title: Plantar pressure changes using a novel negative pressure wound therapy technique.
abstract: This study evaluated changes in pressure imparted to diabetic foot wounds using a novel negative pressure bridging technique coupled with a robust removable cast walker. Ten patients had plantar pressures assessed with and without a bridged negative pressure dressing on the foot. Off-loading was accomplished with a pressure-relief walker. Plantar pressures were recorded using two pressure-measurement systems. The location and value of peak focal pressure (taken from six midgait steps) were recorded at the site of ulceration. Paired analysis revealed a large difference (mean +/- SD, 74.6% +/- 6.0%) between baseline barefoot pressure and pressure within the pressure-relief walker (mean +/- SD, 939.1 +/- 195.1 versus 235.7 +/- 66.1 kPa). There was a mean +/- SD 9.9% +/- 5.6% higher pressure in the combination device compared with the pressure-relief walker alone (mean +/- SD, 258.0 +/- 69.7 versus 235.7 +/- 66.1 kPa). This difference was only 2% of the initial barefoot pressure imparted to the wound. A modified negative pressure dressing coupled with a robust removable cast walker may not impart undue additional stress to the plantar aspect of the foot and may allow patients to retain some degree of freedom (and a potentially reduced length of hospital stay) while still allowing for the beneficial effects of negative pressure wound therapy and sufficient off-loading.
authors.affiliation: Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Kristin
authors.initials: K
authors.lastname: Kunze
authors.forename: Billy R
authors.initials: BR
authors.lastname: Martin
authors.forename: Heather R
authors.initials: HR
authors.lastname: Kimbriel
authors.forename: Brent P
authors.initials: BP
authors.lastname: Nixon
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D001458:Bandages; D003131:Combined Modality Therapy; D017719:Diabetic Foot / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005528:Foot / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D011312:Pressure; D016896:Treatment Outcome; D014618:Vacuum; D016474:Weight-Bearing; D014945:Wound Healing