Case reports


Managing diabetic foot ulceration with a new, highly portable NPWT device


Authors: Teresa Awad, Martyn Butcher


This article examines the use of highly portable negative pressure wound therapy (NPWT) in the management of diabetic foot ulceration, a significant sequelae of diabetes that affects some 61,000 people in the UK at any given time. NPWT is a non- invasive therapy that uses controlled sub-atmospheric pressure in a closed system applied to a wound to promote healing. Conflict of interest: one of the authors is an independent consultant working on behalf of Spiracur Ltd.


INTRODUCTION In 2010, 2.3 million people in the UK were registered as having diabetes, with 3.1 million estimated as having the condition[1]


Page points


1. It is estimated that more than 4.6 million people in the UK will have diabetes by 2030


2. In 2010–11, the NHS in England spent an estimated £639m–£662 on diabetic foot ulceration and the management of its complications


3. Generally poor healing outcomes appear to make the use of new technologies as an adjunct to ‘best


practice’ reasonable when managing diabetic foot ulceration


foot ulceration and the management of its complications[1]


. . However,


the incidence is rapidly rising and by 2030 it is estimated that more than 4.6 million people will have the condition[1]


. Foot ulceration is seen as


one of the most significant sequelae of diabetes, which, for some, even with good preventative and treatment care, is a frequent occurrence. Currently, it is estimated that there are around 61,000 people with diabetic foot ulceration at any given time. It is estimated that around 6,000 people with


diabetes undergo leg, foot or toe amputation each year in England alone[2]


, with the risk of lower


extremity amputation for people with diabetes more than 20 times greater than that of individuals without diabetes[2]


. Ulceration and amputation


substantially reduce quality of life and are associated with high mortality[2]


. Foot ulceration places a significant financial


burden on healthcare and social care agencies. The inability for an individual to work has multiple economic effects — they are no longer able to financially support their families, they no longer contribute to national productivity and so deplete the job market and the Inland Revenue of tax contributions, while the lack of paid employment places an increased demand on social funding. In addition, diabetes management and


the treatment of diabetic foot ulceration can represent a significant cost to healthcare providers. Diabetic foot ulceration develops in about 15% of individuals with diabetes, and foot disorders are a leading cause of diabetes-related hospitalisation[3][4]


spent an estimated £639m–£662m on diabetic 40 Wounds International Vol 3 | Issue 3 | ©Wounds International 2012


MANAGEMENT The National Institute for Health and Clinical Excellence (NICE) states that key elements within the management of diabetic foot ulceration are assessment, investigation and multidisciplinary intervention[5]


. Management of any vascular and infection


issues must be addressed if successful healing outcomes are to be assured. Worryingly, even if bioburden can be managed and vascularisation can be optimised, healing rates for chronic diabetic foot ulcerations are slow; in a meta-analysis of five prospective diabetic foot ulceration trials, Margolis et al (2000)[6]


reported an aggregated healing rate


of 24% after 12 weeks and 31% after 20 weeks of standard treatment. This means that after 20 weeks of ‘standard treatment’ approximately 70% of diabetic foot ulcerations remain unhealed. Failure of a wound to heal may be due to


the presence of wound bioburden or itself may provide an environment in which wound bioburden becomes pathogenic[7]


. Given the poor


state of host immune response seen in diabetic individuals[8]


, and the high risk of poor outcomes


when this occurs, it appears reasonable to utilise new technologies as an adjunct to ‘best practice’ to achieve optimum outcomes when managing diabetic foot ulceration. One of these adjuncts is negative pressure wound therapy (NPWT). Despite the recent NICE guidance on the in- patient management of diabetic foot ulceration[5]


. In 2010–11, the NHS in England


,


which states that NPWT should only be used as part of a clinical trial or as a rescue therapy to prevent amputation, it could be argued that timely


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