Use of Multiple Adjunctive Negative Pressure Wound Therapies Across the Continuum of Care in Deep, Complex Wounds of Diabetic Patients

Complications of diabetes mellitus type II involve numerous factors, including poor wound healing, chronic ulceration, and ensuing limb amputation. Impaired wound healing in diabetic patients is caused by multiple local and systemic factors that require a multidisciplinary treatment approach for effective wound management.

Wounds with deep tissue loss are often further complicated by soft tissue infection and osteomyelitis. In addition to debridement, systemic antibiotics, and addressing underlying wound causes, adjunctive use of negative pressure wound therapy (NPWT) with and without instillation has been successful to treat deep, complex wounds of diabetic patients. We describe our experience in managing nonhealing post-amputation foot wounds and extensive Fournier’s gangrene gluteal/scrotal wounds in three diabetic patients with multiple comorbidities.

The amputation wounds displayed exposed muscle, tendon, and bone, as well as osteomyelitis. Patients received antibiotics and debridement, when appropriate, and wounds were treated with several advanced wound care modalities, including NPWT with and without instillation of normal saline (10-minute dwell times and 2–3 hours of NPWT), oxidized regenerated cellulose (ORC)/collagen/ORC-silver dressings, and hyperbaric oxygen therapy throughout the continuum of care in inpatient and outpatient settings.

All patients were male, and the average age was 56. In cases of adequate glucose control of the patient and offloading of the wound, use of NPWT resulted in enhanced granulation tissue formation and wound volume reduction. Negative pressure wound therapy modalities may be considered an important tool in the holistic care of difficult wounds in diabetic patients.