Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2015; 6(4): 387-393
Published online May 18, 2015. doi: 10.5312/wjo.v6.i4.387
Management of negative pressure wound therapy in the treatment of diabetic foot ulcers
Marco Meloni, Valentina Izzo, Erika Vainieri, Laura Giurato, Valeria Ruotolo, Luigi Uccioli
Marco Meloni, Valentina Izzo, Erika Vainieri, Laura Giurato, Valeria Ruotolo, Luigi Uccioli, Department of Medicina dei Sistemi, University of Tor Vergata, 00133 Roma, Italy
Author contributions: Meloni M and Uccioli L defined the study design; Meloni M, Izzo V and Uccioli L made critical revisions related to intellectual content of the manuscript; all the authors approved the final version of the manuscript.
Conflict-of-interest: Authors declare they have no conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Marco Meloni, MD, Department of Medicina dei Sistemi, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
Telephone: +39-06-20900359 Fax: +39-06-209024977
Received: November 21, 2014
Peer-review started: November 30, 2014
First decision: December 26, 2014
Revised: March 4, 2015
Accepted: April 1, 2015
Article in press: April 3, 2015
Published online: May 18, 2015

Diabetic foot (DF) is a common complication of diabetes and the first cause of hospital admission in diabetic patients. In recent years several guidelines have been proposed to reinforce the the management of DF with a notable increase in diabetes knowledge and an overall reduction of amputations. Significant improvements have been reached in the treatment of diabetic foot ulcers (DFUs) and nowadays clinicians have several advanced medications to apply for the best local therapy. Among these, negative pressure wound therapy (NPWT) is a useful adjunct in the management of chronic and complex wounds to promote healing and wound bed preparation for surgical procedures such as skin grafts and flap surgery. NPWT has shown remarkable results although its mechanisms of action are not completely understood. In this paper, we offer a complete overview of this medication and its implication in the clinical setting. We have examined literature related to NPWT concerning human, animal and in vitro studies, and we have summarized why, when and how we can use NPWT to treat DFUs. Further we have associated our clinical experience to scientific evidence in the field of diabetic foot to identify a defined strategy that could guide clinician in the use of NPWT approaching to DFUs.

Keywords: Diabetes, Diabetic foot, Negative pressure wound therapy, Advanced medication, Wound healing

Core tip: This paper represents a summary of the mechanism of action of negative pressure wound therapy and its effectiveness. Further, according to scientific findings and our experience, we propose a flow chart about its use addressed to the field of diabetic foot.