Effects of Vacuum-Compression Therapy on Healing of Diabetic Foot Ulcers: Randomized Controlled Trial

By Akbari, Asghar; Moodi, Hesam et al. | Journal of Rehabilitation Research & Development, September-October 2007 | Go to article overview

Effects of Vacuum-Compression Therapy on Healing of Diabetic Foot Ulcers: Randomized Controlled Trial


Akbari, Asghar, Moodi, Hesam, Ghiasi, Fatemeh, Sagheb, Hamidreza Mahmoudzadeh, Rashidi, Homayra, Journal of Rehabilitation Research & Development


INTRODUCTION

Diabetic foot ulcers are common and serious complications of chronic diabetes mellitus [1]. The prevalence of foot ulcers among patients with diabetes is 15 percent [2]. Hospital stays are approximately 60 percent longer among patients with foot ulcers compared with those without ulcers [3].

Diabetic foot ulcers accounts for >50 percent of all nontraumatic lower-leg amputations [4]. Peripheral neuropathy and vascular insufficiency lead to foot ulceration. Diabetes also affects the flow of blood. Generally, poor circulation to the skin can lead to ulcers and infections. These wounds heal slowly or not at all, and amputation of the foot or part of the leg may be needed [3,5]. Effective prevention practices and appropriate interventions should decrease the incidence of foot complications and thereby reduce hospitalizations and lower-limb amputations among individuals with diabetes.

The effects of vacuum-compression therapy (VCT) on the healing of ischemic ulcers have been studied. This procedure involves the Vasotrain-447 (Enraf-Nonius, Rotterdam, the Netherlands), a machine with cycles of vacuum and subsequent compression to increase capillary filling. Use of the machine enhances the delivery of oxygen and nutrients to the wound, which, in turn, facilitates healing [6].

Although current preventive methods and treatment modalities effectively heal foot ulcers, statistics show a high incidence of foot ulcers and amputations in individuals with diabetes [2,4]. Closure of the wound is hampered by both physiological impairments in wound healing and an increased susceptibility to wound infection [3,5,7-8]. Therefore, if impairments are prevented and proper intervention achieved, healing should accelerate and the prevalence of amputations should decrease. On the other hand, only a few studies have examined the effects of the Vasotrain-447 in healing diabetic foot ulcers. Thus, we evaluated the impact of VCT with the Vasotrain-447 on diabetic foot ulcers using the stereological method based on Cavalieri's principle. We hypothesized that the diabetic foot ulcer surface area would decrease from the vacuum-compression effects of the Vasotrain-447.

METHODS

Participants

We recruited 18 subjects with diabetic foot ulcers by performing simple nonprobability sampling and approaching the consultant physician. Patients were selected based on the following inclusion criteria: a diabetic foot ulcer corresponding to grade 2 of the University of Texas Diabetic Foot Wound Classification System (wound penetrating to tendon or capsule, not involving bone or joint) [9-10], no history of deep venous thrombosis, and no hemorrhage in ulcer. Subjects were excluded if they had significant loss of protective sensation, hemorrhage, or vertigo or had not completed their treatment. We assessed sensory status using a biothesiometer (Bio-Medical Instrument Company, Newbury, Ohio) and by applying a Semmes-Weinstein 10 g monofilament (Touch-Test Sensory Evaluator, North Coast Medical, Inc, Morgan Hill, California) to the plantar surface of the foot. Subjects who were unable to detect the monofilament on the plantar surface of the foot or who had a vibrator perception threshold of more than 25 V as measured with a biothesiometer were considered to have a significant loss of protective sensation [10-11]. This single-blind randomized controlled trial was conducted at the Department of Physiotherapy, Razmejo-Moghadam Outpatient Clinic, Zahedan University of Medical Sciences, Zahedan, Iran, in 2006. The purpose of the study and the testing protocol to be used were explained to the subjects. The local ethical committee approved the study, and all patients gave their written voluntary informed consent before participation.

Procedures

We administered a brief questionnaire to obtain each subject's medical history. Subjects were questioned regarding the history of their disease, type of diabetes, duration of diabetes, and site of ulcer. …

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