Indian Journal of Surgery

, Volume 80, Issue 5, pp 457–460 | Cite as

Resource Utilization and Cost Effectiveness of Negative Pressure Wound Therapy (NPWT) Versus Moist Wound Therapy (MWT) in Management of Diabetic Foot Transmetatarsal Amputation (TMA)

  • Pravin Sakharam NarkhedeEmail author
  • Vivekanand
  • M. Vishnu
  • K. Sumanthraj
  • C. P. S. Sravan
  • Vaibhav Lende
  • Lawish Agarwal
  • K. R. Suresh
Original Article


To evaluate resource utilization and direct economic costs of care for patients treated with negative pressure wound therapy (NPWT) in comparison with standard moist wound therapy (MWT) for preparation of diabetic foot TMA wounds for skin grafting. We retrospectively analyzed 56 patients who underwent transmetatarsal amputation (TMA) for infected diabetic foot from January 2014 to April 2015 at Jain Institute of Vascular sciences (JIVAS), Bangalore. Twenty-eight patients received negative pressure wound therapy (NPWT) (VAC® KCI, TX, USA) dressing while 28 received standard MWT daily. Resource utilization, revascularization procedures, number of secondary procedures (debridement), and total cost for wound bed preparation were calculated in both groups. There was no significant difference in both groups regarding age, gender, comorbidities, and number of revascularization procedures. All patients were having ankle brachial index (ABI) more than 0.8 or ankle pressures more than 80 mmHg before enrolling to study group. MWT group required more debridement (15 vs. 2; P = 0.0001). Average number of dressing changes performed per patients were 25 (range 20–32) for MWT versus 3 (range 2–5) in NPWT group. MWT group had more OPD visits compare to NPWT (14 vs. 2; P value =0.0001). Mean duration for wound bed preparation was 24.61 ± 3.20 days (range 20–32 days) in MWT group and significantly higher than NPWT group 9.11 ± 2.38 days (range 6–15 days) (P = 0.0001; 95% CI difference 13.99 to 17.01). The average total cost for wound bed preparation of TMA wound was Rs 26,875 ± 6810.5 in MWT group and was significantly higher than compared to Rs 23,089.29 ± 6637.5 in NPWT group (P = 0.03; 95% CI difference 182.54 to 7388.89). NPWT resulted in lower resource utilization, reduced costs, and acceleration of wound bed preparation for diabetic foot TMA wound in comparison to standard MWT.


Negative pressure wound therapy Vacuum dressing Diabetic transmetatarsal amputation Cost effectivity Resource utilization 


  1. 1.
    King H, Aubert RE, Herman WH (1998) Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21:1414–1431CrossRefGoogle Scholar
  2. 2.
    McCallon SK, Knight CA, Valiulus JP, Cunningham MW, McCulloch JM, Farinas LP (2000) Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds. Ostomy Wound Manage 46(8):28–32 34 PubMedGoogle Scholar
  3. 3.
    Nalini S, David G, Armstrong DG, Lipsky BA (2005) Preventing foot ulcers in patients with diabetes. JAMA 293:217–228CrossRefGoogle Scholar
  4. 4.
    Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA et al (1999) Causal pathways for incident lower extremity ulcers in patients with diabetes from two settings. Diabetes Care 22:157–162CrossRefGoogle Scholar
  5. 5.
    Frykberg RG (1991) Diabetic foot ulcerations. In: Frykberg RG (ed) The high risk foot in diabetes mellitus. Churchill Livingstone, New York, pp 151–195Google Scholar
  6. 6.
    Frykberg RG (1998) Diabetic foot ulcers: current concepts. J Foot Ankle Surg 37:440–446CrossRefGoogle Scholar
  7. 7.
    Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S et al (2000) Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons. J Foot Ankle Surg 39(5 Suppl):S1–60PubMedGoogle Scholar
  8. 8.
    Winter GD (1962) Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature 193:293–294CrossRefGoogle Scholar
  9. 9.
    Orgill DP, Bayer LR (2013) Negative pressure wound therapy: past, present and future. Int Wound J 10(Suppl 1):15–19CrossRefGoogle Scholar
  10. 10.
    White R, McIntosh C (2008) Topical therapies for diabetic foot ulcers: standard treatments. J Wound Care 17:426–432CrossRefGoogle Scholar
  11. 11.
    2011 Wound Care Product Manufacturing in the US: Market Research Report. 2011 URL wound-care-product-manufacturing.html [accessed on 1 Mar 2013]
  12. 12.
    2012 Wound Care Product Manufacturing in the US: Market Research Report. 2012. URL wound-care-product-manufacturing.html [accessed on 1 Mar 201
  13. 13.
    Kruse I, Edelman S (2006) Evaluation and treatment of diabetic foot ulcers. Clin Diabetes 24:91–93CrossRefGoogle Scholar
  14. 14.
    Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38:563–576CrossRefGoogle Scholar
  15. 15.
    Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W (1997) Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38:553–562CrossRefGoogle Scholar
  16. 16.
    Akhlak Hussain, Kuldip Singh, and Mohinder Singh Cost effectiveness of vacuum-assisted closure and its modifications: a review. ISRN Plastic Surgery, vol. 2013, Article ID 595789, 5 pages, 2013Google Scholar
  17. 17.
    Banwell PE, Teotl L (2003) Topical negative pressure (TNP): the evolution of a novel wound therapy. J Wound Care 12(1):28–30CrossRefGoogle Scholar
  18. 18.
    Thomas S (2001) An introduction to the use of vacuum assisted closure. World Wide Wounds:1–12Google Scholar
  19. 19.
    Armstrong DG, Lavery LA, Diabetic Foot Study Consortium (2005) Negative pressure wound therapy after partial diabetic foot amputation: a multicenter randomized controlled trial. Lancet 366:1704–1710CrossRefGoogle Scholar
  20. 20.
    Fleischmann W, Lang E, Russ M (1997) Treatment of infection by vacuum sealing. Unfallchirurg 100(4):301–304CrossRefGoogle Scholar
  21. 21.
    Amit kumar C Jain, Ajit kumar Varma, Mangalandan, Arun Bal, Harish Kumar (2011) Negative pressure wound therapy in salvaging the diabetic foot—an A.I.M.S experience. The Journal of Diabetic Foot Complications 3(1):13–16Google Scholar
  22. 22.
    Apelqvist J, Armstrong DG, Lavery LA, Boulton AJ (2008) Resource utilization and economic costs of care based on a randomized trial of vacuum-assisted closure therapy in the treatment of diabetic foot wounds. Am J Surg 195:782–788CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Pravin Sakharam Narkhede
    • 1
    Email author
  • Vivekanand
    • 1
  • M. Vishnu
    • 1
  • K. Sumanthraj
    • 1
  • C. P. S. Sravan
    • 1
  • Vaibhav Lende
    • 1
  • Lawish Agarwal
    • 1
  • K. R. Suresh
    • 1
  1. 1.Department of Vascular and Endovascular SurgeryJain Institute of Vascular Sciences (JIVAS)BengaluruIndia

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