Time to Wound Closure Surgery… and other quality markers

As we (finally) see signs of movement from “volume” to “value”-based care, what are some key markers that we should use to determine quality in the high-risk diabetic foot?

  1. Ulcer-free days: for the patient in diabetic foot remission, this key indicator for the highest risk patient might be helpful.
  2. Hospital-free days
  3. Time to Closure: While important, perhaps it is surpassed by 1 and 2
  4. Time to wound closure surgery: split thickness skin graft, delayed primary closure and rotational/free flaps might be more important here to move people toward “wound simplification”
  5. Activity profile: perhaps time standing, steps, walking (barefoot/shod) will become increasingly important as our wearables become increasingly ubiquitous.
  6. Time of / time to independent movement at home (see #5)

There are just a few. Please let us know what you think!



David G. Armstrong

Dedicated to amputation prevention, wound healing, diabetic foot, biotechnology and the intersection between medical devices and consumer electronics.


  • 1.Number of dressings till closure is very important marker to assess value added DFCare.
    2.Ambulation with 100% offloading very important in Economically poor patients.
    3.DFW management done with conventional dressings.

  • Crucial start point… to determine the real end-points after revasc in limb-threatenining ischemia!… amputation-free survival is probably the worst (and easiest) outcome to achieve after mediocre endo or surgery….

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