Efficacy of 3D Wound Assessment in Predicting Granulation Tissue Velocity Following Negative Pressure Wound Therapy in Diabetic Foot Ulcers

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Wound healing in diabetic foot ulcers (DFU) poses challenges, requiring extensive debridement and amputations. Negative pressure wound therapy (NPWT) can be utilized for DFUs with large soft tissue defects to promote granulation tissue growth. The optimal timeframe for successful NPWT lacks extensive studies. Advanced wound scanning with a three-dimensional (3D) camera can enhance DFU area and volume calculations. This study aimed to investigate the efficacy of 3D wound assessment in predicting granulation tissue filling velocity following NPWT in DFUs. Methods: After receiving IRB approval from the single Korean center, a retrospective case series study was performed for 101 DFUs (Wagner classification 3 and 4) undergoing NPWT from September 2018 to June 2019. Demographic data, vascular patency, and wound characteristics were recorded. Wound was irrigated before NPWT. An infra-red 3D camera (inSight ® , eKare, Fairfax, VA, USA) was used to capture digital photographs. Wound area and volume were measured. Measurements were taken weekly from before treatment to one month after using inSight ® cloud software. The risk factors of diabetic foot ulcers related to wound healing were evaluated. Results: NPWT resulted in significant area improvements for open diabetic foot ulcers (p = 0.001). Postoperative 1-week area change velocity was 1.35 cm2/day, peaking at 2 weeks (1.84 cm2/day). Volume also showed significant improvement over time (p = 0.001), with a 1-week peak velocity of 1.20 cm3/day. All peak area and volume changes occurred within two weeks after NPWT application. Midfoot and hindfoot exhibited higher velocity of volume than forefoot (p = 0.001). Postoperative volume change was the fastest with a patent peroneal artery. Conclusion: 3D wound assessment for velocity of granulation tissue filled in an open DFU after NPWT could be effective to predict outcomes. Most wound healing following NPWT in DFUs was completed within two weeks. Application of NPWT for an additional two weeks did not significantly impact the completion of wound healing even though midfoot and hindfoot exhibited higher velocity of volume than forefoot.