Role of ulcer grading classification in predicting level of amputation in diabetic foot ulcer.

Objectives: The study was designed to analyze and predict the diabetic foot ulcer outcome in terms of either healing or progression to amputation in patients presenting with diabetic foot. Study Design: Cross Sectional study. Setting: POF Hospital Wah Cantt. Period: January 2017 to December 2017. Material & Methods: Demographics of patients along with duration of diabetic foot ulcer and its grade according to Wagner classification were recorded. Nonprobability consecutive sampling was done for the data collection. Management of ulcer was carried out with debridement, daily dressings and appropriate antibiotic. Patients were followed over period until ulcer healed completely or amputation performed. The outcome of diabetic foot ulcer was noted to complete the study. Results: One hundred patients with mean age were 54.24±3.65 years. Mean duration of diabetic ulcer was 17.61±4.6 days. All patients with grade I ulcer recovered completely without the need of amputation. Out of 25 patients with grade II ulcers 13 (52%) patients recovered without amputation while 12 (48%) patients had minor amputation. Similarly 16 patients presenting with grade III ulcers 12 (75%) had minor amputation while 4 (25%) underwent major amputation. Out of 18 patients with grade IV ulcers, 6 (33%) had minor amputation while 12 (67%) had major amputation. All 13 patients with grade V ulcer underwent major amputation. Relation of grades of ulcer with respect to level of amputation inside the grading classification of ulcer showed significant (p=0.000). Conclusion: Healing of the diabetic foot ulcer with preservation of limb function must be a goal of treating diabetic foot. Wagner classification of diabetic foot ulcer high grade is associated with increased risk along with high level of foot amputation.

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“ ASSESSMENT OF SEVERITY OF DIABETIC FOOT ULCERS USING DIABETIC ULCER SEVERITY SCORE.”

10.36106/gjra/0903090 ◽

2020 ◽

pp. 19-21

Author(s):

Aarushi Mishra ◽

Anilkumar P. Bellad ◽

M.I. Uppin

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Severity Score ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Major Amputation ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Diabetic Ulcer ◽

The Past

INTRODUCTION : Diabetes mellitus is a common metabolic disorder, prevalence steadily increasing over the past few decades. The complications associated with it , hence , has also increased. Diabetic foot ulcer is one of the most serious complications , utilizing resources, significantly contributing to the morbidity of the patient. There is hence, a need to correctly identify the severity of the diabetic foot ulcer so as to plan the appropriate management and to help in counselling of such patients. AIM : To assess severity in diabetic foot ulcer using diabetic ulcer severity score. MATERIAL AND METHODOLOGY : This is a hospital based longitudinal study , conducted on 93 study subjects admitted with diabetic foot ulcers. Diabetic ulcer severity score was calculated for each patient . The score was calculated by adding scores of the respective parameters constituting site of ulcer, number of ulcers, presence/absence of pedal pulsations, presence/ absence of bone involvement. Each patient was followed up for a period of 6 months , or earlier in case of patient undergoing minor/major amputation. After the study was conducted , analysis was done by calculating various percentages of healing /amputation with respect to the score. RESULTS : Out of the total 93 study subjects , 74.2% were males. The mean age was calculated to be 59.6 years with maximum number of subjects being in 55-60 years of age group range. Majority of them had diabetic ulcer severity score of 2 (42%). Out of the total study subjects , 58% had a complete healing , 28% underwent minor amputation whereas 14% underwent major amputation. 100% of the study participants with score 0 had healing of ulcer which decreased to 85% for score 1 , 53.8% for score 2 , 6.25% for score 3 and 0% for score 4. This was suggestive of poorer chances of healing as the diabetic ulcer severity score increases. CONCLUSION : With the increasing incidence of patients diagnosed with diabetes mellitus , the rate of complications of diabetes has also increased over the past few decades including the risk and occurence of diabetic foot ulcers There is an increasing need for diabetic foot ulcer prognostication systems and universal use of the same. Thus ,we recommend the use of diabetic ulcer severity score as a prognostic tool to assess the severity of the diabetic foot which will further enhance communication and counselling of the patient and will help in providing the appropriate treatment to such patients.

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Factors Associated With Ulcer Healing and Quality of Life in Patients With Diabetic Foot Ulcer

Angiology ◽

10.1177/0003319716651166 ◽

2016 ◽

Vol 68 (3) ◽

pp. 242-250 ◽

Cited By ~ 11

Author(s):

Konstantinos Spanos ◽

Vasileios Saleptsis ◽

Athanasios Athanasoulas ◽

Christos Karathanos ◽

Alexandra Bargiota ◽

...

Keyword(s):

Quality Of Life ◽

Ulcer Healing ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Major Amputation ◽

Diabetic Patients ◽

Factors Associated ◽

Minor Amputation

A prospective nonrandomized cohort study on consecutive diabetic patients with foot ulcer was undertaken to assess the factors associated with the healing process or limb salvage and evaluate the impact of their treatment on their quality of life. Quality of life was evaluated using Diabetic Foot Ulcer Scale–Short Form (DFS-SF) questionnaire before and after treatment. A total of 103 diabetic patients with ulcer (mean age 69.7 ± 9.6 years, 77% male) were treated and followed up for 12 months. Ulcer healing, minor amputation, and major amputation rates were 41%, 41%, and 18%, respectively, while the mortality rate was 18%. Ulcer healing was associated with University of Texas wound grade 1 and the Study of Infections in Diabetic feet comparing Efficacy, Safety and Tolerability of Ertapenem versus Piperacillin/Tazobactam trial’s diabetic foot infection wound score. Limb loss was associated with nonpalpable popliteal artery, longer in-hospital stay, and delay until referral. Quality of life was improved in all domains of DFS-SF ( P < .0001) throughout the cohort of our patients regardless of their outcome, and no outcome (healing, minor amputation, or major amputation) was superior to other. Significant improvement was observed in all domains of hygiene self-management after consultation during the follow-up period.

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Monitoring and Prevention the Risk of Diabetic Foot Ulcer Infection during Coronavirus Disease-19 Pandemic: A Narrative Review and Perspective Algorithm

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6135 ◽

2021 ◽

Vol 9 (B) ◽

pp. 577-582

Author(s):

Mariya Dmitriyeva ◽

Saken K. Kozhakhmetov ◽

Dulat K. Turebayev ◽

Saltanat N. Urazova ◽

Talgat M. Omarov ◽

...

Keyword(s):

Remote Monitoring ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Cochrane Library ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Diabetic Ulcer ◽

Number Of Patients ◽

Increased Risk

BACKGROUND: The coronavirus disease (COVID)-19 pandemic leads to significant changes in the healthcare system and undermining best practices for maintaining a diabetic limb. A large number of patients with diabetic foot are left without timely medical care and are at increased risk of complications, hospitalization, lower limb amputation, and death. A new paradigm must be adopted for the transition from inpatient care to community-based care. The introduction of a pandemic remote management for patients with diabetic foot ulcer includes an assessment of the risk of complications through telemedicine and further stratification of patients according to the developed algorithm. METHODS: A literature review was performed for articles related to telemedicine. We used PubMed, Google Scholar, Cochrane Library, and Ovid MEDLINE to search published articles. We used the following keywords: “Telemedicine,” “diabetes mellitus,” “COVID-19,” “diabetic foot ulcer,” and “remote monitoring.” RESULTS: Implementation of the proposed pandemic care includes telemedicine for remote monitoring and treatment of patients with diabetic foot ulcers, as well as an algorithm for determining the risk of diabetic ulcer infection and patient management tactics according to the identified risk. CONCLUSION: The management of patients with diabetic foot ulcers during a pandemic includes the following goals – to reduce the burden on the health-care system, maintain the safety and functionality of diabetic foot at home, and reduce the risk of COVID-19 in patients with diabetic foot ulcers.

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KEJADIAN DERAJAT LUKA DIABETES TIDAK BERHUBUNGAN DENGAN NILAI RISIKO DIABETIC FOOT ULCER

Jurnal Ilmu dan Teknologi Kesehatan ◽

10.32668/jitek.v4i2.91 ◽

2017 ◽

Vol 4 (2) ◽

pp. 215-227

Author(s):

Risma Anggraeni Yuliastuti ◽

Megah Andriany ◽

Eka Putri Y.

Keyword(s):

Diabetic Foot ◽

Wound Care ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Risk Level ◽

Diabetic Patients ◽

Cross Sectional ◽

Diabetic Ulcer ◽

Significance Level ◽

Risk Levels

The highest diabetic complication percentage is neuropathy (54%) causing diabetic foot ulcer (DFU). The study aimed to know the relationship between diabetic foot ulcer risk levels with diabetic ulcer severity levels. Scope of the study was diabetic wound care, particularly on legs mostly experienced by diabetic patients. The method used was descriptive correlation with cross sectional design. Sampling method was non probability with purposive sampling. Respondent number was 16 persons with inclusion criteria was diabetic patients with ulcer in one leg and no ulcer on another side in the second visitation to a diabetic clinic in Bekasi,Indonesia and agreed to be involved in the study. DFU risk level instrument modified from Diabetes Foot Screening and Risk Stratification Form of New Zealand Society for Study of Diabetes (NZSSD) to measure the DFU degree on legs with no ulcer. Another tool was to measure severity level of legs with ulcer according to Wagner. Data analysis used Kendall’s tau with 0.05 of significance level. The result shows there is no relationship between DFU risk levels with severity degree of diabetic ulcers. From the study, we can conclude that nurses do not need provide specific DFU prevention based on diabetic ulcer severity grade.

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Diabetic foot ulcer management in a multidisciplinary foot centre: one-year healing, amputation and mortality rate

Journal of Wound Care ◽

10.12968/jowc.2020.29.8.464 ◽

2020 ◽

Vol 29 (8) ◽

pp. 464-471

Author(s):

Georges Ha Van ◽

Chloe Amouyal ◽

Olivier Bourron ◽

Carole Aubert ◽

Aurelie Carlier ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Median Duration ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Major Amputation ◽

Minor Amputation ◽

One Year

Objective: To describe the rates of healing, major amputation and mortality after 12 months in patients with a new diabetic foot ulcer (DFU) and their care in a French diabetic foot service (DFS). Method: A prospective single-centre study including patients from March 2009 to December 2010. The length of time to healing, minor amputation, major amputation and mortality rate after inclusion were analysed using the Kaplan–Meier method. Results: Some 347 patients were included (3% lost to follow-up), with a median follow-up (IQR) of 19 (12–24) months. The mean (SD) age was 65±12 years, 68% were male, and the median duration of the ulcer was 49 (19–120) days. Complications of the DFU were ischaemia (70%), infection (55%) and osteomyelitis (47%). Of the patients, 50% were inpatients in the DFS at inclusion (median duration of hospitalisation 26 (15–41) days). The rate of healing at one year was 67% (95% confidence interval (CI): 61–72); of major amputation 10% (95% CI: 7–17); of minor amputation 19% (95% CI: 14–25), and the death rate was 9% (95% CI: 7–13). Using an adjusted hazard ratio, the predictive factors of healing were perfusion and the area of the wound. The risk factors for a major amputation were active smoking and osteomyelitis. The risk factors for mortality were perfusion and age. Conclusion: This study confirms the need to treat DFUs rapidly, in a multidisciplinary DFS.

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Diabetic foot ulcer management in a multidisciplinary foot centre: one-year healing, amputation and mortality rate

Journal of Wound Care ◽

10.12968/jowc.2021.30.sup6.s34 ◽

2021 ◽

Vol 30 (Sup6) ◽

pp. S34-S41

Author(s):

Georges Ha Van ◽

Chloe Amouyal ◽

Olivier Bourron ◽

Carole Aubert ◽

Aurelie Carlier ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Median Duration ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Major Amputation ◽

Minor Amputation ◽

One Year

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Efficacy of diabetic ulcer severity score in patients with diabetic foot ulcer in predicting prognosis

International Surgery Journal ◽

10.18203/2349-2902.isj20213977 ◽

2021 ◽

Vol 8 (10) ◽

pp. 2961

Author(s):

Robinson George ◽

Joe Mathew ◽

Vishnu M. L. ◽

Jacob P. Thomas

Keyword(s):

Diabetic Foot ◽

Severity Score ◽

Scoring System ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Major Amputation ◽

Classification Systems ◽

Clinical Parameters ◽

Diabetic Ulcer

Background: Diabetic foot ulcer (DFU) is a full-thickness wound, skin necrosis or gangrene below the ankle induced by peripheral neuropathy or peripheral arterial disease in patients with diabetes. There are well-accepted classification systems for DFUs, namely Wagner’s scoring system, university of Texas scoring system etc. However, only few are scientifically validated. Diabetic ulcer severity score (DUSS) introduced by Beckert et al consists of easily accessible clinical parameters which categorizes wounds into specific subgroups for comparison of outcomes.Methods: A prospective study was conducted on 250 diabetic ulcer patients, attending the out-patient department (OPD) of surgery, Pushpagiri institute of medical sciences, Tiruvalla.Results: Most common age group affected with diabetic foot was between 51-60 years (mean 58.9±10.2 years). Males accounted for 54% of patients. Most common ulcers were of score of 2 followed by score 3. Overall, 105 (42%) of 250 people had amputations in our study with majority undergoing minor amputation (30%) than the major amputation (12%). None of the patients with scores 0, 1 and 2 had major amputation. Probability of healing among the various scores were-100% for score 0, 97.9% for score 1, 83.4% for score 2, 17.7% for score 3 and 4.8% for score 4. Lower score is strongly associated with primary healing and higher score with amputations.Conclusions: DUSS system is an easy wound based diagnostic tool for anticipating probability of healing or amputation and need for surgery by assessing the four clinical parameters and combining them which is safe and easily reproducible.

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Clinical utility of diabetic ulcer severity score in surgical practice

International Surgery Journal ◽

10.18203/2349-2902.isj20192976 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2469

Author(s):

Jose V. Francisco Menezes ◽

Sreenidhi G. M. ◽

Satya Vani K.

Keyword(s):

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Major Amputation ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Clinical Tool ◽

Aggressive Approach ◽

Diabetic Ulcer ◽

Surgical Practice

Background: In surgical practice we come across many diabetic foot ulcer patients who often present late, leading to limb loss and even death. In the search for an effective screening tool to assess the severity of the disease and predict the outcome we have adopted the DUSS.Methods: Prospective study from October 2016 to April 2018 including 200 patients with diabetic foot ulcers conducted at Surgery Department in KIMS, Bangalore. DUSS was applied at the time of admission. DUSS comprises 4 clinical parameters: 1) pedal pulses, 2) probing to bone, 3) ulcer site and 4) ulcer number. These wounds were graded into score 0, 1, 2, 3, 4. Standard management was given to all patients according to a protocol. The outcome of treatment was recorded as healed ulcer, minor amputations, (toe or forefoot) or major amputations (below or above knee). Co-relation between the DUSS scores and final outcome was done.Results: Healing rates were higher in those with lower DUSS scores (88.9% in score 0 compared to 0% in Score 4). Minor amputation rates for scores 0, 1, 2,3 were 11.1%, 30.5%,28.3% and 44.1% respectively. Major Amputation rates were higher in patients with high DUSS scores i.e. 3 (41.8%) and 4 (100%).Conclusions: DUSS is an effective clinical tool to assess the severity of diabetic foot ulcers. DUSS scores help in predicting the outcome of treatment hence it can be used to counsel the patient regarding the disease and its prognosis. Patients with higher DUSS scores should require a more aggressive approach to minimise morbidity and mortality.

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Clinical Utility of the Ankle-Brachial Index and Toe Brachial Index in Patients with Diabetic Foot Ulcers

Current Diabetes Reviews ◽

10.2174/1573399815666190531093238 ◽

2020 ◽

Vol 16 (3) ◽

pp. 270-277 ◽

Cited By ~ 1

Author(s):

Mutasem Ababneh ◽

Mousab Y. Al Ayed ◽

Asirvatham A. Robert ◽

Mohamed A. Al Dawish

Keyword(s):

Diabetic Foot ◽

Statistical Significance ◽

Ankle Brachial Index ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Cross Sectional Study ◽

Screening Tests ◽

Cross Sectional ◽

Toe Brachial Index

Background: This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. Materials and Methods: The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients’ medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the “χ2” test. Results: From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. Conclusion: In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.

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Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study

Journal of Diabetes Research ◽

10.1155/2017/2879249 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 22

Author(s):

Tesfamichael G. Mariam ◽

Abebaw Alemayehu ◽

Eleni Tesfaye ◽

Worku Mequannt ◽

Kiber Temesgen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Cross Sectional Study ◽

Care Practice ◽

Diabetic Patients ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

Diabetes mellitus is a metabolic disorder which is characterized by multiple long-term complications that affect almost every system in the body. Foot ulcers are one of the main complications of diabetes mellitus. However, there is limited evidence on the occurrence of foot ulcer and influencing factors in Ethiopia. An institutional-based cross-sectional study was conducted in Gondar University Hospital, Ethiopia, to investigate foot ulcer occurrence in diabetic patients. Systematic random sampling was used to select 279 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. Odds ratio with 95% confidence interval was computed to determine the level of significance. Diabetic foot ulcer was found to be 13.6%. Rural residence [AOR = 2.57; 95% CI: 1.42, 5.93], type II diabetes mellitus [AOR = 2.58; 95% CI: 1.22, 6.45], overweight [AOR = 2.12; 95% CI: 1.15, 3.10], obesity [AOR = 2.65; 95% CI: 1.25, 5.83], poor foot self-care practice [AOR = 2.52; 95% CI: 1.21, 6.53], and neuropathy [AOR = 21.76; 95% CI: 8.43, 57.47] were factors associated with diabetic foot ulcer. Diabetic foot ulcer was found to be high. Provision of special emphasis for rural residence, decreasing excessive weight gain, managing neuropathy, and promoting foot self-care practice would decrease diabetic foot ulcer.

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