Determinants and estimation of healing times in diabetic foot ulcers

Zimny, Stefan; Schatz, H.; Pfohl, Martin

doi:10.1016/s1056-8727(01)00217-3

Cited by 89 publications

(76 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The 133-day average healing time for foot ulcers in individuals with diabetes was consistent with that of another study with an average healing time of 123 days. 28 There was a higher percentage of individuals with type 1 diabetes whose ulcers healed (n = 7, 77.8%) as compared with individuals with type 2 diabetes (n = 32, 59.3%), yet ulcer healing time for individuals with type 1 diabetes was longer at 125 days on the average. This could perhaps be explained by ulcer size, or perhaps microvascular changes that occur over time in patients with type 1 diabetes, supported by the fact that all subjects with type 1 diabetes had been diagnosed for at least 10 years.…”

Section: Discussionmentioning

confidence: 90%

The Relationship between Hemoglobin A1c Values and Healing Time for Lower Extremity Ulcers in Individuals with Diabetes

Markuson

Hanson

Anderson

et al. 2009

Advances in Skin &Amp; Wound Care

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 90%

The Relationship between Hemoglobin A1c Values and Healing Time for Lower Extremity Ulcers in Individuals with Diabetes

Markuson

Hanson

Anderson

et al. 2009

Advances in Skin &Amp; Wound Care

View full text Add to dashboard Cite

show abstract

“…Zimny et al (13,14) reported median healing times of 77.7 and 75.9 days in two observational studies of neuropathic ulcers. In one of the two multicenter trials of human skin equivalent products, Veves et al (4) reported median healing times of 65 and 90 days in the intervention and control arms, respectively.…”

Section: Results -mentioning

confidence: 99%

Rate of Healing of Neuropathic Ulcers of the Foot in Diabetes and Its Relationship to Ulcer Duration and Ulcer Area

2007

View full text Add to dashboard Cite

OBJECTIVE -To examine the outcome of neuropathic foot ulcers and to seek associations between healing and features of the ulcers at baseline.RESEARCH DESIGN AND METHODS -Data were collected prospectively during the course of routine management. All patients were selected who presented to a single unit between 1 January 2000 and 31 December 2004 with neuropathic foot ulcers and without evidence of either peripheral arterial disease or infection. Associations were sought between ulcer characteristics at baseline and clinical outcome.RESULTS -A total of 154 patients (66.9% male) presented with 410 ulcers. Age was 57.4 Ϯ 12.0 years (means Ϯ SD). A total of 178 (43.4%) ulcers were on the plantar aspect of the foot; 73.7% of ulcers had a cross-sectional area of Ͻ1 cm 2 . Median ulcer duration at referral was 15 days (range 1-1,046). Healing without amputation was observed in 91.7%. The percentage of ulcers healed at 12, 20, and 52 weeks were 59.3, 70.5, and 86.6%, respectively. Significant associations were observed between area at referral and outcome type ( 2 P Ͻ 0.0001), prior ulcer duration (Kruskal-Wallis P ϭ 0.006), and time to healing (Kruskal-Wallis P ϭ 0.014), as well as between ulcer duration and time to healing (Spearman , r ϭ 0.104, P ϭ 0.047). There was no difference between plantar and nonplantar ulcers.CONCLUSIONS -The rate of healing in this cohort provides a benchmark for comparison with other centers. While further work is needed to determine how outcomes can be improved in unselected series such as these, the confirmation of close relationships between ulcer duration at referral, ulcer area, and outcome emphasizes the importance of early expert assessment of newly occurring neuropathic ulcers. Diabetes Care 30:660 -663, 2007W hile there is evolving consensus on the best management of different types of diabetic foot disease, there remain differences in clinical practice between different expert centers, and it is important to determine whether these differences are associated with better or worse clinical outcomes. If different outcomes can be identified, it should add to the evidence base underlying current consensus and serve as a spur to planning further research. However, one major barrier to effective comparison lies in the fact that studies in expert centers are necessarily undertaken in populations that are selected by referral. It follows that the results of comparison are only meaningful when the populations (of both people and ulcers) are well characterized. This is the rationale for the drive to develop simple but robust classifications, as has been argued elsewhere (1). Nevertheless, there is one group of foot ulcers in which case definition is less problematic-the neuropathic ulcer, whether on the plantar surface of the foot or elsewhere. The classic neuropathic ulcer is readily recognized in clinical practice, being associated with surrounding callus and occurring on a foot with loss of protective sensation but relative preservation of peripheral arterial blood supply. The relative hom...

show abstract

“…Foot ulcers take a notoriously long time to heal: the International Working Group on the Diabetic Foot reports a mean healing time of 6 months for diabetic foot ulcers [29]. The foot ulcer healing time reported in many studies varies widely depending on the patients' characteristics [30,31] and in particular were different for patients with neuropathic or ischaemic ulcers [16,32]. This is probably because in diabetic patients revascularisation can restore normal blood flow in the large vessels, including the pedal arteries, but cannot restore normal microvascular flow [33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Prospective study on microangiopathy in type 2 diabetic foot ulcer

et al. 2016

View full text Add to dashboard Cite

Aims/hypothesis We investigated the significance of microangiopathy in the development of foot ulcer, which is still disputed. Methods We assessed microangiopathy by histological analysis of the capillary ultrastructure using transmission electron microscopy and capillary density and arteriolar morphology in paraffin-embedded sections from the skin of type 2 diabetic patients: 30 neuroischaemic patients (Isc) revascularised with peripheral angioplasty and 30 neuropathic patients (Neu) with foot ulcer, compared with ten non-diabetic volunteers. Results In the diabetic patients, capillaries in the dermal papillary layer were fewer (−22.2%, 159 ± 43 vs 205 ± 52 mm 2 in non-diabetic volunteers, p < 0.01). They also showed detrimental remodelling, with a 2.2-fold increase in capillary basement membrane thickness (3.44 ± 1.19 vs 1.53 ± 0.34 μm in non-diabetic volunteers, p < 0.001) and a 57.7% decrease in lumen area (14.6 ± 11.1 vs 34.7 ± 27.5 μm 2 , p < 0.001). No differences were observed between the diabetic Isc or Neu patients. Isc were more prone to develop arteriolar occlusion than Neu (16.8 ± 6.9% vs 6.7 ± 3.7%, respectively, p < 0.001).No patient had been amputated at 30 days and healing time was significantly longer in Isc (180 ± 120 vs 64 ± 50 days in Neu, p < 0.001). Conclusions/interpretation Capillary microangiopathy is present in equal measure in neuroischaemic and neuropathic diabetic foot skin. The predominance of arteriolar occlusions with neuroischaemia indicated the existence of an additional 'small vessel disease' that did not affect an effective revascularisation and did not worsen the prognosis of major amputations but slowed the healing process of the neuroischaemic foot ulcer. Trial registration: ClinicalTrials.gov NCT02610036.

show abstract

Determinants and estimation of healing times in diabetic foot ulcers

Cited by 89 publications

References 23 publications

The Relationship between Hemoglobin A1c Values and Healing Time for Lower Extremity Ulcers in Individuals with Diabetes

The Relationship between Hemoglobin A1c Values and Healing Time for Lower Extremity Ulcers in Individuals with Diabetes

Rate of Healing of Neuropathic Ulcers of the Foot in Diabetes and Its Relationship to Ulcer Duration and Ulcer Area

Prospective study on microangiopathy in type 2 diabetic foot ulcer

Contact Info

Product

Resources

About