Vacuum Compression Therapy And Diabetic Foot
Original Editor - Syeda Bushra Zehra Zaidi
Top Contributors - Rishika Babburu, Angeliki Chorti, Vidya Acharya and Syeda Bushra Zehra Zaidi
Introduction
Diabetic foot ulcers are a common and serious complication of diabetes, often resulting from poor circulation, nerve damage, and high blood sugar levels. These ulcers can be slow to heal, leading to increased risk of infections and, in severe cases, amputation. Diabetic foot ulcers typically occur on the soles or toes of the feet and may be difficult to treat using conventional methods alone.[1]One promising therapy for promoting healing in diabetic foot ulcers is Vacuum Compression Therapy (VCT), a treatment that applies negative pressure to promote blood circulation and encourage tissue regeneration.[2]
What is Vacuum Compression Therapy (VCT)?
VCT is a non-invasive treatment that uses a device to apply alternating positive and negative pressure to an affected area, usually wrapped in a vacuum chamber or cuff. The device is connected to a pressure monitor and compressor unit to regulate the pressure cycles.
In the case of diabetic foot ulcers, VCT is used to:
- Stimulate circulation and oxygenation of the affected tissues
- Increase granulation tissue formation (the tissue that forms during wound healing)
- Promote the closure of the ulcer by reducing swelling and inflammation
- Helps remove exudate (fluid that accumulates in wounds) and debris from the wound bed.[2][3]
Mechanism of Action
Enhancing Circulation
The negative pressure phase of VCT creates a vacuum effect that draws blood into the affected area, increasing blood flow to the ulcer. This helps supply oxygen and nutrients needed for healing. The positive pressure phase helps facilitate venous drainage, removing toxins and metabolic waste.[2]
Accelerating Tissue Regeneration
By improving circulation and increasing oxygen levels in the tissues, VCT promotes cellular regeneration and the formation of healthy tissue around the wound. This can significantly speed up the healing process in diabetic foot ulcers[4]
Reducing Swelling and Infection Risk
VCT can help reduce edema (swelling) around the wound area, which may impede proper healing. Additionally, the negative pressure has been shown to help lower the risk of infection by encouraging proper fluid drainage and keeping the wound environment stable.[2]
Treatment Protocol
Patient Preparation
- Remove any clothing or shoes around the affected foot
- Clean the ulcer and ensure the wound is free of any debris or infection
- Place the foot inside a vacuum chamber or cover the area around the ulcer with a rubber cuff[5]
VCT Parameters
The vacuum therapy device is typically set with the following parameters:
- Negative pressure phase: -75 mmHg (0.10 bar) for 60 seconds
- Positive pressure phase: +38.5 mmHg (0.05 bar) for 30 seconds
These settings may be adjusted based on the patient's condition and the stage of wound healing.[5]
Treatment Duration
During each treatment session, the device is monitored to ensure proper functioning. VCT therapy typically lasts for one hour per session, and alternate-day therapy (every other day) is recommended for up to ten sessions, depending on the progress of healing[5]
Post-Treatment Care
After each session, the patient should be assessed for any discomfort or side effects. The affected area may be dressed with appropriate wound care materials and monitored closely for healing progress.[5]
Benefits of Vacuum Compression Therapy
Faster Healing
VCT accelerates the healing process of diabetic foot ulcers by improving circulation and encouraging tissue regeneration.[4] [5]The enhanced blood flow delivers oxygen and nutrients essential for cellular repair, while the removal of metabolic waste products creates an optimal environment for healing.
Reduced Infection Risk
The negative pressure facilitates drainage of excess fluid and debris from the wound bed, reducing bacterial load and the risk of infection.[6][7] This is particularly important in diabetic foot ulcers, where infection represents a major complication that can lead to hospitalisation and amputation.[6]
Pain Management
VCT can help manage pain and discomfort associated with diabetic foot wounds by improving circulation, reducing tissue hypoxia, and decreasing swelling.[7] Improved perfusion may also help address ischaemic pain in cases where arterial insufficiency contributes to symptoms.
Non-Invasive Approach
VCT is a relatively simple, non-surgical procedure that can be performed in outpatient clinical settings.[7]This non-invasive nature often reduces the need for more aggressive interventions such as extensive surgical debridement, potentially avoiding additional tissue loss.
Improved Quality of Life
By promoting faster ulcer healing and reducing complications, VCT can help patients return to normal activities more quickly, improving overall quality of life and reducing the psychological burden associated with chronic wounds.
Side Effects and Precautions
While VCT is generally considered safe, some patients may experience mild, temporary side effects, including:
- Tingling or numbness in the area being treated
- Mild discomfort due to the pressure changes
- Bruising or skin irritation around the edges of the vacuum cuff
Patients should always communicate any discomfort to their healthcare provider during or after the treatment.[5]
Conclusion
Vacuum Compression Therapy (VCT) offers significant potential in the management of diabetic foot ulcers by promoting faster healing, reducing infection risk, and improving circulation. For patients suffering from chronic diabetic foot issues, VCT can provide an effective, non-invasive option that complements traditional treatments and diabetic rehabilitation.
References
- ↑ Lepäntalo M, Apelqvist J, Setacci C, Ricco JB, de Donato G, Becker F, Robert-Ebadi H, Cao P, Eckstein HH, De Rango P, Diehm N, Schmidli J, Teraa M, Moll FL, Dick F, Davies AH. Chapter V: Diabetic foot. Eur J Vasc Endovasc Surg. 2011 Dec;42 Suppl 2:S60-74. doi: 10.1016/S1078-5884(11)60012-9. PMID: 22172474.
- ↑ 2.0 2.1 2.2 2.3 Khadir AMK SA, Chatterjee SP. Effects of vacuum compression therapy on lower limb vascular parameters in people with type 2 diabetes. Int J Ther Rehabil. 2015 Sep 2;22(9):421-6.
- ↑ Prucha J, Socha V, Hanakova L, Lalis A, Hana K. Objectivization of vacuum-compression therapy effects on micro-and macrovascular perfusion in type 2 diabetic patients. Biomed Tech (Berl). 2020 Aug 27; 65(4):469-76.
- ↑ 4.0 4.1 Besedin OM, Tsygankov KV, Kuzhevsky IV, Gritsenko PO. Cell transformation of wounds in diabetic foot patients under vacuum therapy. Morphologia. 2015;9(2):18-23.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Akbari A, Moodi H, Ghiasi F, Sagheb HM, Rashidi H. Effects of vacuum-compression therapy on healing of diabetic foot ulcers: randomized controlled trial. J Rehabil Res Dev. 2007 Sep 1;44(5).
- ↑ 6.0 6.1 Pedrosa H, Leme L, Novaes C, Saigg M, Sena F, Gomes E, Coutinho A, Boulton A. The diabetic foot in South America: progress with the Brazilian Save the Diabetic Foot Project. International Diabetes Monitor. 2004;16:.
- ↑ 7.0 7.1 7.2 Turan Y, Ertugrul BM, Lipsky BA, Bayraktar K. Does physical therapy and rehabilitation improve outcomes for diabetic foot ulcers? World J Exp Med. 2015 May 20;5(2):130-9. doi: 10.5493/wjem.v5.i2.130. PMID: 25992328; PMCID: PMC4436937.