Case reports
use of this therapy offers significant benefits in preventing diabetic foot ulceration-related amputation. Indeed, despite the guidance, NPWT is viewed by many clinicians as an essential part of the treatment armoury used in diabetic foot ulceration management.
NEGATIVE PRESSURE WOUND THERAPY NPWT has been utilised in the treatment of wounds of differing aetiologies for over 15 years. It is a non-invasive therapy that uses controlled sub- atmospheric pressure in a closed system applied to a wound to promote healing. Despite criticisms that the therapy lacks a comprehensive evidence- base[9]
, it has been the subject of multiple
peer-reviewed clinical trials and case studies and there is a vast amount of clinical data showing the clear benefits of using this therapy in practice[10,11]
. References
1. Diabetes UK. Diabetes in the UK 2010: Key statistics on diabetes. 2010;
Available at:
http://www.diabetes.org.uk/ Documents/Reports/Diabetes_in_the_ UK_2010.pdf (Accessed on 20 August, 2012).
2. NHS Diabetes. Report: Footcare for People with Diabetes: The Economic Case for Change. 2012; Available at:
http://www.diabetes.nhs.uk/document. php?o=3372 (Accessed on 20 August, 2012).
3. Palumbo PJ, Melton LJ III. Peripheral vascular disease and diabetes. In:
Diabetes in America: Diabetes Data Compiled 1984. Washington, DC:
Government Printing Office. 1985; XV–1–XV–21.
4. Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM. Preventive foot care in people with diabetes. Diabetes Care 1998; 21(12): 2161–77.
5. NICE. Diabetic foot problems:
inpatient management of diabetic foot problems. NICE clinical guideline 119. 2011; Available at:
http://www.nice.org. uk/nicemedia/live/1 3416/53556/53556. pdf (Accessed on 20 August, 2012).
6. Margolis DJ, Kantor J, Santanna J, et al. Risk factors for delayed healing of neuropathic diabetic foot ulcers: a pooled analysis. Arch Dermatol 2000; 136: 12, 1531–35.
7. European Wound Management
Association (EWMA). Position Document: Identifying criteria for wound infection. 2005; London: MEP Ltd.
8. Edmonds M, Foster A. The use of
antibiotics in the diabetic foot. Am J Surg 2004; 187(5A): 25S–28S
Many of these studies have included subjects with diabetic foot ulceration.
The reported benefits of using NPWT include[12]
n Increased local blood flow to the wound through increased dilation of arterioles
n Reduced tissue oedema through the removal of excess fluid
n Stimulation of granulation tissue, resulting in progressive wound closure
n Stimulation of cell proliferation n Removal of free radicals from the wound n Removal of slough n Reduction in wound volume n Protection from outside contaminants n Decrease in wound bioburden n Maintenance of a moist wound healing environment.
SNAP The SNaP® device (Spiracur) is a unique highly portable NPWT system which does not rely on external electrical power supply (battery or mains) to operate. The system uses patented integral ‘memory springs’ — a proprietary spring mechanism that generates consistent, even levels of pressure — to drive the unit and achieve sustained sub-atmospheric pressure at pre- determined levels (-75mmHg, -100mmHg and -125mmHg)[13]
Figure 2. Therapy was commenced at -125mmHg and the dressing was covered with a wound pad and retention bandage.
:
Figure 1. High exudate levels and slough leading to peri-wound maceration and excoriation.
device[14] . In the study, SNaP use was associated
with reduced cost of treatment and significantly improved ease of application and use. SNaP is used in conjunction with a dedicated
hydrocolloid film dressing which has an integral drainage tube. This tube can be cut to the desired length for safe and easy placement of the cartridge. The product is available with both foam and antimicrobial (AMD) gauze interface dressing
Figure 3. Exposed tendon is visible.
at the wound interface. This makes
the system silent, light, highly portable, disposable and easy to operate. The system is useful for the treatment of low to moderately exuding wounds (less than 120mls/week). Despite its relative simplicity, a randomised
control trial of 100 patients has demonstrated that treatment with SNaP achieves the same clinical outcomes as a ‘Gold Standard’ electrically-powered
42 Wounds International Vol 3 | Issue 3 | ©Wounds International 2012
Figure 4. The foot at the time of discharge.
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