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. 2020 Dec;9(12):676-685.
doi: 10.1089/wound.2018.0903. Epub 2019 Nov 19.

Study on the Effect of the Five-in-One Comprehensive Limb Salvage Technologies of Treating Severe Diabetic Foot

Yiling Liu  1 , Yan Shi  2 , Junyou Zhu  1 , XiaoDong Chen  3 , RongHua Yang  3 , Bin Shu  1 , Ziheng Zhou  1 , Jian Liu  1 , Ri-Qiang Wu  4 , Julin Xie  1
Affiliations

Study on the Effect of the Five-in-One Comprehensive Limb Salvage Technologies of Treating Severe Diabetic Foot

Yiling Liu et al. Adv Wound Care (New Rochelle). 2020 Dec.

Abstract

Objective: To explore the clinical efficacy and advantages of five-in-one comprehensive limb salvage technologies for the treatment of severe diabetic foot ulcer (DFU). Approach: Clinical data for 120 patients with severe DFU treated between January 2012 and December 2017 were analyzed retrospectively. The control group (48 cases) was treated with traditional therapies, including controlling blood sugar, improving microcirculation, preserving nerve function, and dressing changes, whereas the experimental group (72 cases) was treated with traditional therapy combined with additional techniques, such as early and thorough debridement, negative pressure wound therapy, revascularization, and skin graft or flap. Ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), wound healing rate, healing time, ulcer recurrence rate, and amputation rate were recorded. Results: Compared with the control group, the experimental group significantly improved wound healing rate (93.1% vs. 72.9%; p < 0.01), decreased wound healing time (16.2 ± 5.4 days vs. 32.2 ± 7.8 days; p < 0.05), reduced major limb amputation rate (1.4% vs. 10.4%, p < 0.05), and ulcer recurrence rate (5.6% vs. 14.6%; p < 0.05). There were no significant differences in amputation rate between experimental and control group (29.2% vs. 33.3%, p = 0.628). After revascularization, the revascularization group showed significantly improved ABI (0.75 ± 0.21 vs. 0.35 ± 0.16, p < 0.05) and TcPO2 (36 ± 6 mmHg vs. 15 ± 4 mmHg, p < 0.05). Innovation: We propose a five-in-one comprehensive treatment method, which provides a multidisciplinary cooperative model for comprehensive medical and surgical treatments for DFU. Conclusion: The five-in-one comprehensive limb salvage treatment technologies played a vital role in enhancing the healing rate of severe DFU, shortening the healing time, and reducing the rate of recurrence and major amputation, thus improving the overall quality of life.

Keywords: NPWT; amputation; diabetic foot ulcer; revascularization; wound healing.

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Conflict of interest statement

No competing financial interests exist. The content of this article was expressly written by the authors listed. No ghostwriters were used to write this article.

Figures

None
Julin Xie, MD, PhD
Figure 1.
Figure 1.
The flowchart of subjects assessed for participation in the study.
Figure 2.
Figure 2.
Revascularization of lower limb. (a) Before revascularization, CTA indicated ASO of bilateral lower limbs, especially in the right side. (b) Vasculature during revascularization. After revascularization, lower limb pain was alleviated, ABI was raised from 0.35 preoperatively to 0.95 postoperatively with good perfusion of the wound. ABI, ankle–brachial index; ASO, arteriosclerosis obliterans; CTA, computer tomographic angiogram. Color images are available online.
Figure 3.
Figure 3.
Kaplan–Meier plot for the cumulative proportion of patients healed. Color images are available online.
Figure 4.
Figure 4.
The case of the five-in-one comprehensive limb salvage technologies of treating severe diabetic foot. (a) The wound condition of DFU on admission. (b) Intraoperative debridement. (c) NPWT. (d) Wound bed preparation. (e) Skin grafting. (f) Cure of DFU eventually. DFU, diabetic foot ulcer; NPWT, negative pressure wound therapy. Color images are available online.
See this image and copyright information in PMC

References

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