High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.
Intriguing new work from our SALSAmigos and DFCon Alums from Lund.
Abstract
Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n=770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1st 1983 to December 31st 2012 were considered for the study. 701 patients (median age 67 (22-95) fulfilled the inclusion criteria and were followed according to a pre-set protocol until final outcome (healing or death). Severe peripheral vascular disease (SPVD) was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five per cent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, nine per cent (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine per cent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing.
I think the percentage of patient cured in one form or another, compared to those who have been amputated or who have died is correlative of each individual personally. If one changes regions or time space, the result may be totally different. So the medical intervention had no significant support.
Whatever the position of the ulcer, whatever its advanced condition, whatever the past or present behavior of the patient, apart from the management of the level of glucose stability, the following treatment is of any efficiency.
Put a sealing patch to keep the natural moisture of the ulcer and avoid contamination from the outside; Do not use antibiotics. Pus practice a cure of immature keratinocytes, from the plantar to the knees of both feet. After 8 weeks, this hole should disappear. And the treatment will continue for several months, until a total satisfaction.