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NPWT: a gate of hope for patients with diabetic foot ulcers

27 June 2019
Case Report
02 June 2019
Volume 28 · Issue 12

Abstract

Non-healing diabetic foot ulcers are a common and costly complication of type 2 diabetes and can result in lower extremity amputation. This case study concerns a 51-year-old man with a 17-year history of uncontrolled type 2 diabetes. He had developed a deep ulcer to the calcaneus of his left foot, which was 12x7 cm in size and infected with multi-drug-resistant Staphylococcus aureus. He was admitted to hospital for the non-healing diabetic foot ulcer and uncontrollable fever and was a candidate for amputation. He was treated with wound irrigation and debridement as well as negative-pressure wound therapy and antibiotic treatment. This strategy was effective and the wound size reduced progressively. The patient recovered well. Medical and wound care teams who deal with non-healing diabetic foot ulcers can benefit from a strategy of combination therapy.

Diabetes is one of the commonest health problems in the world (Alamdari et al, 2017). Globally, 382 million people were affected with diabetes in 2013; this is expected to rise to 592 million by 2035 (Guariguata et al, 2014). In Iran, approximately 4.5 million people had diabetes in 2011, and this number is predicted to reach 9.2 million people by 2030 (Javanbakht et al, 2015).

Diabetic foot ulcer (DFU) is one of the most devastating and costly complications of diabetes (Rice et al, 2013; Zhang et al, 2014). The lifetime risk of a person with diabetes developing a DFU is estimated to be 10–25% (Zhang et al, 2014). The healing process is impaired in people with diabetes, because of intrinsic factors, such as neuropathy and vascular complications, and extrinsic factors, such as wound infection, excessive pressure at the site and callus formation (Catrina and Zheng, 2016). If DFUs do not heal, this often leads to lower extremity amputations (Yazdanpanah et al, 2015). The incidence of non-traumatic lower extremity amputations in people with diabetic foot ulcers has been reported to be 40–70% (Zhang et al, 2014).

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Negative pressure wound therapy
Foot ulcer
Diabetes
Multi-drug resistance
Staphylococcus aureus
MRSA