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Unlocking the Potential of Negative Pressure Wound Therapy in Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

R. A. Kadavan,Nikhil Deans,Rithin Punnackal Joseph,Jisna Vincent,A. S,Merary Merybal

Published 2025 in Cureus

ABSTRACT

Diabetes mellitus (DM), which affects millions globally, is rising exponentially. Diabetic foot ulcers (DFUs) are a major health and economic concern in patients with uncontrolled DM. Complex factors such as neuropathy, ischemia, and susceptibility to infection contribute to the development of DFUs, which can lead to amputations and significant mortality. Traditional DFU therapies often struggle to address the diversity and complexity of ulcers. Current guidelines for DFU care recommend Negative Pressure Wound Therapy (NPWT) as a potential treatment option. NPWT applies controlled negative pressure to optimize wound healing. Despite its promise, limited evidence, varying methodologies, and restricted data accessibility necessitate a comprehensive evaluation. Our study adhered to PRISMA standards and conducted an extensive search across multiple databases, including PubMed, Embase, and the Cochrane Library, to identify randomized controlled trials (RCTs) published after 2008. The search included targeted keywords related to diabetic foot complications and NPWT to evaluate the safety and efficacy of this approach compared with conventional wound treatments. In the meta-analysis comprising 11 studies and a total of 1,135 participants, significant outcomes favored NPWT for DFUs. NPWT demonstrated a substantial impact on complete wound closure, with an OR of 2.193 (95% CI: 1.562-3.079; p < 0.0001). Ulcer healing also showed a statistically significant improvement, with an OR of 2.771 (95% CI: 1.511-5.082; p = 0.0010). Granulation tissue development improved markedly, as indicated by a standardized mean difference of -1.3384 (95% CI: -1.5577 to -1.1192; p < 0.0001). NPWT notably reduced amputation rates by 63%, with an OR of 0.368 (95% CI: 0.182-0.746). Although there was a trend toward fewer adverse events with NPWT, the effect did not reach statistical significance (log OR: 0.1548; 95% CI: -0.4364 to 0.7460). These findings underscore the clinical efficacy of NPWT in the management of DFUs. In conclusion, this systematic review and meta-analysis confirm the effectiveness of NPWT in improving wound closure, accelerating recovery, and reducing amputation rates in patients with DFUs.

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