at a higher proportion of about 33.3% in intermittent VAC as compared to 26.7% in continuous VAC group and subsequently the wound culture (no growth) rates are attained 53.6 % in intermittent VAC group as compared to 41.4% in continuous VAC group. CONCLUSION The most common complication of diabetes is diabetic foot syndrome, if not treated properly at time leads to fatality. So many therapies are available to heal ulcers effectively along with glycemic control. Among these NPWT (intermittent and continuous) has shown promising results in the past studies.In our study, controls received continuous VAC therapy and cases received intermittent VAC therapy. Cases have 33.3% wound closure rates on Day 6 compared to 26.7% wound closure rates in control group.Hence we conclude that, although the wound closure rates are higher in VAC therapy, there is a slightly higher proportion of wound closure rates in intermittent VAC group as compared to Continuous VAC group favouring the application of Intermittent VAC therapy in the healing of diabetic leg ulcers.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221711006 |
| Uncontrolled Keywords: | Diabetic foot syndrome, Negative pressure wound therapy(continuous & intermittent), Bates Jensen wound score, Wagner Grading, Vacuum assisted closure. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 00:19 |
| Last Modified: | 09 Feb 2021 00:19 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13929 |
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