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Title: Aetiology More Than Wound Size Determines Healing Time For Diabetic Foot Ulcers

URL: http://www.medicinedirect.com/journal/journal/article
?acronym=JDC&format=abstract&uid=PIIS1056872701002173

J Diabetes Complications 2002; 16: 327-332. "Determinants and estimation of healing times in diabetic foot ulcers"
10/09/2002 01:59:05 PM
By Andrew A. Skolnick

Wound healing times are better determined by aetiologic factors than by wound size in standard care for diabetic foot ulcers. In a prospective study of patients with type 1 or type 2 diabetes, Dr. Stefan Zimny and colleagues at the Ruhr-Universitat Bochum, in Bochum, Germany, assessed wound healing times of plantar foot ulcers. Thirteen consecutive diabetic patients with neuropathic foot ulceration, 10 diabetic patients with neuroischaemic ulceration, and eight diabetic patients with peripheral occlusive vascular disease were selected for the study. All patients received identical ulcer wound care, including use of proper footwear, non-weight-bearing limb support, use of appropriate antibiotics, debridement, tight control of serum glucose levels, and careful monitoring of the ulcer, the investigators noted. Ulcer healing was assessed by planimetric measurement of the wound area every second week until wound healing. The time course of wound healing was calculated by the daily wound radius reduction. The mean wound area in patients with neuropathic foot ulceration was 61.2 ± 17.1 mm² at the beginning, and 3.2 ± 1.5 mm² after 70 days. The wound radius decreased by 0.045 mm per day, with most of the wound healing occurring between the first and seventh week of ulcer care. The average healing time was 77.7 days, the researchers reported. In the neuroischaemic group, the initial average wound area was 26.6 ± 7.0 mm² and 6.25 ± 1.7 mm² after 10 weeks. The wound radius reduction was 0.019 mm per day, with an average healing time of 123.4 days. Diabetic patients with peripheral occlusive vascular disease had an average wound size of 32.6 ± 13.1 mm² at the beginning and 23.9 ± 10.7 mm² after 70 days. The daily wound radius reduction was 0.0065 mm. Average ulcer duration was 133 days, although three of eight patients achieved no wound healing, the investigators reported. "Providing standard care, the time course of wound healing in diabetic foot ulcers is predominantly determined by aetiologic factors, and less by wound size," they concluded. "Taking wound aetiology and wound radius into account, the expected healing time can reliably be estimated in neuropathic and neuroischaemic ulcers."

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