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Clinical Research
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Noninvasive vascular studies as predictors of chronic wound healing in patients with diabetes Rosemay Michel, DPM, Qeena Woodard, DPM, Kathren McCarty, DPM, Shelli Brewington, DPM Problem: to determine if arterial non-invasive vascular studies (NIVs) are accurate predictors of chronic wound healing in patients with Diabetes Non-invasive vascular studies are an integral part of the evaluation of patients with diabetic foot pathology, assisting in the diagnosis of peripheral arterial occlusive disease. The routine non-invasive panel, which includes ankle-brachial index (ABI), toe-brachial index (TBI), segmental and toe pressures, Doppler waveforms (DWFs) and pulse volume recordings (PVRs), provides information regarding a patient's macrovascular status. These tests are also useful in vascular disease surveillance and in higher-risk patients contemplating elective foot surgery. One of its most invaluable applications is in patients with non-healing chronic wounds. A significant population of patients with chronic wounds possess both macrovascular and microvascular disease, and it is imperative to first determine the role of macrovascular disease based on arterial NIVs. We evaluate the predictability of arterial NIVs in wound healing in a population of patients with superficial, non-infected pedal wounds in existence for more than four weeks. Methods: retrospective review of subjects' charts and NIVs from our outpatient clinics from January 2001 to January 2004..Inclusion criteria: patients at least 18 years of age, with diabetes without a history of cancer or prednisone use in the year previous to ulcer presentation.Exclusion criteria: smoking history within 10 years of presentation, amputation within 4 weeks on involved lower extremity, history of lower extremity bypass, albumin less than 3 mg/dL, active soft tissue or bone infection..Results: we expect that NIVs are not adequate predictors for chronic wound healing in patients with diabetes. Often necessary is the need for further diagnostic evaluation, namely an angiogram or transcutaneous oxygen measurement (TCOMs) to address microvascular disease. DeGraff J. Evaluation of toe pressure and transcutaneous oxygen measurements in management of chronic leg ischemia: a randomized clinical trial. J Vasc Surg. 2003;528:34 Sumpio B. Vascular evaluation and arterial reconstruction of the diabetic foot. Clin Pod Med Surg. 2003;20:689Ð708 Sykes MT, Godsey JB. Vascular evaluation of the problem diabetic foot. Clin Pod Med Surg. 1988;15(1):49Ð83. |
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