Analysis of Causes of the Failure of NPWT in the Treatment of Diabetic Foot Wounds and Its Countermeasures

ZHANG Xiao-fu; JU Shang; YANG Bo-hua; GAO Yu; CAO Xin; YAN Cheng-cheng; WANG Ning; LIAN Xiao-tong; FAN Xu-xuan; LI Wei-hong; WANG Gang

doi:10.3969/j.issn.1002-3429.2018.07.016

Abstract：Objective To analyze the causes of failure of negative pressure wound therapy ( NPWT) in the treatment of diabetic foot wounds, and to explore preventive measures in order to improve therapeutic effects. Meth-ods The clinical data of 580 patients with diabetic foot who were treated with NPWT in Dongzhimen Hospital of Bei-jing University of Chinese Medicine from January 2012 to December 2016 were analyzed retrospectively. After one course of NPWT treatment, the patients who did not respond to therapies were included in the failure group and those with effective and markedly effective treatment as well as those with clinically healed wounds were included in the success group according to curative effect evaluation based on the Guiding Principles of Clinical Research on New Drugs of Traditional Chinese Medicine. The general conditions, wound-related indicators and indicators related to the whole body before treatment were compared between the two groups. Logistic multivariate regression analysis was used to analyze the factors that had statistical differences. Thus, the factors influencing the failure of NPWT in diabetic foot wounds were investigated. Results Of 580 patients, 36 cases failed in NPWT treatment, mainly due to the ag-gravation of wound infection. Multivariate Logistic analysis showed independent risk factors in treatment failure of dia-betic foot wound by NPWT, including ankle brachial index less than 0. 3, wound infection grade greater than or equal to grade 3, wound with active bleeding, wound granulation coverage less than 25% , and wound skin malignant trans-formation. Conclusion To improve the success rate of NPWT for patients with diabetic foot, it is the key to evaluate the degree of ischemia, infection and debridement as well as the general condition of the patients, and to prepare the wound bed accordingly before applying NPWT.