Comparative Study of Vacuum Assisted Closure and 3% Citric Acid Dressing in the Management of Diabetic Foot Ulcers in Resource Limited Settings

Background: Diabetic foot ulcers (DFUs) are a major cause of morbidity, with a significant risk of amputation if not managed effectively. Advanced wound care modalities such as Vacuum Assisted Closure (VAC) therapy and economical alternatives like 3% citric acid dressings have shown promise, but comparative evidence remains limited. Material and Methods: This prospective comparative study was conducted at Government General Hospital, Vijayawada, from December 2018 to November 2020.Sixty patients with non-traumatic diabetic foot ulcers were randomly allocated into two groups: VAC therapy (Group A, n=30) and 3% citric acid dressing (Group B, n=30). All patients underwent debridement and standard care. Wound area was measured using photographic analysis with ImageJ software. Primary outcome was percentage reduction in wound area; secondary outcome was duration of hospital stay. Results: Baseline characteristics were comparable between groups. The mean percentage reduction in wound area was significantly higher in the VAC group (23.10% ± 4.26) compared to the citric acid group (17.90% ± 3.17) (p < 0.001). Mean hospital stay was also significantly shorter in the VAC group (14.3 ± 2.36 days) compared to the citric acid group (19.4 ± 3.97 days) (p < 0.001). Staphylococcus species were the most commonly isolated organisms. Conclusion: VAC therapy is significantly more effective than 3% citric acid dressing in promoting wound healing and reducing hospital stay in DFUs. However, citric acid remains a cost-effective alternative in resource-limited settings.

Keywords: 3% Citric acid, VAC, Vacuum Assisted Closure, Negative Pressure Wound Therapy, Diabetic foot ulcer, diabetic foot complications.