Negative-pressure wound therapy for diabetic ischemic foot
wounds in hemodialysis patients
Received: 24 November 2015 /Accepted: 8 February 2016 /Published online: 27 February 2016
Springer-Verlag Berlin Heidelberg 2016
Background The evidence-based recommendations in 2011
state that a negative-pressure wound therapy (NPWT) may
be considered as an advanced wound care therapy for lower
limb ulceration after successful revascularization. Since the
grade of recommendation was determined by six articles
which did not study patients with similar wound severity to
critical limb ischemia (CLI), we investigated the patients with
Methods Of the 169 cases who were surgically treated for
lower extremity wounds due to CLI between January 1,
2007, and December 31, 2013, nine cases satisfied the follow-
ing criteria in our institute. There were patients on hemodial-
ysis due to diabetic nephropathy among patients with CLI,
and percutaneous transluminal angioplasty (PTA) was per-
formed. These patients had foot gangrene, underwent debride-
ment, and then underwent second-stage midfoot wound clo-
sure. Their wounds were completely healed. After performing
debridement until the second-stage wound closure surgery, the
localized wound therapy without NPWT in three patients
(group 1) before health insurance covered NPWT in 2010
and using NPWT in six patients (group 2) thereafter.
Results The mean period until wound closure surgery after
debridement was 55.7 ± 11.2 days in group 1 and 31.3 ± 6.6
in group 2. Significant difference in the number of days was
observed between the two groups (p =0.002).
Conclusions Period of time from debridement to the time of
wound closure surgery was significantly shortened with NPWT
after revascularization by means of PTA in CLI patients.
Level of Evidence: Level IV, therapeutic study.
Keywords Critical limb ischemia
Negative-pressure wound therapy
Peripheral arterial disease
In 2000, the V.A.C.
(KCI San Antonio, USA) treatment system,
a negative-pressure wound therapy (NPWT) device, obtained
approval by the Medicare public medical insurance system for
use in the elderly and disabled in the USA . Furthermore, the
V. A . C .
treatment system was used by the US Defense Force
Hospitals in Iraq and Afghanistan and was also in extensive
global publications regarding the usefulness of NPWT .
Through the benefits of living in a technological society, the fact
that NPWT is widely spread throughout the world was already
known to wound treatment specialists, even in Japan, from the
start of 2000. However, these devices were not widely used in
Japan until health insurance covered NPWT in 2010 .
Meanwhile, the number of diabetic patients has increased be-
tween 2000 and 2010, based on a health survey by the
Ministry of Health, Labour and Welfare . The number of
diabetic nephropathy patients on dialysis has increased in parallel
to the increase in diabetic patients. Diabetes mellitus and renal
insufficiency are both risk factors for peripheral arterial disease
(PAD) . A major challenge of medical treatment is also foot
wounds in critical limb ischemia (CLI), a severe form of PAD.
In order to treat diabetic foot ulcers with single-stage sur-
gery, amputation must occur at a site that is free of infection,
and amputation must take place more proximally than the
* Kyoichi Matsuzaki
Department of Plastic and Reconstructive Surgery, Keio University
School of Medicine, 35 Shinanomachi,
Shinjuku-ku, Tokyo 160-8582, Japan
Eur J Plast Surg (2016) 39:353–358