Background: Foot wounds in people with diabetes mellitus (DM) are common and serious global health issue. Negative pressure wound therapy can be used to treat these wounds and a clear and current overview of current evidence is required to facilitate decision-making regarding its use. Objective: To assess the efficacy of vacuum assisted closure dressings as compared to conventional moist wound dressings in improving the healing process in diabetic foot wounds. Patients and methods: This prospective randomized comparative study was conducted in the General and Vascular Surgery Departments at Al-Azhar university hospitals and Al-Ahrar teaching hospital, in the period from January 2019 to May 2020. The study included 30 patients randomized into two equal groups: VAC therapy and conventional dressing suffering from diabetic foot wounds. All chronic wounds where conventional dressings indicated were included in the study. Results: Wound bed showed signs of healing by granulation tissue formation in 11 among 15 patients (73.3%) in VAC therapy group. In conventional treatment, 4 showed granulation among 15 patients (26.7%) one week after initiation of treatment. (P=0.01). There was a statistically significant difference between average granulation as % of ulcer area and it was significantly high in vacuum dressing. It was 50.2 ± 18.9 in Conventional treatment compared with 77.4 ± 19.3 in NPWT group (p- value = 0.005). Also, at the end of the study, we found that the total mean cost in conventional dressing group was 1993 ± 193 EP compared to 2261 ± 183 EP in VAC group. There was a difference in the total cost finally. Being higher in cost, VAC therapy although has a shorter hospital stay and faster healing time in comparison with conventional dressing. Conclusion: Negative pressure wound therapy (NPWT) using vacuum-assisted closure (VAC) was more efficacious than conventional therapy in the management of foot ulcers in diabetic patients. Hospital stay was significantly shorter in NPWT patients, so less consuming of hospital service than conventional dressing. This is finally decreasing the total budget to the hospital.