Effectiveness and Safety of Negative-Pressure Wound Therapy for Diabetic Foot Ulcers

Background: The authors conducted a meta-analysis to evaluate the effectiveness and safety of negative-pressure wound therapy for diabetic foot ulcers. Methods: PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies published up to February of 2013. All randomized controlled trials comparing negative-pressure wound therapy and non–negative-pressure wound therapy (i.e., standard wound care) for diabetic foot ulcers were included. Results were pooled using meta-analysis to assess the efficacy and safety of negative pressure in managing diabetic foot ulcers. Results: The databases were derived from eight qualified studies that included a total of 669 patients. Overall, compared with the non–negative-pressure wound therapy–treated diabetic foot ulcers, negative pressure resulted in a significantly higher proportion of healed ulcers (relative risk, 1.52; 95 percent CI, 1.23 to 1.89; p < 0.001), more reduction of ulcer area (standardized mean difference, 0.89; 95 percent CI, 0.41 to 1.37; p = 0.003), and shorter time to wound healing (standardized mean difference, −1.10; 95 percent CI, −1.83 to −0.37; p = 0.003). Negative-pressure wound therapy patients also experienced significantly fewer major amputations (relative risk, 0.14; 95 percent CI, 0.04 to 0.51; p = 0.003), but the rate of minor amputations was not affected (p = 0.837). No significant difference was observed between negative-pressure wound therapy and non–negative-pressure wound therapy (p = 0.683). No heterogeneity among studies was detected. Conclusion: Negative-pressure wound therapy appears to be more effective for diabetic foot ulcers compared with non–negative-pressure wound therapy, and has a similar safety profile. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.