Dıabetic Foot: Wound Healing, Amputation Decision, and Innovative Developments

Year 2024, Volume: 7 Issue: 1, 23 - 26, 11.03.2024

Rana Kapukaya Mehmet Bozkurt

https://doi.org/10.36516/jocass.1404365

Abstract

Aim: To review the effects of diabetes-related diseases on the healing process and amputation decision in diabetic foot ulcers (DFU), negative pressure wound therapy (NPWT) results, and current treatment approaches.
Materials and Methods: The study was planned as retrospective and cross-sectional. Data of patients who were admitted to our clinic due to DFU and were treated were examined. A total of 38 patients were included in the study. The results of patients (n=19) who underwent periodic debridement and classic dressing were compared with the results of patients (n=19) who underwent NPWT. Healing in patients was achieved by amputation (n=8), repair with partial thickness grafts or flaps (n=10), and secondary epithelialization development (n=10). The effect of diabetes-related peripheral arterial disease (PAD), cardiovascular disease (CVD), chronic kidney disease (CKD), diabetic retinopathy (DRP), and previous amputation history (AH) on recovery time was examined. The predictive importance of diabetes-related diseases for amputation was investigated.
Results: It was determined that diabetes-related diseases caused a delay in wound healing. [PAD (p<0.044), CVD (p<0.016), CKD (p<0.001), DRP (p<0.001)], The delay in wound healing was evident in the presence of CKD and DRP. Wound healing time was not affected in patients with AH (p>0.05). The incidence of PAD was higher in patients who underwent amputation. There was no significant difference between NPWT (mean 67 days) and the classic dressing group (mean 73 days) in terms of healing time (p>0.05).
Conclusion: In the presence of diabetes-related diseases, wound healing time was prolonged. This effect was more evident in the presence of DRP and CKD. This may be explained by microvascular disease, but larger series studies are needed. Wound healing was not affected in patients with AH. The incidence of PAD was found to be higher in patients who underwent amputation. Improving the care conditions of patients with diabetes and accessing treatment facilities will reduce DFU and amputation rates. No difference was found between NPWT and classic dressing in terms of healing time. However, it was observed that NBWT increased the development of granulation in the wound, reduction of edema, wound contraction, and the chance of success of the graft or flap surgery. Innovative studies are needed to develop optimum wound surfactant molecules in this regard.

Keywords

diabetic foot ulcer, wound healing, amputation, diabetes-related diseases

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