Outcomes after foot surgery in people with a diabetic foot ulcer and a 12-month follow-up

J Wound Care. 2017 May 2;26(5):218-227. doi: 10.12968/jowc.2017.26.5.218.

Abstract

Objective: The aim of this study was to retrospectively measure the outcomes of foot-sparing surgery at one year follow-up for patients with diabetic foot ulcers (DFUs). We assessed wound healing and the need for further surgery in relation to the variables that influence healing.

Method: Data were retrospectively collected by reviewing the electronic files of patients attending the Wound Expert Clinic (WEC). Outcomes of surgical debridement, toe, ray and transmetatarsal amputations were assessed.

Results: A total of 129 cases in 121 patients were identified for inclusion. The results demonstrated that complete wound healing was reached in 52% (61/117) of the patients within 12 months. The need for additional surgery or for major amputation was 56% (n=72/129) and 30% (n=39/129) respectively. The need for an additional procedure was particularly high after surgical debridement (75%, 33/44) and transmetatarsal amputation (64%, 7/11). Risk factors for non-healing or for a major amputation were: infection (p=0.01), ischaemia (p=0.01), a history of peripheral arterial occlusive disease (p<0.01) and smoking (p=0.01). Additional findings were that not all patients underwent vascular assessment and in half of the patients there was a delay in undergoing revascularisation.

Conclusion: The results of the study reveal some areas for improvement including timely revascularisation and performance of multiple debridement procedures if needed in order to save a limb.

Keywords: diabetic foot surgery; minor amputation; surgery risk factors; surgical debridement; wound healing.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical*
  • Angioplasty*
  • Debridement*
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 2 / complications
  • Diabetic Foot / epidemiology
  • Diabetic Foot / etiology
  • Diabetic Foot / surgery*
  • Follow-Up Studies
  • Foot / blood supply
  • Foot / surgery
  • Humans
  • Ischemia / complications
  • Ischemia / epidemiology
  • Ischemia / surgery
  • Middle Aged
  • Organ Sparing Treatments
  • Peripheral Arterial Disease / complications
  • Peripheral Arterial Disease / epidemiology
  • Peripheral Arterial Disease / surgery*
  • Reoperation / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors
  • Toes / blood supply
  • Toes / surgery
  • Treatment Outcome
  • Wound Healing*
  • Young Adult