Effectiveness and safety of negative-pressure wound therapy for diabetic foot ulcers: a meta-analysis.

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.