Negative pressure therapy in diabetic foot wounds.

摘要

David Armstrong and Lawrence Lavery (Nov 12, p 1704)1 should be commended for their effort to assess the effect of negative pressure therapy on foot wounds in diabetes, since there is currently little evidence to support this technique in the management of wounds. However, I have concerns about the study methods and the conclusion that the treatment is safe and effective. The manufacturer of the vacuum-assisted closure device has provided financial support for the study and its main investigators. Clearly, robust methods are of particular importance if a study is not blinded and a conflict of interest potentially exists.Regarding foot wounds, despite randomisation of patients by the sponsor, wound duration was on average 50% greater in the control group than in the treatment group (1-8 months [SD 5-9] vs 1-2 months [3-9])- Was this difference significant? Wounds of longer duration are more prone to infections, including osteomyelitis, and could take longer to heal. How was healing assessed? Was wound depth similar between the two groups?Regarding a second assessment of complete re-epithelialisation of wounds, were the photographs assessed independently?