Negative Pressure Wound Therapy in Diabetic Foot Ulcer Management

Diabetic foot ulcers are chronic lesions arising from neuropathy and impaired vascular supply in patients with diabetes, often leading to infection, prolonged hospitalisation and amputation. Negative pressure wound therapy (NPWT) employs a sealed dressing connected to a vacuum device to remove exudate, reduce oedema and promote perfusion. By mechanically deforming the wound bed, NPWT stimulates cell proliferation, angiogenesis and granulation tissue formation, while modulating inflammation and oxidative stress. This integrated approach has transformed management of complex diabetic foot wounds, shortening healing times, lowering complication rates and enabling limb salvage. Current research spans molecular mechanisms in animal and in vitro models to clinical trials comparing NPWT with standard care or adjunctive treatments. Studies also address resource utilisation, risk factors for ulcer morbidity and consensus guidelines for optimal application. Despite variability in pressure settings and dressing protocols, NPWT is recognised as a cornerstone of multidisciplinary diabetic foot care, with global adoption reflecting its impact on patient outcomes and health-care efficiency.

Research from Nature Portfolio

Recent studies have shown that NPWT enhances healing of diabetic foot ulcers by up-regulating peroxiredoxin-2 (PRDX2) in wound margin tissue. Treatment elevated PRDX2 levels, increased antioxidant enzyme activity and glutathione concentration, while reducing lipid peroxidation and inflammatory indicators. Improved PRDX2 expression correlated with accelerated four-week healing rates. In vitro assays demonstrated that heightened PRDX2 mitigates oxidative stress in dermal fibroblasts, promoting their proliferation, migration and survival. These findings underscore a redox-regulated mechanism by which NPWT fosters tissue repair in diabetic wounds.

Negative Pressure Wound Therapy in Diabetic Foot Ulcer Management publication trend

The graph below shows the total number of articles in negative pressure wound therapy in diabetic foot ulcer management across all publications each year (not limited to Nature Index journals).

Technical terms

Negative pressure wound therapy (NPWT): A method using a sealed wound dressing connected to controlled vacuum to remove fluid, reduce oedema and stimulate healing.

Diabetic foot ulcer (DFU): A chronic skin lesion on the foot of a person with diabetes, caused by neuropathy and poor blood flow, prone to infection and slow healing.

Peroxiredoxin-2 (PRDX2): An antioxidant enzyme that reduces oxidative stress and supports cell survival during wound repair.

Re-epithelialisation: The process by which epidermal cells migrate and proliferate to restore the skin barrier over a wound.

Platelet-rich plasma (PRP): A blood plasma fraction enriched in platelets and growth factors, used to boost tissue regeneration.

References

1. Deciphering Early-Stage Molecular Mechanisms of Negative Pressure Wound Therapy in a Murine Model. International Journal of Molecular Sciences (2024).
2. Negative pressure wound therapy promotes wound healing of diabetic foot ulcers by up-regulating PRDX2 in wound margin tissue. Scientific Reports (2023).
3. Consensus on the application of negative pressure wound therapy of diabetic foot wounds. Burns & Trauma (2021).
4. Risk factors for diabetic foot ulcers mortality and novel negative pressure combined with platelet-rich plasma therapy in the treatment of diabetic foot ulcers. Frontiers in Pharmacology (2022).
5. NPWT resource use compared with standard moist wound care in diabetic foot wounds: DiaFu randomized clinical trial results. Journal of Foot and Ankle Research (2022).