scholarly journals Using DIRECT Wound Assessment to Predict Limb Salvage and Provide Prognosis of Diabetic Foot Ulcers

2021 ◽  
Vol 17 (1) ◽  
pp. 9-18
Author(s):  
Dongkeun Jun ◽  
Yongseok Kwon ◽  
Jaehyun Bae ◽  
Myungchul Lee ◽  
Jeenam Kim ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Complete Healing ◽  
Classification Systems ◽  
Assessment System ◽  
Foot Ulcers ◽  
Grading System ◽  
Diabetic Foot Ulcers ◽  
Coding System ◽  
Wound Assessment

Background: Many wound assessment systems including the Wagner classification and University of Texas (UT) grading system have been previously described. The authors of this study applied the DIRECT (Debridement of necrosis, Infection control, Revascularization, Exudate control, Chronicity, and Top surface) wound coding system for initial assessment of diabetic foot ulcers (DFUs) to predict limb salvage and prognosis.<br/>Methods: From January 2016 to February 2020, a total of 169 first-time DFU patients were retrospectively evaluated using the DIRECT wound coding assessment system. DFUs were followed up for at least 6 months, and scores in each component of the coding system according to final limb status were statistically evaluated. The coding assessment’s ability to predict major amputation was compared to those of the Wagner classification and the UT grading system.<br/>Results: Subjects were divided into complete healing (n=80, 47.3%), not healed (n=71, 42%), and amputation (n=18, 10.7%) groups. The mean values of each component of DIRECT assessment for the complete healing/amputation groups were D 0.86/1.56 (P<0.001), I 0.46/0.89 (P=0.001), R 0.65/0.94 (P=0.014), E 1.15/1.56 (P=0.049), C 0.69/0.89 (P=0.086), T 0.53/0.72 (P=0.13) and the sum was 3.140/4.741 (P<0.001). The area under the receiver operating characteristic curve of the DIRECT, Wagner, and UT grading systems was 0.722, 0.603, and 0.663, respectively.<br/>Conclusion: The DIRECT coding system shows a greater association with prediction of amputation or complete healing, compared with the Wagner and UT wound classification systems. This more accurate wound assessment system will be helpful in predicting prognosis and planning treatments.

scholarly journals Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

2018 ◽  
Vol 35 (02) ◽  
pp. 117-123 ◽  
Author(s):  
Jocelyn Lu ◽  
Michael DeFazio ◽  
Chrisovalantis Lakhiani ◽  
Michel Abboud ◽  
Morgan Penzler ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Diabetic Foot ◽  
Functional Outcomes ◽  
Free Tissue Transfer ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Flap Survival ◽  
Foot Reconstruction

Background Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. Methods Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K.K.E.). In all cases, microsurgical reconstruction was offered as an alternative to major amputation for the management of recalcitrant DFUs. Overall rates of flap survival, limb salvage, and postoperative ambulation were evaluated. The lower extremity functional scale (LEFS) score was used to assess functional outcomes after surgery. Results Overall rates of flap success and lower limb salvage were 93 and 79%, respectively. Flap failure occurred in two patients with delayed microvascular compromise. Seven patients in this series ultimately required below-knee amputation secondary to recalcitrant infection (n = 5), intractable pain (n = 1), and limb ischemia (n = 1). The average interval between FTT and major amputation was 8 months (r, 0.2–15 months). Postoperative ambulation was confirmed in 25 patients (86%) after a mean final follow-up of 25 months (r, 10–48 months). The average LEFS score for all patients was 46 out of 80 points (r, 12–80 points), indicating the ability to ambulate in the community with some limitations. Conclusion FTT for the management of recalcitrant DFUs is associated with high rates of reconstructive success and postoperative ambulation. However, several patients will eventually require major amputation for reasons unrelated to ultimate flap survival. These data should be used to counsel patients regarding the risks, functional implications, and prognosis of microvascular diabetic foot reconstruction.

Limb Salvage of Infected Diabetic Foot Ulcers with Microsurgical Free-Muscle Transfer

1991 ◽  
Vol 26 (3) ◽  
pp. 212-220 ◽  
Author(s):  
Chung-Sheng Lai ◽  
Sin-Daw Lin ◽  
Chin-Chiang Yang ◽  
Chih-Kang Chou ◽  
Sin-Fu Wu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Muscle Transfer

scholarly journals Proximal Tibial Cortex Transverse Distraction Facilitating Healing and Limb Salvage in Severe and Recalcitrant Diabetic Foot Ulcers

2020 ◽  
Vol 478 (4) ◽  
pp. 836-851 ◽  
Author(s):  
Yan Chen ◽  
Xiaocong Kuang ◽  
Jia Zhou ◽  
Puxiang Zhen ◽  
Zisan Zeng ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Tibial Cortex

Limb salvage of infected diabetic foot ulcers with free deep inferior epigastric perforator flaps

Microsurgery ◽  
2006 ◽  
Vol 26 (2) ◽  
pp. 87-92 ◽  
Author(s):  
Masayoshi Ohta ◽  
Mika Ikeda ◽  
Takeshi Togo ◽  
Shigehiko Suzuki
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Perforator Flaps ◽  
Deep Inferior Epigastric Perforator

scholarly journals Spray on skin for diabetic foot ulcers: an open label randomised controlled trial

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Laurens Manning ◽  
Emma J. Hamilton ◽  
Edward Raby ◽  
Paul E. Norman ◽  
Wendy Davis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Wound Healing ◽  
Diabetic Foot ◽  
Controlled Trial ◽  
Economic Benefits ◽  
Complete Healing ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Open Label

Abstract Background One Australian loses a limb every 3 h as a result of infected diabetic foot ulcers (DFU). This common condition accounts for substantial morbidity and mortality for affected individuals and heavy economic costs for the health sector and the community. There is an urgent need to test interventions that improve wound healing time, prevent amputations and recurrent ulceration in patients presenting with DFU whilst improving quality of life and reducing health care costs. Methods One hundred and fifty eligible participants will be randomised to receive an autologous skin cell suspension, also termed ‘spray-on’ skin (ReCell®) or standard care interventions for their DFU. The primary outcome is complete wound healing at 6 months, but participants will be followed up for a total of 12 months to enable secondary outcomes including total overall costs, ulcer free days at 12 months and quality of life to be assessed. Discussion Outpatient costs for dressings, home nursing visits and outpatient appointments are key cost drivers for DFU. If spray-on skin is effective, large cost savings to WA Health will be realised immediately through a shortened time to healing, and through a higher proportion of patients achieving complete healing. Shortened healing times may enable participants to return to work earlier. Any economic benefits are likely to be amplified across Australia and other similar demographic settings where aging populations with increased diabetes rates are considered major future challenges. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000511235. Registered on 9 April 2018.

Point of care ultrasound imaging as a wound assessment tool in diabetic foot ulcers: a case series

2020 ◽  
Vol 29 (Sup8) ◽  
pp. S28-S34
Author(s):  
Frances R Henshaw ◽  
Ian B Reid ◽  
Anna M Spencer ◽  
Deborah E Turner
Keyword(s):  
Diabetic Foot ◽  
Point Of Care ◽  
Case Series ◽  
World Health ◽  
Foot Ulcers ◽  
Multidisciplinary Teams ◽  
Point Of Care Ultrasound ◽  
Diabetic Foot Ulcers ◽  
Meaningful Information ◽  
Wound Assessment

Foot ulceration is a common and devastating complication of diabetes. Traditionally, diabetic foot ulcers (DFU) are managed by multidisciplinary teams in tertiary hospital settings. Wound management decisions are based largely on visual observations at the point of care, using rudimentary evaluation of superficial tissues, such as wound tracings and photography combined with expert knowledge of the treating practitioners. Imaging based methods of assessment, such as X-ray, magnetic resonance imaging, scintigraphy or computed tomography are able to more comprehensively categorise wounds and to determine whether re-epithelialised wounds are in fact healed. Ultrasound has been advocated by the World Health Organization for the monitoring of chronic diseases and for screening because it is considered low risk, comfortable for patients and low cost. It can be performed in real time at the point of care and using B-mode, Doppler and elastography has the potential to provide clinically meaningful information for monitoring the status of hard-to-heal wounds, but to date this imaging technique has not been exploited in this field. This case series highlights the utility of diagnostic musculoskeletal ultrasound as an adjunct to traditional wound assessment that can provide diagnostically meaningful information to assist in clinical decision making. Future research will be needed to determine if routine incorporation of ultrasound in wound assessment improves patient outcomes.

Sign in / Sign up

Export Citation Format

Share Document