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Oral Abstracts (Session 1 of 5)
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(Presentation 32.2) An algorithm for the management of lower-extremity diabetic wounds using an acellular regenerative matrix based on UT wound classification Brock A. Liden, DPM; Jodi F. Hartman, MS; Michelle L. Wright, BS Treatment of diabetes and its associated complications is a significant challenge. The primary cause of hospitalization among patients with diabetes is foot ulcers. Diabetic foot complications are the main cause of nontraumatic lower-extremity amputations. Early diagnosis and individualized aggressive treatment are crucial in preventing such amputations. The outlined evidence-based algorithm for managing diabetic lower-extremity wounds is based on the University of Texas (UT) Diabetic Wound Classification System. The algorithm stratifies wound management according to ischemia, infection, wound depth, and involvement of underlying structures. After addressing vascular insufficiency, infection is treated with intravenous antibiotics or local antibiosis with implantation of calcium sulfate beads. Wound closure is achieved using an acellular tissue matrix according to a standardized application and multimodal postoperative management protocol. Results of 14 consecutive wounds treated in accordance with this algorithm are provided. Twelve (85.7%) were on the foot, one (7.1%) was on the ankle, and one (7.1%) was on the calf. The mean wound age was 20.4 weeks (2.7–111.0). UT Diabetic Wound Classifications were 2 (14.3%) ID, 1 (7.1%) IID, and 11 (78.6%) IIID. All wounds were ischemic and infected; 85.7% were neuropathic. Mean times to graft incorporation, 100% granulation, and wound healing were 0.97 weeks (0.43–2.7), 5.7 weeks (0.43–16.7) and 14.7 weeks (5.0–29.7), respectively. The graft success rate was 85.7%. One failure resulted from repeated incidences of patient noncompliance; the other was caused by infection. A graft was reapplied to one wound, which subsequently healed within 7 weeks. The healing rate was 92.9%, as only 1 of 14 wounds did not heal. There were no below-knee amputations. This standardized algorithm streamlines management of lower-extremity wounds in patients with diabetes and provides consistent excellent clinical results. Implementation of this algorithm is recommended, as it produces predictable outcomes and reduces the likelihood of lower-extremity amputation. |
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