The impact of vacuum sealing drainage on wound healing and infection control in diabetic foot ulcer patients

To describe observed associations between vacuum sealing drainage (VSD) and wound healing, infection control, and pain outcomes in a retrospective cohort of diabetic foot ulcer (DFU) patients. This single-center retrospective cohort study included 253 DFU patients (Wagner grades 2–3) divided into a conventional treatment group (n = 138) and a VSD group (n = 115, receiving standard care plus continuous-irrigation VSD). Treatment allocation was non-randomized and based on clinical suitability, physician discretion, patient preference, and logistics. Wound area, complete healing rate, healing time, infection control, inflammatory cytokines (IL-1β, IL-6, IL-8), SF-MPQ pain scores, and adverse events were compared between groups. Logistic regression identified factors associated with poor healing and poor infection control. In this cohort, VSD was associated with a higher complete healing rate (91.30% vs. 78.26%, P = 0.005; absolute difference 13.0%, NNT = 8), shorter median healing time (72 vs. 79 days; difference 7 days), better infection control (93.91% vs. 81.16%, P = 0.003), lower inflammatory cytokine levels, and lower SF-MPQ scores. Adverse events were fewer in the VSD group (9.57% vs. 20.29%, P = 0.019). Logistic regression identified VSD as a factor associated with reduced odds of poor healing (OR = 0.350) and poor infection control (OR = 0.285). In this retrospective, non-randomized cohort, continuous-irrigation VSD was associated with modestly better outcomes across several measured parameters. However, the absolute benefits were small, the study lacks data on cost, convenience, and treatment burden, and the findings are specific to the combined protocol used at this center. Given the observational design and the inherent risk of confounding by indication, these results should be interpreted as exploratory associations rather than as evidence of superiority. Prospective randomized trials are needed before any firm treatment recommendations can be made.