Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

Background: We sought to determine patient and ulcer characteristics that predict wound healing in patients living with diabetes. Methods: A prospective observational study was conducted on 99 patients presenting with diabetic foot ulceration. Patient and ulcer characteristics were recorded. Patients were followed up for a maximum of 1 year. Results: After 1 year of follow-up, ulcer characteristics were more predictive of ulcer healing than were patient characteristics. Seventy-seven percent of ulcers had healed and 23% had not healed. Independent predictors of nonhealing were ulcer stage (P = .003), presence of biofilm (P = .020), and ulcer depth (P = .028). Although this study demonstrated that the baseline hemoglobin A1c reading at the start of the study was not a significant predictor of foot ulcer outcome (P = .603, resolved versus amputated), on further statistical analyses, when hemoglobin A1c was compared with the time taken for complete ulcer healing (n = 77), it proved to be significant (P = .009). Conclusions: The factors influencing healing are ulcer stage, presence of biofilm, and ulcer depth. These findings have important implications for clinical practice, especially in an outpatient setting. Prediction of outcome may be helpful for health-care professionals in individualizing and optimizing clinical assessment and management of patients. Identification of determinants of outcome could result in improved health outcomes, improved quality of life, and fewer diabetes-related foot complications.

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Causation Research on Diabetic Foot Complications—What I Learned From Roger Pecoraro: The 2021 Roger E. Pecoraro Award Lecture

10.2337/figshare.15048282 ◽

2021 ◽

Author(s):

Edward J. Boyko

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Past History ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Clinical Information ◽

Arterial Perfusion ◽

Primary Care Population ◽

Foot Complications ◽

Patients With Diabetes

Roger Pecoraro made important contribution to diabetic foot research and is primarily responsible for instilling in me an interest in these complications. Our collaboration in the final years of his life led to the development of the Seattle Diabetic Foot Study. At the time it began, the Seattle Diabetic Foot Study was perhaps unique in being a prospective study of diabetic foot ulcer conducted in a non-specialty primary care population of patients with diabetes and without foot ulcer. Important findings from this research include the demonstration that neurovascular measurements, diabetes characteristics, past history of ulcer or amputation, body weight, and poor vision all significantly and independently predict foot ulcer risk. A prediction model from this research that included only readily available clinical information showed excellent ability to discriminate between patients who did and did not develop ulcer during follow-up (area under ROC curve=0.81 at one year). Identification of limb-specific amputation risk factors showed considerable overlap with those risk factors identified for foot ulcer, but suggested arterial perfusion as playing a more important role. Risk of foot ulcer in relation to peak plantar pressure estimated at the site of the pressure measurement showed a significant association over the metatarsal heads, but not other foot locations, suggesting that the association between pressure and this outcome may differ by foot location. The Seattle Diabetic Foot Study has helped to expand our knowledge base on risk factors and potential causes of foot complications. Translating this information into preventive interventions remains a continuing challenge.

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Soft Tissue Reconstruction Pyramid in the Diabetic Foot

Foot & Ankle Specialist ◽

10.1177/1938640010375113 ◽

2010 ◽

Vol 3 (5) ◽

pp. 241-248 ◽

Cited By ~ 14

Author(s):

Claire M. Capobianco ◽

John J. Stapleton ◽

Thomas Zgonis

Keyword(s):

Soft Tissue ◽

Diabetic Foot ◽

Weight Bearing ◽

Soft Tissue Coverage ◽

Soft Tissue Reconstruction ◽

Best Interest ◽

Foot Complications ◽

Uncontrolled Diabetes ◽

Wound Healing Response ◽

Tissue Reconstruction

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non—weight bearing, all of which have been shown to adversely affect the patient’s quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient’s best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.

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DIABETIC FOOT AMPUTATION;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.02.501 ◽

2017 ◽

Vol 24 (02) ◽

pp. 302-307

Author(s):

Naveed Akhtar ◽

Sultan Ahmed ◽

Hassan Mahmood Tabassum ◽

Sadaf Lanjar

Keyword(s):

Diabetic Nephropathy ◽

Diabetic Foot ◽

Cross Sectional Study ◽

Study Data ◽

Cross Sectional ◽

Surgical Department ◽

Foot Complications ◽

Qualitative Variables ◽

Foot Lesions ◽

Diabetic Foot Lesions

Introduction: Diabetic foot lesions have remained a major cause of morbidity inpatients with kidney failure. Foot complications are more than twofolds in diabetic nephropathypatients, and the rate of amputation is 6 to 10 times higher in diabetic nephropathy patientsin comparison to the general diabetic population. Objectives: To determine the frequencyof diabetic nephropathy in patients undergoing diabetic foot amputation. Study Design:Observational cross-sectional study. Setting: Surgical Department Unit-II, Sheikh ZayedMedical College and Hospital Rahim Yar khan. Material and Methods: The duration of thestudy was 2 years from Dec-2013 to Dec-2015. A total number of 73 patients were includedin this study. Patients who were admitted to the department of surgery for amputation of thefoot or the leg having the history of diabetes regardless of their age and sex were selectedfor this study. Data analyses were carried out using SPSS Version17 software. Quantitativevariables were presented as Mean and standard deviations. Frequency and percentages werecomputed for qualitative variables. Results: The mean age of the patients was 57.51±7.61years. Out of 73 cases, there were 43(58.9%) males and 30 (41.1%) females. Previous historyof amputation was observed in 26 (35.62%) cases, 48 (65.75%) patients were hypertensive.Out of 73 patients, Forty (54.79%) had controlled diabetes and 33 (45.21%) had uncontrolleddiabetes. Twenty seven patients (36.99%) were diagnosed for diabetic nephropathy. Theincidence of nephropathy was high in patients with advancing age. This incidence was in 26(56.62%) patients with age 51 to 60 years and 18 (39.13%) in patients having age more than 60years. Conclusions: Lower extremity amputations are strongly associated with nephropathy indiabetic patients. It is very important to check and improve the renal function in patients withdiabetic foot ulcers who are hypertensive, increasing age and long duration of DM to preventlower limb amputations.

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