Efficacy of negative-pressure wound therapy with adjunctive silver nanoparticle spray in post-revascularization diabetic foot wounds: A randomized controlled trial.

BACKGROUND

Diabetic foot wounds persisting after successful revascularization are challenging to heal and prone to infection. Negative-pressure wound therapy (NPWT) facilitates granulation, while silver nanoparticles offer antimicrobial benefits; their combination may improve clinical outcomes.

OBJECTIVE

To compare the efficacy of NPWT with adjunctive silver nanoparticle spray versus standard NPWT alone in patients with post-revascularization diabetic foot wounds.

METHODS

This single-center, randomized, double-blinded controlled trial enrolled 115 patients with diabetic foot wounds following successful surgical or endovascular revascularization. Patients were randomized 1:1 to receive either NPWT with silver nanoparticle spray (Group A) or standard NPWT (Group B). Primary outcomes were the incidence and time to complete epithelialization over six months. Secondary outcomes included skin grafting, changes in wound dimensions, and infection rates.

RESULTS

A total of 100 patients (50 per group) completed the study. Complete closure was achieved in 74% of Group A versus 62% of Group B (p = 0.198). While the mean time to complete closure was similar between groups, the time to skin grafting was significantly shorter in the silver NPWT group (3.5 ± 0.3 vs. 4.1 ± 0.3 months; p = 0.001). Group A also showed significant reductions in wound area and depth at three and six months. Additionally, Group A had significantly lower systemic inflammatory markers (CRP and WBC) and a shorter mean hospital stay (5.6 ± 3.2 vs. 7.05 ± 4.0 days; p = 0.048).

CONCLUSIONS

Adjunctive silver nanoparticle therapy with NPWT significantly reduced wound infection risk, accelerated wound reduction, and shortened the time to grafting and hospital stay, although it did not significantly alter ultimate closure rates. These findings support a selective, adjunctive role for silver nanoparticles in managing complex post-revascularization diabetic foot wounds.