Consensus statement on negative pressure wound therapy (V.A.C. Therapy) for the management of diabetic foot wounds.
In 2004, a multidisciplinary expert panel convened at the Tucson Expert Consensus Conference (TECC) to determine appropriate use of negative pressure wound therapy as delivered by a Vacuum Assisted Closure device (V.A.C. THERAPY, KCI, San Antonio, Texas) in the treatment of diabetic foot wounds. These guidelines were updated by a second multidisciplinary expert panel at a consensus conference on the use of V.A.C. THERAPY, held in February 2006, in Miami, Florida. This updated version of the guidelines summarizes current clinical evidence, provides practical guidance, offers best practices to clinicians treating diabetic foot wounds, and helps direct future research. The Miami consensus panel discussed the following 12 key questions regarding V.A.C.


METHODS
(1) How long should V.A.C. THERAPY be used in the treatment of a diabetic foot wound? (2) Should V.A.C." THERAPY be applied without debriding the wound? (3) How should the patient using V.A.C. THERAPY be evaluated on an outpatient basis? (4) When should V.A.C. THERAPY be applied following revascularization? (5) When should V.A.C. THERAPY be applied after incision, drainage, and debridement of infection? (6) Should V.A.C. THERAPY be applied over an active soft tissue infection? (7) How should V.A.C. THERAPY be used in patients with osteomyelitis? (8) How should noncompliance to V.A.C. THERAPY be defined? (9) How should V.A.C. THERAPY be used in combination with other modalities? (10) Should small, superficial wounds be considered for V.A.C. THERAPY? (11) How should success in the use of V.A.C. THERAPY be defined? (12) How can one combine effective offloading and V.A.C. THERAPY?
Andros
George
G
Diabetic Foot Center, Providence Saint Joseph Medical Center, Burbank, CA, USA.
Armstrong
David G
DG
Attinger
Christopher E
CE
Boulton
Andrew J M
AJ
Frykberg
Robert G
RG
Joseph
Warren S
WS
Lavery
Lawrence A
LA
Morbach
Stephan
S
Niezgoda
Jeffrey A
JA
Toursarkissian
Boulos
B
D000465:Algorithms; D000553:Ambulatory Care / Q000592:standards; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D015984:Causality; D000075202:Contraindications; D003646:Debridement / Q000592:standards; D003663:Decision Trees; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005122:Exudates and Transudates; D006801:Humans; D017053:Infection Control / Q000592:standards; D018579:Patient Selection; D011159:Population Surveillance; D016032:Randomized Controlled Trials as Topic; D017592:Skin Care / Q000592:standards; D016038:Skin Transplantation; D013396:Suction / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing