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Clinical Research
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Successful treatment of complex diabetic wounds in patients previously designated as amputation candidates Brock A. Liden, DPM, Jodi F. Hartman, MS, Michelle L. Wright, BS Diabetic foot complications are the principal cause of nontraumatic lower extremity amputations. Previous evidence suggests that up to 85% of diabetic foot and leg amputations may be prevented with the appropriate knowledge of risk factors and multidisciplinary treatment. The purpose of this study is to present a multimodal evidence-based treatment approach for the treatment of complex diabetic wounds Four patients (9 wounds) for whom limb amputation was recommended by at least one other clinician sought a second opinion by the senior author. A stepwise multimodal treatment approach addressing ischemia, treating infection, and utilizing an acellular regenerative tissue matrix for wound closure was implemented in an attempt to salvage the lower extremity All patients were obese women, with a mean age of 58.2. The mean wound age was 18.5 weeks (8.1Ð111.0). Wound locations included the foot (77.8%), ankle (11.1%), and calf (11.1%). University of Texas Diabetic Wound Classifications were 2 (22.2%) ID, 1 (11.1%) IID, and 6 (66.7%) IIID. All wounds were ischemic and infected, with osteomyelitis present in all but one case. In addition, 88.9% of the wounds were neuropathic Mean times to graft incorporation, 100% granulation, and wound healing were 0.91 weeks (0.43Ð2.7), 6.4 weeks (1.43Ð16.7), and 13.5 weeks (5.0Ð29.7), respectively. The graft success rate was 77.8%. One failure resulted from repeated incidences of patient noncompliance; the other was caused by infection. A graft was re-applied to one wound, which subsequently healed within 7 weeks. Therefore, 8 of the 9 wounds in the study healed, yielding a healing rate of 88.9%. There were no below knee amputations. Aggressive treatment including the use of an acellular regenerative tissue matrix successfully healed complex wounds in patients for whom limb amputation was previously recommended. This multimodal approach facilitates wound healing and may prevent unnecessary amputation of the lower extremity |
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