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Review
. 2017 Apr 18:13:533-544.
doi: 10.2147/TCRM.S131193. eCollection 2017.

Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis

Si Liu  1 , Chao-Zhu He  1 , Yan-Ting Cai  1 , Qiu-Ping Xing  1 , Ying-Zhen Guo  1 , Zhi-Long Chen  1 , Ji-Liang Su  1 , Li-Ping Yang  2
Affiliations
Review

Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis

Si Liu et al. Ther Clin Risk Manag. .

Abstract

Objectives: The aim of this study was to perform an updated systematic review and meta-analysis to assess the clinical efficacy, safety, and cost-effectiveness of negative-pressure wound therapy (NPWT) in the treatment of diabetic foot ulcers (DFUs).

Methods: We searched the Cochrane Library, MEDLINE, EMBASE, Ovid, and Chinese Biological Medicine databases up to June 30, 2016. We also manually searched the articles from reference lists of the retrieved articles, which used the NPWT system in studies of vacuum-assisted closure therapy. Studies were identified and selected, and two independent reviewers extracted data from the studies.

Results: A total of eleven randomized controlled trials, which included a total of 1,044 patients, were selected from 691 identified studies. Compared with standard dressing changes, NPWT had a higher rate of complete healing of ulcers (relative risk, 1.48; 95% confidence interval [CI]: 1.24-1.76; P<0.001), shorter healing time (mean difference, -8.07; 95% CI: -13.70- -2.45; P=0.005), greater reduction in ulcer area (mean difference, 12.18; 95% CI: 8.50-15.86; P<0.00001), greater reduction in ulcer depth (mean difference, 40.82; 95% CI: 35.97-45.67; P<0.00001), fewer amputations (relative risk, 0.31; 95% CI: 0.15-0.62; P=0.001), and no effect on the incidence of treatment-related adverse effects (relative risk, 1.12; 95% CI: 0.66-1.89; P=0.68). Meanwhile, many analyses showed that the NPWT was more cost-effective than standard dressing changes.

Conclusion: These results indicate that NPWT is efficacious, safe, and cost-effective in treating DFUs.

Keywords: amputation; complete wound closure; cost-effectiveness; diabetic foot ulcers; meta-analysis; negative-pressure wound therapy.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram for identification of studies for inclusion in meta-analysis. Abbreviation: RCT, randomized controlled trial.
Figure 2
Figure 2
Risk of bias graph. Note: Review authors’ judgments about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Risk of bias summary. Note: Review authors’ judgments about each risk of bias item for each included study.
Figure 4
Figure 4
NPWT compared with standard dressing changes, outcome 1: the complete DFU healing rate. Abbreviations: NPWT, negative-pressure wound therapy; DFU, diabetic foot ulcer; CI, confidence interval; df, degrees of freedom; M–H, Mantel–Haenszel.
Figure 5
Figure 5
NPWT compared with standard dressing changes, outcome 2: time to complete healing of DFUs. Abbreviations: NPWT, negative-pressure wound therapy; DFU, diabetic foot ulcer; CI, confidence interval; df, degrees of freedom; SD, standard deviation; IV, inverse variance.
Figure 6
Figure 6
NPWT compared with standard dressing changes, outcome 3: reduction of DFU area. Abbreviations: NPWT, negative-pressure wound therapy; DFU, diabetic foot ulcer; CI, confidence interval; df, degrees of freedom; SD, standard deviation; IV, inverse variance.
Figure 7
Figure 7
NPWT compared with standard dressing changes, outcome 4: reduction of DFU depth. Abbreviations: NPWT, negative-pressure wound therapy; DFU, diabetic foot ulcer; CI, confidence interval; df, degrees of freedom; SD, standard deviation; IV, inverse variance.
Figure 8
Figure 8
NPWT compared with standard dressing changes, outcome 5: amputation. Abbreviations: NPWT, negative-pressure wound therapy; CI, confidence interval; df, degrees of freedom; M–H, Mantel–Haenszel.
Figure 9
Figure 9
NPWT compared with standard dressing changes, outcome 6: treatment-related adverse events. Abbreviations: NPWT, negative-pressure wound therapy; CI, confidence interval; df, degrees of freedom; M–H, Mantel–Haenszel.
Figure 10
Figure 10
NPWT compared with standard dressing changes, outcome 7: sensitivity analysis. Abbreviations: NPWT, negative-pressure wound therapy; CI, confidence interval; df, degrees of freedom; SD, standard deviation; IV, inverse variance.
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