الفهرس 
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Abstract
DM is a global public health problem that has increased in the recent two decades. Diabetic foot problems, including DFUs, are major contributor to hospitalization, and subsequent complications including DFIs. The high prevalence of foot ulceration in the diabetic patient population (15-25%), and the subsequent risk of limb or life loss highlight the urgent need to develop a standardized method of assessment, diagnosis, and treatment for diabetic foot ulcers.
Diapetic foot complications are a major cause of hospital admissions in diabetic patients and comprise a disproportionately high number of hospital days because of multiple surgical procedures and prolonged length of stay in hospital.
DFUs are prone to infections that could be more severe than those found in nondiabetic patients, affecting the skin, soft tissues, and underlying bone. The combined effect of hyperglycemia, poor vascularization (poor oxygenation), neurological problems, and immunological disturbances contribute to sustaining DFIs.
Prevention of DFU infection, prompt diagnosis, and adequate patient education remain the cornerstone in prevention of complications including amputations and subsequently improving patients‘ prognosis.
Diabetic foot infection presents a significant challenge to treating physicians. The pillars of treatment today include the following: local wound care with surgical debridement, dressings promoting a moist wound environment, wound off-loading, vascular assessment, treatment of active infection, and strict glycemic control. In addition to these principles, multidisciplinary diabetic foot care is now becoming a mainstay of therapy.
This study aims at assessment the role of NPWT in the management of DFUs in terms of the rate of granulation tissue formation & disappearance of the
wound discharge, the mean of percentage decrease in the wound area, rate of secondary amputations, treatment-related adverse effects (e.g., edema, infection, pain, bleeding), and safety & effictiveness.
A total of 80 DFUs patients were included in the present study to assess the outcomes of NPWT in the management of DFUs. Patients were divided into two treatment groups; each group is composed of 40 patients.
The mean age of the study patients was 55 years with a slight predominance of females (60%). The mean decrease in the wound area was significantly higher in the NPWT group than the conventional group (14.7±6.6% vs 5.7±8.1%, p<0.001).
The patients on NPWT therapy showed earlier complete healthy GTF compared to the patients treated by conventional dressings. At the 4th week, 75% of NPWT patients achieved complete healthy GTF compared to 30% of conventional dressing patients. Moreover, all NPWT patients showed a complete GTF by the end of the 6th week, whereas only 75% of conventional dressing patients who showed a complete GTF by the end of the 8th week.
The mean time to complete healthy GTF was 30.45±4.63 days in all NPWT patients, whereas in the subset of conventional dressing patients who showed complete GTF (30 out of 40 patients) the mean time was 38.3±10.67 days (P=0.001).
The rate of disappearance of wound discharge was faster in group I than group II. In NPWT patients, no wound discharge was observed after the 6th week of treatment, compared to 20% of conventional dressing patients who continued to discharge till the 8th week (p=0.001).
There are multiple limitations in present study including cost analysis of the dressing types and assessment of patient satisfaction with NPWT and the conventional dressing.
In conclusion, NPWT is an important adjunct treatment for DFUs and infected wounds as it can decrease wound drainage and promote wound healing and earlier formation of granulation tissue compared to the conventional dressings.