Negative pressure wound therapy (NPWT) is superior to conventional moist dressings in wound bed preparation for diabetic foot ulcers: A randomized controlled trial

Yin Wu; Gan Shen; Chao Hao

doi:10.15537/smj.2023.44.20230386

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Figure 1
- A Kaplan‒Meier plot and histological analysis. (A) A Kaplan‒Meier plot demonstrated that patients in the NPWT group had less time to STSG surgery. X axis: time to STSG surgery (day), Y axis: cumulative event. (B) Representative CD31 immunohistochemical staining for granulation tissues (original magnification ×200). (C) Representative Masson staining for collagen fibers (original magnification ×200). NPWT: negative pressure wound therapy, STSG: split thickness skin graft
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Figure 2
- The wound blood perfusion. (A) The wound blood perfusion image. (B) The wound blood perfusion. X axis: time points (day), Y axis: perfusion (LSCI). *P=4.6×10^-4. (C) The blood vessel diameters of DFU wounds. X axis: time points (day), Y axis: µm. *P=1.2×10-4. (D) The blood flow velocity of DFU wounds. X axis: time points (day), Y axis: mm/s. *P=3.5×10^-5. LSCI: laser speckle contrast imaging, DFU: diabetic foot ulcer
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Figure 3
- The NET formation in DFU wounds on Day 6. NETs: neutrophil extracellular traps, DFU: diabetic foot ulcer, NE: neutrophil elastase, MPO: myeloperoxidase
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Figure 4
- M1 and M2 macrophages. (A) The M1 macrophages. (B) The M2 macrophages. (C) The M1 macrophages percentage in DFU wounds. X axis: Time points (day), Y axis: percentage. *P=1.5×10-4. (D) The M2 macrophages percentage in DFU wounds. X axis: yime points (day), Y axis: percentage. *P=2.3×10-5. DFU: diabetic foot ulcer.

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Table 1

- Demographics of patients in the 2 groups.

Characteristics	Control group (n=50)	NPWT group (n=50)	P-value
Gender, n (%)			0.545
Male	27(54)	30(60)
Female	23(46)	20(40)
Age (years)	66.2±6.6	64.3±9.0	0.159
Duration of DM (years),	13.1±2.7	13.6±3.1	0.421
Baseline wound area (cm²)	14.0±2.0	14.0±2.5	0.578
Hypertension, n (%)	30(60)	31(62)	0.838
Smoking history, n (%)	20(40)	17(34)	0.534
Wagner grade			0.629
Wagner grade 2	10(20)	12(24)
Wagner grade 3	40(80)	38(76)

NPWT: negative pressure wound therapy, DM: diabetes mellitus.p<0.05 was deemed significant. Chi-squared test and Student’s t test were used for comparing the patient and wound demographics.

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Table 2

- The laboratory variables before and after treatment.

Characteristics	FBG (mmol/L)	HbA1c (%)	CRP (mg/dl)	WBC (×10⁹)	Alb (g/L)	ABI
Control Group (n=50)
D0	11.2±1.5	10.9±1.2	40.8±9.2	14.0±1.6	28.9±3.8	0.7±0.1
D6	11.0±1.4	10.9±1.2	28.8±7.0	12.9±1.2	31.1±3.6	0.7±0.1
NPWT Group (n=50)
D0	10.7±1.7	10.8±1.0	41.6±9.6	13.2±3.3	29.6±4.2	0.7±0.1
D6	10.6±1.8	10.5±0.9	24.1±9.3	9.5±2.0	34.4±4.2	0.7±0.1
mean difference	0.05	-0.26	-5.35	-3.06	2.76	0.01
(95%CI)	(-0.32 to 0.43)	(-0.47 to -0.06)	(-7.44 to -3.26)	(-3.51 to -2.60)	(1.74 to 3.79)	(-0.02 to 0.03)
p value	0.773	0.013	2.0×10^-6	1.1×10^-23	5.8×10^-7	0.923

FBG: fasting blood glucose, HbA1c: glycosylated hemoglobin, CRP: C reactive protein, WBC: white blood cells, Alb: albumin, ABI: Ankle/Brachial Index, NPWT: negative pressure wound therapy, Mean difference: difference (intervention-control) is shown for mean changes from baseline (D6-D0). Analysis of covariance analysis was used to compare the difference of change from baseline between the 2 groups with the baseline value as a covariate, p<0.0083 was deemed significant.