Diabetic foot complications exact a significant toll on patients and health care systems. Vacuum Assisted Closure (VAC) has emerged as the standard care for these complex wounds. Despite its popularity, it has some drawbacks which hinder early patient discharge. A new system, the VAC Via, has revolutionised management of diabetic foot complications, permitting effective outpatient treatment.
Diabetic foot disease and amputation
Incidence of foot ulceration is high among people with diabetes. Those at greatest risk of developing foot ulcers include those who have a history of foot ulcers and amputation. Foot complications are a leading cause of hospitalisation for patients with diabetes. The World Health Organisation (WHO) has estimated that there are approximately 250,000 lower limb amputations per year in diabetic patients in Europe alone. Diabetic foot ulcer precedes and causes 85% of these amputations, highlighting the importance of appropriate management of foot lesions.
Negative wound pressure therapy (NWPT)
Negative wound pressure therapy (NWPT), is becoming a mainstay in the treatment of complex wounds. The National Institute of Health and Clinical Excellence (NICE) guidelines recommend that NPWT can be used for rescue therapy when the only other option is amputation. Consequently NWPT is frequently used in hospitals for diabetic foot ulceration that threaten amputation. The most commonly used NWPT device is the Vacuum Assisted Closure (VAC) device. It consists of an open-cell foam dressing covered with a transparent air- and water-tight dressing which in turn is connected to a vacuum pump via a plastic tubing that creates and maintains a subatmospheric pressure (intermittent or continuous).
Problems associated with Vacuum Assisted Closure (VAC) therapy
Treatment of VAC therapy is associated with a number of reported complications. The most pertinent is reduced mobility because of the need to remain connected to a mechanical device. This has been greatly reduced with the arrival of smaller, lighter, more portable devices with long-lasting batteries, such as the VAC Via.
The benefits of VAC Via
In April 2011, the VAC Via was introduced worldwide and University College Hospital (UCLH) in the UK became one of the pioneers of this new engineering technology for patients with diabetic foot disease.
VAC Via provides multiple benefits. For patients, its portable, discreet, easy-to-operate design enables them to return to ‘normality’. Due to existing mobility issues, we found the VAC Via, with its palm-sized, lightweight design to be more of a benefit compared to the other heavier VAC therapy devices. VAC Via may allow for earlier patient discharge by reducing or eliminating the need for inpatient treatment.
The cost of this treatment
The estimated cost of treating single foot ulceration during a two-year period is £14,000 in the USA. Diabetic patients with neuropathic risk factors incur five times more direct medical costs for ulcers and amputations. Evidence suggests that VAC therapy is cost-effective as it reduces the length of hospital stay thus decreasing overall medical costs. VAC therapy was found to be equally as expensive as conventional moist gauze. However, as there is a longer time between dressing changes with VAC, there is less demand on nursing staff.
It is important to note that calculations made in one country may not be generalised in other countries. When assessing the costs, the disposable material required for the change of dressing should also be taken into account. The emergence of new devices, such as the VAC Via, should reduce these costs.
It has been shown that in diabetic patients suffering from restricted blood supply to the limbs, revascularisation (the augmentation of the blood supply) is feasible in most cases and reduces the rate of early major amputation. To achieve this, multiple revascularisation procedures may be required, and close surveillance is mandatory. Of paramount importance is that revascularisation should precede VAC on a diabetic foot suffering from restricted blood supply.
Use by public health systems
VAC therapy has been shown to be useful in the treatment of certain diabetic foot complications. Revascularisation options are not limited, but length of treatment may be significantly reduced with the use of VAC Via. It facilitates early discharge as treatment can be achieved effectively as an outpatient. The cost effectiveness of VAC depends on the public health care system and local operational practices. Needless to say, cost effectiveness is what drives the UK’s National Health Service (NHS). Lack of UK based studies to promote VAC Via as a combined therapeutic option based on cost effectiveness, leaves clinicians nationwide vulnerable. Emerging therapies thrive in the glory of competitive technology, and as we face a financial hurdle with potentially devastating consequences on the NHS, robust clinical trials need to be expedited to ensure we maintain our stance in the forefront of medical discovery.