The effects of lower limb intermittent negative pressure on foot circulation and wound healing - Experimental and prospective studies exploring the acute circulatory and clinical effects of intermittent mild ambient subatmospheric pressure to the lower leg and foot

Abstract

Sundby and co-workers have in this thesis studied the isolated effects of applying mild negative pressure (-40 mrnHg) to the limb on foot macro- and microcirculation in healthy volunteers, patients with peripheral arterial disease, and in people with spinal cord injuries. The main objectives of this thesis were (i) to explore the acute effects oflower limb intermittent negative pressure (INP) on foot arterial and cutaneous blood flow, and (ii) to explore the use of an INP device for home use for patients with poor foot circulation and chronic leg and foot ulcers. The results of this PhD thesis demonstrated an immediate and significant effect of negative pressure on foot macro- and microcirculation. Further, constant negative pressure applied to the lower limb decreased foot circulation. The same negative pressure applied intermittently increased arterial and skin blood flow of the foot in healthy volunteers. A randomized controlled pilot study on patients with spinal cord injuries and chronic leg and foot ulcers demonstrated that INP can be used as a home-based treatment for patients with spinal cord injuries. Lastly, the pilot study indicated that INP combined with standard wound care improves ulcer healing compared to standard wound care alone. Similar effects were also observed on wound healing in a case study of four patients with critical limb ischemia and chronic leg and foot ulcers who were treated with INP for eight weeks. The efficacy of INP should be tested in an adequately sized, preferably multicenter, randomized superiority trial.