Efficacy of routine diabetic foot treatments at an outpatient clinic: a cohort study

Reliable data on the efficacy of treatment for diabetic foot (DF) ulcers (DFUs) is essential for planning outpatient services, comparison of several DF clinics, pharmacoeconomic studies and prognosis of healing time. However, no reports based on Russian DF cases have been published to date.Aim. The aim of our study was to analyse of the outcomes of routine DFU treatments at one DF outpatient clinic (DFOC).Materials and methods. We analysed the medical records of all patients admitted to one DFOC for foot/leg ulcers in 2012 (72 patients, 77 episodes of treatment, 124 ulcers in total). The median age of the patients was 66 years (range: 45?90 years), 51% patients were females and 49% were males. Three (4%) patients had type 1 diabetes mellitus, whereas the rest had type 2 diabetes mellitus. The median duration of ulcer prior to the initiation of treatment was 31 days (range: 1?392 days). A total of 106 (85%) cases involved DFUs, whereas 18 (15%) involved leg ulcers in patients with diabetes. One patient had a combination of foot and leg ulcers. Examination and treatment of all patients were conducted by a single experienced doctor according to international and national guidelines. The follow-up time ranged from 8?20 months.Results. Lower extremity ischemia was observed in 39% cases. The healing rate for all ulcers at 3, 6 and 12 months was 34%, 51% and 65%, respectively. At follow-up time, ulcers remained unhealed in 16% patients and 9% survived amputations [1 (1%), below knee; 6 (8%), minor)]. Furthermore, 4% patients died on account of cardiovascular events. The results of the present study were comparable to those reported in other countries. Modern and effective treatment modalities (such as contact casting and revascularisation) were not used extensively; therefore, their active utilisation is necessary to improve treatment outcomes.Conclusions. The healing rate for ulcers in our cohort was 34%, 51% and 65% at 3, 6 and 12 months, respectively. Treatment efficacy should be improved by increasing the use of total contact casting and revascularisation. Person-related measures (i.e. healing of all ulcers in a patient) are optimal for most cases, although ulcer-related measures can be significant in cases where several ulcers are detected in a patient. Our studied cohort is typical for a DFOC; therefore, our data can be used for planning outpatient services, evaluation of other DFOCs and pharmacoeconomic studies.

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Skin grafting in the treatment of hard-to-heal leg ulcers

Italian Journal of Wound Care ◽

10.4081/ijwc.2018.18 ◽

2018 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Giovanni Mosti ◽

Vincenzo Mattaliano ◽

Pietro Picerni ◽

Costantino Christou

Keyword(s):

Ulcer Healing ◽

Healing Rate ◽

Skin Grafting ◽

Leg Ulcers ◽

Clinical Routine ◽

Ulcer Size ◽

Donor Skin ◽

Post Traumatic ◽

Chronic Leg Ulcers

Some risk factors or comorbidities may make Chronic Leg Ulcers (CLU) very difficult to heal. These ulcers are usually defined refractory ulcers and may require an in-hospital intensive care to increase the healing rate. Aim of this retrospective study was to assess if our clinical routine in hospitalized patients, made up with surgical debridement followed by donor skin grafting (allografts), may favor the ulcer healing. The records of 120 patients (55 males and 65 females; mean age 73.9±11.3 years) with ulcers greater than 100 cm2 and lasting for more than 1 year were analyzed. The median ulcer size was 165 cm2 (IQR 130-250 cm2; range 100-1000 cm2). The median ulcer duration was 24 months (IQR 16-32 months; range 12-300 months). The ulcer pathophysiology was venous in 74 patients, arterial in 21, mixed in 12, vasculitis in 5 and post-traumatic in 8 patients. After debridement the patients were submitted to allograft procedures (single or multiple) up to the ulcer healing. When allograft was able to create an effective granulation tissue and reduce the ulcer size an autograft was performed to get the ulcer closure. 109 patients healed and 11 were lost at follow-up. 65 patients healed just with one allograft in 16 weeks (IQR 13-21 weeks). 42 patients healed with 2 procedures in 20 weeks (IQR 18-23 weeks). 31 of them received a final autograft while 11 healed with two allografts. 2 patients with an ulcer surface of 200 cm2, both affected by CLI, healed with 3 allografts procedures in 40 and 33 weeks, respectively. Pain and exudate amount were significantly decreased and even disappeared after the first allograft. Allografts alone or followed by an autograft are able to get the ulcer healing also in case of extensive and long lasting ulcers refractory to all previous treatments.

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Incidence of Diabetic Foot Ulcer and Its Predictors Among Diabetes Mellitus Patients at Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: A Retrospective Follow-Up Study

Diabetes Metabolic Syndrome and Obesity Targets and Therapy ◽

10.2147/dmso.s280152 ◽

2020 ◽

Vol Volume 13 ◽

pp. 3703-3711

Author(s):

Ali Mekonen Adem ◽

Asrat Atsedeweyn Andargie ◽

Achamyeleh Birhanu Teshale ◽

Haileab Fekadu Wolde

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Northwest Ethiopia ◽

Referral Hospital ◽

Bahir Dar ◽

Follow Up Study ◽

Felege Hiwot Referral Hospital

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Effectiveness of fast-track pathway for diabetic foot ulcerations

Acta Diabetologica ◽

10.1007/s00592-021-01721-x ◽

2021 ◽

Author(s):

Marco Meloni ◽

Jose Luis Lazaro Martinez ◽

Raju Ahluwalia ◽

Benjamin Bouillet ◽

Valentina Izzo ◽

...

Keyword(s):

Diabetic Foot ◽

Fast Track ◽

Independent Predictor ◽

Major Amputation ◽

Healing Time ◽

Early Referral ◽

The Mean ◽

Late Referral

Abstract Aim To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. Methods The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. Results Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. Conclusion After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.

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A randomized trial of surgery alone versus surgery plus compression in the treatment of venous leg ulcers in patients with primary venous insufficiency

Vojnosanitetski pregled ◽

10.2298/vsp180710147m ◽

2020 ◽

Vol 77 (8) ◽

pp. 811-815

Author(s):

Dragan Milic ◽

Sasa Zivic ◽

Mladjan Golubovic ◽

Dragan Bogdanovic ◽

Milan Lazarevic ◽

...

Keyword(s):

Ulcer Healing ◽

Venous Insufficiency ◽

Healing Rate ◽

Surgical Intervention ◽

Compression Therapy ◽

Healing Time ◽

Leg Ulcers ◽

Compression Device ◽

Group A ◽

Group B

Background/Aim.Venous leg ulcers (VLU) are a significant health problem worldwide. It is well known that VLU are difficult to treat and that they have high tendency for recurrence. Compression therapy is the preferred treatment modality but there is growing evidence that correction of underlying venous disorder in early stages of the disease in addition to compression treatment may improve ulcer healing and reduce recurrence rate. Methods. An open, prospective, randomized, single-center study, with a 6-months follow-up was performed to determine the efficacy of two different treatment modalities (surgery alone versus surgery plus compression) in the treatment of VLU in patients with primary venous insufficiency. Patients with secondary venous insufficiency and/or thrombosis were excluded from the study. Overall, 71 patients were randomized (37 men, 34 women; mean age 60 years) into two groups: the group A ? 34 patients who underwent surgical intervention (stripping) and postoperatively were treated with simple wound dressing only, and the group B ? 37 patients who underwent surgical intervention (stripping) and wore a heelless open-toed elastic class III compression device knitted in tubular form ?Tubulcus? (Laboratoires Innothera, Arcueil, France). All patients in group B were instructed to wear compression device continuously during the day and night. The study was performed at the Clinic for Cardiovascular and Transplant Surgery, Clinical Centre Nis (Serbia) with primary endpoint of the study being complete ulcer healing at 180 days. Results. The healing rate was 29.41% (10/34) in the group A, and 56.76% (21/37) in the group B (p < 0.01). Mean healing time in the group A was 141 ?15 days, and in the group B it was 98 ?12 days (Log-rank life table analysis: p < 0.001). Conclusion. This study suggests that for VLU in patients with primary venous insufficiency, surgery plus compression therapy provides higher healing rate and faster healing time compared to surgery only.

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Antibiotic Bone Cement Combined With Other Comprehensive Interventions in the Treatment of Diabetic Foot Osteomyelitis

10.21203/rs.3.rs-431432/v1 ◽

2021 ◽

Author(s):

Fanyu Bu ◽

Xiaofeng Guo ◽

Peng Xu ◽

Jin Wang ◽

Mingyu Xue ◽

...

Keyword(s):

Bone Cement ◽

Diabetic Foot ◽

Pathogenic Bacteria ◽

Healing Time ◽

Foot Ulcers ◽

Diabetic Patients ◽

Ulcer Recurrence ◽

Duration Of Hospitalization ◽

Diabetic Foot Osteomyelitis

Abstract BackgroundDiabetic foot osteomyelitis (DFO) is serious chronic complication that causes disability or death in diabetic patients. Antibiotic-loaded bone cement is an effective sustained-release system for the treatment of chronic osteomyelitis and induces biofilm formation. This study aimed to valuate the outcomes and summarize the experiences of bone cement loaded with vancomycin combined with other comprehensive interventions in the treatment of DFO.MethodsOne hundred and twelve involved feet in 93 patients (43–92 years old) with DFO treated with antibiotic-loaded bone cement combined with other comprehensive interventions were retrospectively analyzed. The durations of oral and intravenous antibiotics and hospitalization, ulcer healing times, recurrence and rehospitalization rates, and the rates of amputation above the ankle were evaluated at the last follow-up. One hundred and forty four pathogenic bacteria were co-cultured from the secretions of deep wounds from foot ulcers. The Maryland criteria were used to evaluate the recoveries of foot functions. ResultsEighty seven patients with 105 involved feet were followed up successfully over an average period of 14 months. All wounds exhibited good union on follow up, and DFO was cured. The average durations of oral and intravenous antibiotic administrations were 12.2 ± 1.5 and 10.8 ± 2.5 days, respectively. The average duration of hospitalization was 14.0 ± 2.7 days and the healing time for the ulcers was 37.8 ± 6.3 days. Rehospitalization presented in 21 (18.8％) foot ulcers among those with ulcer recurrence. No patients required amputation above the ankle. According to the Maryland criteria, 31, 45, 26, and three feet were rated as excellent, good, fair, and failures, respectively. Overall, 72% were rated as excellent-good. ConclusionsThe rate of amputation above the ankle was significantly reduced with the use of comprehensive interventions to retain foot function and improve quality of life. This management strategy in the treatment of DFO is effective and comprehensive comprehensive; therefore, it should be more frequently used in clinical settings.

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Healing Times of Diabetic Ulcers in the Presence of Fixed Deformities of the Foot Using Total Contact Casting

Foot & Ankle International ◽

10.1177/107110079801900908 ◽

1998 ◽

Vol 19 (9) ◽

pp. 613-618 ◽

Cited By ~ 33

Author(s):

David Ft. Sinacore

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Healing Time ◽

Foot Ulcers ◽

Strongly Correlated ◽

Diabetic Foot Ulcers ◽

Plantar Ulcers ◽

Life Threatening ◽

Total Contact Casting ◽

Neuropathic Foot

In a diabetic foot, ulcers can lead directly to the loss of a limb, and they may be life threatening if the patient is not provided effective intervention directed at healing. This study reports on the healing times of diabetic neuropathic plantar ulcers in the presence of fixed deformities of the foot using the ambulatory method of total contact casting (TCC). In this study, 21 subjects with chronic diabetes mellitus, plantar ulcers, and fixed deformities of the foot were put in casts, and their progress was followed until the ulcers were completely healed. Results indicated that all of the ulcers healed. The average time to healing was 67 ± 29 days. Ulcers located in the forefoot, midfoot, and rearfoot healed in an average of 35 ± 12 days, 73 ± 28 days, and 90 ± 12 days, respectively. The location of the ulcer and the presence and location of a fixed deformity of the foot strongly correlated with and was predictive of healing time using TCC. The location of the ulcers and the location of the fixed deformities of the foot should always be considered by providers of rehabilitation who treat diabetic neuropathic foot ulcers using TCC.

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The Use of a Novel Super-Oxidized Solution on Top of Standard Treatment in the Home Care Management of Postsurgical Lesions of the Diabetic Foot Reduces Reinfections and Shortens Healing Time

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734618795593 ◽

2018 ◽

Vol 17 (4) ◽

pp. 268-274

Author(s):

Elisabetta Iacopi ◽

Lorenza Abbruzzese ◽

Chiara Goretti ◽

Nicola Riitano ◽

Alberto Piaggesi

Keyword(s):

Diabetic Foot ◽

Chronic Wounds ◽

Standard Of Care ◽

Healing Time ◽

Complete Healing ◽

Group A ◽

Reduced Rate ◽

Group B ◽

Time Required

There are still many unmet needs in the treatment of chronic wounds, especially regarding microenvironment modulation. Nexodyn is a novel super-oxidized solution capable of contrast bacterial proliferation. We aimed to evaluate if this solution, on top of standard of care, was safe and effective in improving diabetic foot outcome. We selected 50 patients admitted in our department to be submitted to surgery for acute diabetic foot infection. All patients were left open to heal for secondary intent. We divided patients into 2 groups: Group A (n = 25, male/female = 17/8, age = 67.3 ± 12.1 years, hemoglobin A1C = 7.9 ± 1.1%), patients treated with standard of care and, on top of this, Nexodyn solution, and Group B, treated only with standard of care. After discharge, patients continued Nexodyn application. We followed up patients until complete healing or up to 6 months. No differences between groups in healing rate, while time required for complete healing was significantly shorter in Group A (64.9 ± 12.1 days vs 147.4 ± 23.1 days, P < .01). During follow-up, the group treated with Nexodyn showed a reduced rate of reinfections (12 patients in Group B vs 3 patients in Group A, P < .05) and of further debridement procedures (1 patient in Group A vs 10 patients in Group B, P < .05). Nexodyn provided effective protection against reinfections in diabetic foot patients, thus reducing the necessity for debridement procedures and their healing time and presents a safety profile similar to saline solution.

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Pilot Experience on the Use of S54P4 Bioactive Glass in the Surgical Management of Diabetic Foot Osteomyelitis

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620926003 ◽

2020 ◽

pp. 153473462092600

Author(s):

Elisabetta Iacopi ◽

Letizia Pieruzzi ◽

Chiara Goretti ◽

Alberto Piaggesi

Keyword(s):

Bioactive Glass ◽

Diabetic Foot ◽

Surgical Procedure ◽

Healing Rate ◽

Complete Healing ◽

Pilot Experience ◽

Novel Material ◽

Mean Time ◽

Host Tissues

To test safety and efficacy of bioactive glass, a novel material used to replace bone, able to completely bond itself to the host tissues on patients treated for osteomyelitis (OM) complicating a diabetic foot (DF). We evaluated a group of patients consecutively admitted in our department between September and December 2018, who underwent surgical DF procedures for OM and in whom the use of bioactive glass could limit the demolition phase of surgical procedure. Patients were treated with bioactive glass S53P4 on top of standard treatment directly in operating room. The patients were weekly controlled for 6 months or until complete healing. During follow-up, we analyzed primarily healing rate and secondarily time of healing, need for further debridement procedures, recurrences, and adverse or hypersensitivity reactions to study treatment. Ten DF patients were enrolled (male/female 6/4; mean age 56 ± 11 years; mean duration of diabetes 10.5 ± 4.7 years, mean hemoglobin A1c 7.2 ± 0.9%). Patients underwent surgical procedure during which, after an accurate debridement, bioactive glass was applied. A healing rate of 80% in a mean time of 34 ± 2 days, with only 1 patient who needed a second surgical look, was observed. Neither recurrences nor adverse events during follow-up were observed in treated patients. This pilot experience demonstrated that bioactive glass can be considered a useful tool for the surgical treatment of DF-related OM.

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