Recurrent diabetic foot ulcers: Results of a maximal multidisciplinary approach including reconstructive foot/ankle surgery.
Wouter BrekelmansWilbert van LaarNicole J TolenRigo HoencampBoudewijn L S Borger van der BrugPublished in: International wound journal (2023)
The diabetic foot ulcer (DFU) and Charcot Neuroarthropathy (CN) are serious complications of diabetes mellitus in which wound closure is complex to achieve. Treating recurrent DFU in patients with a combination of infection, ischemia, and deformities is extremely challenging and this group of patients has a very poor outcome. This case series describes the outcomes of patients with a recurrent DFU and CN, with a mean SINBAD score of 4 and of which 40% had a TCS of D3, using a multidisciplinary protocol that includes reconstructive foot and ankle surgery. In 24/35 (69%) of patients, wound closure was achieved after a mean of 75 days postoperatively. The mean ulcer-free period was 358 days. The mean number of interventions was 6.7 (range 3-9). Post treatment 27/35 (77%) of patients was mobile, without additional amputation or ulcer recurrence. This study shows that wound closure and a long ulcer-free period can be achieved in patients with a DFU and CN and its multifactorial underlying diseases when treated in a multidisciplinary team, including reconstructive foot and ankle surgery.
Keyphrases
- end stage renal disease
- minimally invasive
- surgical site infection
- newly diagnosed
- chronic kidney disease
- coronary artery bypass
- ejection fraction
- peritoneal dialysis
- lymph node metastasis
- randomized controlled trial
- quality improvement
- squamous cell carcinoma
- type diabetes
- physical activity
- adipose tissue
- patient reported outcomes
- acute coronary syndrome
- insulin resistance
- high intensity
- weight loss
- resistance training
- heart rate