Consensus statement on negative pressure wound therapy (V.A.C.® therapy) for the management of diabetic foot wounds

In 2004, a multidisciplinary expert panel convened at the Tucson Expert Consensus Conference (TECC) to determine appropriate use of negative pressure wound therapy as delivered by a Vacuum Assisted Closure® device (V.A.C.® Therapy, KCI, San Antonio, Tex) in the treatment of diabetic foot wounds. These guidelines were updated by a second multidisciplinary expert panel at a consensus conference on the use of V.A.C.® Therapy, held in February 2006, in Miami, Florida. This updated version of the guidelines summarizes current clinical evidence, provides practical guidance, offers best practices to clinicians treating diabetic foot wounds, and helps direct future research. The Miami consensus panel discussed the following 12 key questions regarding V.A.C.® Therapy: 1) How long should V.A.C.® Therapy be used in the treatment of a diabetic foot wound? 2) Should V.A.C.® Therapy be applied without debriding the wound? 3) How should the patient using V.A.C.® Therapy be evaluated on an outpatient basis? 4) When should V.A.C.® Therapy be applied following revascularization? 5) When should V.A.C.® Therapy be applied after incision, drainage, and debridement of infection? 6) Should V.A.C.® Therapy be applied over an active soft tissue infection? 7) How should V.A.C.® Therapy be used in patients with osteomyelitis? 8) How should noncompliance to V.A.C.® Therapy be defined? 9) How should V.A.C.® Therapy be used in combination with other modalities? 10) Should small, superficial wounds be considered for V.A.C.® Therapy? 11) How should success in the use of V.A.C.® Therapy be defined? 12) How can one combine effective offloading and V.A.C.® Therapy?