ARMSTRONG DG, NGUYEN HG. EVIDENCE-BASED ORTHOPAEDICS Intermittent pneumatic compression promoted healing in foot infections. ARCH SURG. 2000 DEC;135:1405-9. IMPROVEMENT IN HEALING WITH AGGRESSIVE EDEMA REDUCTION AFTER DEBRIDFMENT OF FOOT INFECTION IN PERSONS WITH DIABETES. Question: In patients who have diabetes mellitus and edema with foot ulcers requiring débriement, how effective is intermittent pneumatic foot compression after débric1erient in promoting wound-healing? Design: Randomized, double-blind, placebocontrolled trial with 1 2-week follow-up. Setting: University hospital and clinics in San Antonio, Texas, USA. Patients: 115 patients who had diabetes mellitus and foot infections requiring incision and débridement. Patients were excluded if they had active congestive heart failure, endstage renal disease, or a serum ereatinine level of> 177 µmol/L at hospital admission, or if they received a lower-extremity bypass graft during the study. 97 patients (84%) (mean age, 50 years; 74% men) completed the study. Intervention: Patients were allocated to a functioning (n = 52) or placebo (n = 45) pulsatile pneumatic foot compression system (Kinetic Concepts, Inc., San Antonio, Texas, USA). The functioning pump sent intermittent bursts ofair through tubing to a wrap encircling the foot. The bladder in the wrap rapidly inflated to 160 mm Hg for 2 seconds, and the cycle was repeated every 20 seconds. The placebo wrap did not inflate. The patients were instructed to use the device approximately 8 hours/clay. Main outcome measures: Rate of complete wound-healing (complete epithelialization) and compliance (ˆ50 hours of use/week). Results: Complete wound-healing was achieved in more patients in the functioningpump group than in the placebo-pump group (P < 0.02) (table). Time to wound-healing was less in the functioning-pump group (P = 0.04). In the functioning-pump group, healing was achieved in more of the patients who were compliant than in those who were noncompliant (P = 0.03). Healing did not differ among patients in the placebo group, regardless of whether they were compliant or noncompliant (P= 0.10). Conclusion: In patients with diabetes mellitus and edema with fobt ulcers requiring débridement, intermittent pneumatic foot compression after débridement promoted wound-healing. Source of funding: Kinetic Concepts, Inc. For correspondence: Dr. D. G. Armstrong, Department of Surgery, Southern Arizona Veterans Affairs Medical Center, 3601 South Sixth Avenue, Tucson, AZ 85723, USA.