European Journal of Cardiovascular Medicine

Diabetic foot ulcer (DFU) is one of the most debilitating complications of diabetes mellitus, characterized by chronic, non-healing wounds with high morbidity and risk of amputation. It is estimated that 15–25% of diabetic patients will develop a foot ulcer during their lifetime, with recurrence rates exceeding 40% within one year of healing (1). The pathophysiology of DFU is multifactorial, involving peripheral neuropathy, peripheral arterial disease, immune dysfunction, and impaired wound healing due to hyperglycaemia-induced micro vascular changes (2). These ulcers often become chronic due to prolonged inflammation, reduced angiogenesis, and inadequate collagen deposition, making them highly resistant to conventional wound care methods (3).

The management of DFU aims to achieve rapid wound closure, prevent infection, reduce recurrence, and ultimately avoid major amputation. Traditional approaches, including debridement, infection control, offloading, and moist wound dressings, have limited effectiveness in advanced ulcers (4). In recent years, newer adjunctive modalities have been introduced to accelerate healing, among which Platelet-Rich Plasma (PRP) and Vacuum-Assisted Closure (VAC) dressing have gained significant attention (5).

PRP is an autologous blood-derived product containing a high concentration of platelets, growth factors, and cytokines that stimulate cell proliferation, angiogenesis, and extracellular matrix formation (6). Growth factors such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-β) play crucial roles in granulation tissue formation and re-epithelialization (7). Several studies have demonstrated that PRP application in chronic wounds significantly reduces healing time, increases the rate of complete closure, and improves tissue quality compared to conventional dressings (8). Being autologous, PRP is biocompatible, has minimal immunogenic risk, and can be prepared relatively easily in clinical settings.

On the other hand, VAC therapy, also known as negative pressure wound therapy (NPWT), involves the application of sub-atmospheric pressure to the wound bed via a sealed dressing connected to a vacuum pump. This technique promotes wound healing by removing excess exudate, reducing edema, improving local blood flow, stimulating angiogenesis, and mechanically deforming cells to promote proliferation (9). VAC dressing has been shown to reduce bacterial bio burden, promote granulation tissue, and shorten hospital stay in DFU patients compared to conventional dressings (10).

While both PRP and VAC therapy target chronic wound healing, their mechanisms are distinct—PRP acts primarily via biological stimulation, whereas VAC facilitates mechanical and fluid management along with angiogenesis. The comparative efficacy of these modalities in DFU management remains an area of active research. Some studies suggest that PRP may be superior in biologically compromised ulcers due to its regenerative potential, while VAC may be more effective in large, exudative wounds with significant tissue loss (6,9). There is also emerging interest in combining both modalities to exploit their synergistic effects.

Given the increasing prevalence of diabetes worldwide and the substantial economic and social burden of DFUs, identifying the most effective advanced wound care strategy is critical. Head-to-head comparisons of PRP and VAC therapy can guide clinicians in tailoring treatment based on wound characteristics, resource availability, and patient-specific factors. This study aims to evaluate the role of PRP versus VAC dressing in the healing of diabetic foot ulcers, comparing their effectiveness in terms of healing time, wound size reduction, infection control, and overall patient outcomes.

Study Design: Prospective, comparative, interventional study.

Study Setting: Conducted in the Department of General Surgery, [Name of Tertiary Care Hospital].

Study Duration: From May 2024 to June 2025.

Sample Size: Total: 50 patients with diabetic foot ulcers.

Sampling Method: Consecutive sampling of eligible patients meeting inclusion criteria.

Inclusion Criteria

• Patients aged ≥18 years with diagnosed diabetes mellitus.
• Presence of Wagner Grade 1–3 diabetic foot ulcer.
• Ulcers with no evidence of osteomyelitis (confirmed by clinical and radiological evaluation).

Exclusion Criteria

1. Wagner Grade 4–5 ulcers.
2. Ulcers with active gangrene requiring immediate amputation.
3. Patients with severe peripheral arterial disease (ABI < 0.4).
4. Patients with coagulopathy or platelet count < 1,50,000/µL.
5. Patients unwilling to participate or give consent.

STATISTICAL ANALYSIS:-

For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analysed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Numerical variables were summarized using means and standard deviations, while Data were entered into Excel and analyzed using SPSS and GraphPad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant

Table 1 — Baseline demographics

Table 2 — Ulcer characteristics at baseline

Table 3 — Treatment details / resource use

Table 4 — Primary healing outcome at 12 weeks

Table 5 — Time to complete healing (days)

Table 6 — Percent reduction in ulcer area at 4 weeks

Table 7 — Infection & microbiology

Table 8 — Amputation & major complications

Table 9 — Pain, hospital stay & cost

Figure 1 — Infection & microbiology

Figure 2 — Amputation & major complications

The baseline characteristics of the PRP and VAC groups were comparable. The mean age was 55.9 ± 8.8 years in the PRP group and 55.7 ± 6.1 years in the VAC group (p = 0.938). The proportion of male participants was similar between groups (64.0% vs. 60.0%, p = 0.752). Smoking history was reported in 20.0% of PRP patients and 24.0% of VAC patients (p = 0.739). The mean duration of diabetes was 10.5 ± 3.3 years in the PRP group and 10.7 ± 3.0 years in the VAC group (p = 0.821).

The ulcer characteristics were similar between the PRP and VAC groups. The mean ulcer area was 6.96 ± 1.80 cm² in the PRP group and 6.91 ± 1.21 cm² in the VAC group (p = 0.918). The median duration of ulcers was 8 weeks (IQR 6–12) in the PRP group and 9 weeks (IQR 6–12) in the VAC group (p = 0.642). Most patients had Wagner grade I–II ulcers (76.0% in PRP vs. 72.0% in VAC), while higher-grade ulcers (III–IV) were seen in 24.0% and 28.0% of patients, respectively (both p = 0.754).

The treatment-related parameters showed significant differences in the number of sessions required, with the PRP group needing fewer sessions (4.2 ± 1.1) compared to the VAC group (6.8 ± 1.5, p < 0.001). Concomitant systemic antibiotic use was common in both groups (80.0% in PRP vs. 88.0% in VAC, p = 0.466). The need for re-debridement was observed in 28.0% of PRP patients and 40.0% of VAC patients (p = 0.357).

At 12 weeks, complete epithelialization was achieved in 72.0% of patients in the PRP group compared to 48.0% in the VAC group, a difference that did not reach statistical significance (p = 0.148).

The mean time to complete healing was significantly shorter in the PRP group (44.5 ± 9.95 days) compared to the VAC group (60.6 ± 8.94 days, p < 0.001).

The percentage reduction in ulcer area was significantly greater in the PRP group (65.0% ± 12.0%) compared to the VAC group (44.5% ± 15.0%, p = 0.002).

During follow-up, clinical wound infection occurred in 24.0% of patients in the PRP group and 44.0% in the VAC group (p = 0.232). Positive wound cultures were obtained in 36.0% of PRP patients and 52.0% of VAC patients (p = 0.322).

Major amputations (below-knee or above) were performed in 4.0% of patients in the PRP group compared to 16.0% in the VAC group (p = 0.349). Minor amputations involving the toes occurred in 12.0% of PRP patients and 20.0% of VAC patients (p = 0.456). Readmission within 30 days was noted in 8.0% of PRP patients and 24.0% of VAC patients (p = 0.137).

At 4 weeks, the mean VAS pain score reduction was significantly greater in the PRP group (1.93 ± 0.84) compared to the VAC group (1.17 ± 0.64, p = 0.0008). The mean length of hospital stay was also significantly shorter in the PRP group (10.3 ± 3.46 days) than in the VAC group (15.4 ± 3.23 days, p < 0.001). Additionally, the mean direct treatment cost per patient was lower with PRP (₹18,500 ± 4,200) compared to VAC (₹24,700 ± 5,100, p = 0.003).

In the present study, baseline demographic and clinical characteristics between the PRP and VAC groups were comparable, ensuring that observed differences in outcomes were attributable to the interventions. The mean age and gender distribution in both groups were similar to those reported by Villela and Santos (11) and Carter et al. (12), who evaluated advanced wound care modalities in diabetic foot ulcers (DFUs). The shorter mean healing time in the PRP group (44.5 days) compared to the VAC group (60.6 days) aligns with findings by Elsaid et al. (13), who demonstrated that autologous PRP significantly reduced healing duration in chronic wounds compared to standard care. Similarly, Driver et al. (14) reported accelerated closure rates with PRP, attributing the effect to concentrated growth factors enhancing angiogenesis and fibroblast proliferation.

The greater ulcer area reduction in the PRP group (65% vs. 44.5%) corroborates the observations of Saad Setta et al. (15), who found a 62% reduction with PRP versus 40% with saline dressings over 8 weeks. In contrast, our VAC outcomes were slightly lower than those reported by Blume et al. (16), who noted a mean reduction of 55% with VAC in a multicenter randomized controlled trial. This difference may be due to variations in ulcer grade distribution and duration before intervention.

Although the proportion of complete epithelialization at 12 weeks was higher in the PRP group (72% vs. 48%), the difference was not statistically significant, possibly due to sample size limitations. Similar trends were seen in the trial by Ahmed et al. (17), where PRP achieved higher closure rates than VAC, but the results narrowly missed statistical significance. Interestingly, VAC therapy in our study required more sessions (6.8 vs. 4.2), mirroring findings from Armstrong et al. (18), who highlighted the prolonged device use and associated cost with VAC compared to biologically active dressings.

Pain reduction at 4 weeks was significantly greater in the PRP group, which is consistent with findings by Game et al. (19), who suggested that biologic agents like PRP reduce nociceptive stimuli by modulating local inflammation. VAC therapy, while effective for exudate control, can cause discomfort due to negative pressure cycles. Our results also demonstrated shorter hospital stay and lower direct treatment cost in the PRP group, echoing the economic analysis by Carter et al. (2), which favored PRP over device-based therapy in resource-limited settings.

Regarding infection rates, the PRP group had fewer clinical infections and positive cultures, although differences were not statistically significant. This is consistent with the meta-analysis by Goudie et al. (20), which found no significant difference in infection control between advanced biologic dressings and VAC, indicating that both require concurrent infection management protocols.

Overall, our findings reinforce the therapeutic value of PRP in DFU management, offering faster healing, fewer treatment sessions, reduced pain, and cost-effectiveness compared to VAC, particularly in settings with limited resources. VAC therapy remains valuable for large, exudative ulcers and as a bridge to definitive closure, but PRP may be preferable when rapid biological healing is the priority.

In this comparative study, baseline demographic and ulcer characteristics between the PRP and VAC groups were similar, ensuring a fair evaluation of treatment outcomes. PRP therapy demonstrated clear advantages over VAC in several key parameters, including significantly fewer treatment sessions, faster mean healing time, greater percentage reduction in ulcer area, more pronounced pain relief, shorter hospital stay, and lower overall treatment cost. While rates of complete epithelialization, infection, amputation, and readmission favored PRP, these differences did not reach statistical significance, possibly due to sample size limitations. The findings suggest that PRP is a safe, cost-effective, and biologically active therapy that can accelerate healing and improve patient comfort compared to VAC in the management of diabetic foot ulcers. VAC remains a valuable option, particularly for large, exudative wounds, but PRP may be preferred when rapid tissue regeneration, reduced resource utilization, and cost efficiency are primary objectives.

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