Comparative Analysis of Vac Therapy Versus Medicated Dressings in Diabetic Foot Management

Abstract

Background: Diabetic foot ulcers (DFUs) precede up to 85 % of non‑traumatic lower‑limb amputations. Negative‑pressure wound therapy—popularly termed vacuum‑assisted closure (VAC)—has emerged as a promising adjunct, yet its superiority over modern medicated dressings remains debated 

Methods: We undertook a parallel‑group, prospective, single‑centre randomised trial (January 2022 – December 2024) comparing VAC to medicated moist dressings (silver‑impregnated hydro‑fiber plus iodine gauze) in adults with Wagner grade 1‑3 DFUs. Primary outcome was complete ulcer closure at 16 weeks. Secondary outcomes included time‑to‑50 % area reduction, bacterial load change, health‑related quality of life (HR‑QoL), and amputation incidence. Intention‑to‑treat analysis with Kaplan‑Meier survival curves and Cox proportional‑hazards modelling was applied.

Results: Of 164 screened patients, 140 were randomised (VAC n = 70; Dressings n = 70). Baseline characteristics were comparable (mean age 58 ± 9 y; 67 % male; HbA1c 8.7 ± 1.1 %). Complete closure occurred in 57.1 % of VAC versus 34.3 % of dressing recipients (RR 1.66, 95 % CI 1.10‑2.50; p = 0.015). Median time‑to‑closure was 56 days (IQR 44‑79) with VAC and 88 days (IQR 66‑112) with dressings (log‑rank p = 0.002). VAC achieved greater mean log‑reduction in colony‑forming units (2.1 ± 0.5 vs 1.3 ± 0.6; p < 0.001) and higher HR‑QoL scores at 16 weeks (p = 0.03). Major amputation was lower but not statistically significant (5.7 % vs 10.0 %; p = 0.29).

Conclusion: VAC therapy significantly accelerates ulcer healing and bacterial clearance compared with advanced medicated dressings, with favourable—but non‑significant—trends in limb salvage. Cost‑effectiveness and long‑term recurrence require further evaluation