Negative-pressure wound therapy (wound VAC) for foot wounds

What a wound VAC is

A wound VAC turns an open wound into a closed, controlled space. A porous foam dressing fills the wound, a cover seals it, and a tube links it to a pump that applies suction either continuously or in cycles, at pressures up to 125 mm Hg.⁠^[1] Fluid from the wound is drawn away into a canister.⁠^[2]

That steady pull lowers swelling and encourages granulation tissue, the red, grainy tissue that fills a wound from the bottom up.⁠^[1] It also controls drainage and molds to the irregular surfaces that diabetic foot wounds often have.⁠^[8]

Who it helps: wounds that surgery has opened

Surgery that saves a foot often leaves a large, deep wound open on purpose, for example after a severe infection is drained or infected bone is removed through a toe, ray or transmetatarsal amputation. Suction therapy can then build a healthy bed of granulation tissue so the wound is ready for a skin graft, and it can hold a fresh graft firmly in place for about five days.⁠^[8] The International Working Group on the Diabetic Foot (IWGDF) conditionally recommends considering suction as an add-on to good standard care for wounds after diabetic foot surgery, based on low-certainty evidence.⁠^[3]

Other wounds that may need it include:

• An incision that has come apart after foot or ankle surgery. Suction is often used on open surgical wounds,⁠^[1] though a large trial described below found it didn’t speed their healing. See surgical wounds that won’t heal.
• A deep diabetic foot ulcer after surgery to clean it out (surgical debridement). For ulcers that haven’t been operated on, the IWGDF strongly advises against adding suction.⁠^[3] See diabetic foot ulcers.

Dr. Efe Ozturk, a Foot and Ankle Surgeon who is board certified in wound care (FAPWH), uses negative-pressure therapy for the wounds that need it, such as a wound left open after he drains an infection, removes infected bone or performs a partial foot amputation. It is one part of a plan built on regular wound care visits and offloading.

Why surgery comes first

Suction is not a treatment for infection. The IWGDF/IDSA infection guideline suggests not using it to treat a diabetic foot infection.⁠^[4] FDA safety advice lists wounds where suction shouldn’t be used, including dead tissue under a hard crust (eschar), untreated bone infection, cancer in the wound, and exposed blood vessels or nerves; FDA guidance for non-powered suction devices also lists exposed bone or tendons.⁠^[5,9]

So the order matters, and the wound is checked for these problems before suction starts. A pocket of pus is drained, dead tissue is cut away (see wound debridement) and infected bone is removed (see surgery for bone infection). We check blood flow with noninvasive circulation testing at our practice; if it is too poor for healing, we refer you to a vascular specialist (see restoring blood flow). Then a VAC can help a clean, living wound fill in.

What the research shows

• Wounds after partial foot amputation. At 18 US centers, 162 people with diabetes and open amputation wounds up to the transmetatarsal level were randomly assigned to suction or moist dressings. Within 16 weeks, 43 of 77 suction-treated wounds healed, compared with 33 of 85 with dressings, and granulation tissue formed sooner.⁠^[6]
• Diabetic foot ulcers: mixed results. In a trial of 342 people, 43.2% of ulcers closed completely within 112 days with suction versus 28.9% with advanced moist dressings, and fewer people needed a later amputation.⁠^[10] But a German trial with blinded assessment, in 368 people whose ulcers had been present at least 4 weeks, found no significant difference in how many wounds closed or how quickly.⁠^[11] A 2026 review of 19 studies (2,046 patients) found suction made complete healing about 1.4 times as likely, but had too few studies to judge amputation or infection.⁠^[12]
• The overall picture. A Cochrane review of 11 randomized trials (972 people) judged the evidence low certainty: suction may heal more foot wounds, and heal them faster, than dressings.⁠^[2]
• Open surgical wounds, mostly on the foot. A 2026 UK trial enrolled 686 people whose surgical wounds had been left open or had come apart, most after vascular surgery; 80% of the wounds were on the foot, and 80% of people had diabetes. In wounds much like the ones described above, suction did not speed healing: median time to complete healing was 187 days with suction and 195 days with usual care, and suction cost more.⁠^[7]

So we use a wound VAC selectively, mainly to help a wound get ready for a skin graft or to hold a graft in place.

Living with a wound VAC

• The pump goes with you. These devices are usually worn all the time during treatment, can get in the way of moving around, and are often said to be noisy enough to keep some people awake.⁠^[2] The FDA advises learning your pump’s safety alarms and watching especially for bleeding, such as bright red blood in the tubing or canister.⁠^[5] We explain what each alarm means and whom to call.
• Dressing changes and home care. In one trial, dressings were changed every 48 hours;⁠^[6] in another, about nine in ten days of suction therapy were home-care days.⁠^[10] We measure the wound at each visit, so we know when suction has done its job.
• Pressure still has to come off the wound. We fit an offloading device and show you how to get around safely; see total contact casting and non-removable offloading.

When the wound bed is healthy, it may close on its own, or, for the wounds that need it, Dr. Ozturk closes it with a skin graft or local flap. For a wound that good standard care hasn’t healed, the IWGDF also conditionally supports add-ons such as placental-derived products and, for ulcers with poor blood flow, hyperbaric oxygen.⁠^[3] When a wound needs them, we apply skin substitutes and refer you for hyperbaric oxygen therapy. Ozturk Foot & Ankle explains its approach to wound care (external site).

Risks and limits

Side effects were about as common with suction as with dressings in the amputation trial and the 342-person ulcer trial,⁠^[6,10] but in the German trial, more people had at least one medical problem with suction (96 vs 72), though only 16 problems were linked to it.⁠^[11] FDA reports describe rare but serious bleeding in people with blood vessel grafts or infected wounds, in people taking medicine for blood clots, and when dressings stuck to tissue are removed, as well as infections from pieces of dressing left in the wound.⁠^[5] Tell us about every blood thinner you take.

Suction therapy is expensive compared with ordinary dressings,⁠^[2] and the open-wound trial found higher costs without faster healing.⁠^[7]

Questions to ask

• Why does my wound need suction rather than regular dressings?
• Has the infection been cleared, and is my blood flow good enough for this wound to heal?
• How often will the dressing be changed, and where?
• What is the plan to close the wound: will it fill in, or will I need a skin graft or flap?

When to seek care

See us within a day or two for any foot wound that isn’t healing, especially if you have diabetes. If you have diabetes or poor circulation, call us the same day if the skin around a wound turns red, hot or swollen or you have new foot pain at rest or at night. Wound care is available at all three of our offices, in Lyndhurst, Paramus and Millburn; call 908-215-5953.