Evaluation of Combinational Use of Negative Pressure Wound Therapy (NPWT) for Diabetic Foot Wounds

NCT ID: NCT06832787

Last Updated: 2025-07-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-22

Study Completion Date

2026-06-30

Brief Summary

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Singapore has one of the world's highest diabetes-related lower limb amputation rates in the world. Between 2008 - 2017, 4724/5306 (89.0%) of all major amputations and 6656/7227 (92.1%) of all toe/ray amputations performed in Singapore were for diabetic patients. Diabetic foot ulcers are generally slow to heal and poor wound management may lead to infection and subsequently major amputations. Hence, adequate wound care to achieve wound healing efficiently and effectively is of utmost importance.

In the investigators' clinical practice, Negative Pressure Wound Therapy has been the dressing of choice to aid wound closure and prevent infective complications. Drainage of wound exudates helps to reduce and prevent infection, promote granulation tissue proliferation and induce cell growth. When used in combination with dermal substitutes, graft uptake is improved by further promoting proliferation and encouraging tissue regeneration.

Wounds can also be closed surgically though primary closure, where the skin is closed and serves as a physical barrier against infection. The technique is not without its pros and cons. Primary closure may decrease healing time and reduce need for additional surgery, but these patients are also at risk of recurrent infection and may require more proximal amputation. These may be circumvented with delayed primary closure, which is the surgical closure of the amputation wound at a delayed timing after amputation. This gives the clinical team time to optimize the wound and ensure that there is no underlying infection prior to closure.

The experience of NPWT + Kerecis Omega 3 and delayed primary closure have been positive. To the investigators' current knowledge, there is only one case series reported for the use of fish skin graft in combination with NPWT for the treatment of acute pediatric wounds and two case series for the use of NPWT in diabetic foot wound that has undergone surgical closure. The proposed study would be the first RCT to evaluate effects of combination therapy in both open and closed diabetic foot ulcers.

Detailed Description

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Conditions

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Diabetic Foot Ulcer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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NPWT Only

Control: Negative Pressure Wound Therapy only

Group Type OTHER

Negative Pressure Wound Therapy

Intervention Type DEVICE

NPWT applied over wound without any adjuncts

NPWT + Kerecis

Combinational Therapy of Negative Pressure Wound Therapy + application of Kerecis Omega 3 Wound Matrix

Group Type ACTIVE_COMPARATOR

Negative Pressure Wound Therapy

Intervention Type DEVICE

NPWT applied over wound without any adjuncts

Kerecis

Intervention Type DEVICE

Kerecis Omega3 Wound Dressing is derived from fish skin and is used as a dermal substitute.

NPWT + Delayed Primary Closure with Local Flap

Combinational Therapy of Delayed Primary Closure with Local Flap and Negative Pressure Wound Therapy

Group Type ACTIVE_COMPARATOR

Negative Pressure Wound Therapy

Intervention Type DEVICE

NPWT applied over wound without any adjuncts

Delayed primary closure with local flap

Intervention Type DEVICE

Delayed primary closure with local flap to close wound

Interventions

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Negative Pressure Wound Therapy

NPWT applied over wound without any adjuncts

Intervention Type DEVICE

Kerecis

Kerecis Omega3 Wound Dressing is derived from fish skin and is used as a dermal substitute.

Intervention Type DEVICE

Delayed primary closure with local flap

Delayed primary closure with local flap to close wound

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age 21-100
* First or last toe ray amputation
* Adequate perfusion (either \>50% stenosis on duplex ultrasound or undergone successful revascularization with \<30% residual stenosis)

Exclusion Criteria

* Amputations not at first or last toe
* Venous ulcers
* Heel ulcers
* Osteomyelitis
* Active Infection
* Patients on imunosuppressant
* Patients with known allergy to fish
* Patients unable to give informed consent.
Minimum Eligible Age

21 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Singapore General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jack Kian Ch'ng

Role: PRINCIPAL_INVESTIGATOR

Singapore General Hospital

Locations

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Singapore General Hospital

Singapore, , Singapore

Site Status RECRUITING

Sengkang General Hospital

Singapore, , Singapore

Site Status RECRUITING

Countries

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Singapore

Central Contacts

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Charyl Yap, B.Sc

Role: CONTACT

+65 6576 7986

Facility Contacts

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Charyl Yap

Role: primary

+65 65797986

Michelle Mo

Role: primary

+65 6930 5333

References

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Ciprandi G, Kjartansson H, Grussu F, Baldursson BT, Frattaroli J, Urbani U, Zama M. Use of acellular intact fish skin grafts in treating acute paediatric wounds during the COVID-19 pandemic: a case series. J Wound Care. 2022 Oct 2;31(10):824-831. doi: 10.12968/jowc.2022.31.10.824.

Reference Type BACKGROUND
PMID: 36240798 (View on PubMed)

Aerden D, Vanmierlo B, Denecker N, Brasseur L, Keymeulen B, Van den Brande P. Primary closure with a filleted hallux flap after transmetatarsal amputation of the big toe for osteomyelitis in the diabetic foot: a short series of four cases. Int J Low Extrem Wounds. 2012 Jun;11(2):80-4. doi: 10.1177/1534734612446640. Epub 2012 May 4.

Reference Type BACKGROUND
PMID: 22561521 (View on PubMed)

Blume PA, Paragas LK, Sumpio BE, Attinger CE. Single-stage surgical treatment of noninfected diabetic foot ulcers. Plast Reconstr Surg. 2002 Feb;109(2):601-9. doi: 10.1097/00006534-200202000-00029.

Reference Type BACKGROUND
PMID: 11818842 (View on PubMed)

Berceli SA, Brown JE, Irwin PB, Ozaki CK. Clinical outcomes after closed, staged, and open forefoot amputations. J Vasc Surg. 2006 Aug;44(2):347-351; discussion 352. doi: 10.1016/j.jvs.2006.04.043.

Reference Type BACKGROUND
PMID: 16890866 (View on PubMed)

Zhang L, Weng T, Wu P, Li Q, Han C, Wang X. The Combined Use of Negative-Pressure Wound Therapy and Dermal Substitutes for Tissue Repair and Regeneration. Biomed Res Int. 2020 Dec 4;2020:8824737. doi: 10.1155/2020/8824737. eCollection 2020.

Reference Type BACKGROUND
PMID: 33344649 (View on PubMed)

Normandin S, Safran T, Winocour S, Chu CK, Vorstenbosch J, Murphy AM, Davison PG. Negative Pressure Wound Therapy: Mechanism of Action and Clinical Applications. Semin Plast Surg. 2021 Aug;35(3):164-170. doi: 10.1055/s-0041-1731792. Epub 2021 Sep 10.

Reference Type BACKGROUND
PMID: 34526864 (View on PubMed)

Riandini T, Pang D, Toh MPHS, Tan CS, Choong AMTL, Lo ZJ, Chandrasekar S, Tai ES, Tan KB, Venkataraman K. National Rates of Lower Extremity Amputation in People With and Without Diabetes in a Multi-Ethnic Asian Population: a Ten Year Study in Singapore. Eur J Vasc Endovasc Surg. 2022 Jan;63(1):147-155. doi: 10.1016/j.ejvs.2021.09.041. Epub 2021 Dec 14.

Reference Type BACKGROUND
PMID: 34916107 (View on PubMed)

Other Identifiers

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2024/2226

Identifier Type: -

Identifier Source: org_study_id

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