Heal or no heel: Outcomes of ischaemic heel ulcers following lower limb revascularization from a multi‐ethnic Asian Cohort in Singapore

Abstract

Ischaemic diabetic heel ulcers are difficult to treat and prognosis is often guarded. The aim was to document our outcome of treating heel ulcers following revascularization in a predominantly diabetic Asian cohort presenting with chronic limb threatening ischaemia from Singapore. Retrospective cohort study (n = 66, 66 limbs) over a 5‐year period. Data were collected from hospital electronic health records. Outcomes included time to healing, amputation free survival (AFS), and mortality. Minimum follow‐up period was 6 months. Multivariate regression analysis was performed to look for factors associated with poor outcome. Mean age was 67.4 ± 8.8 years. 62/66 (93.9%) were diabetics. Mean wound size at presentation was 3.6 ± 2.3 cm. Mean Wound, Ischaemia, Foot Infection (WIFI) score was 5 ± 1.6. 12/66 (18%) patients had a patent posterior tibial artery pre‐operatively. Straight line flow was restored in only 31/66 (46.9) patients but 47/66 (71.2%) had successful limb salvage. Median time to wound healing was 90.0 (IQR 60‐180) days. A median of 1 (IQR 0‐2) wound debridement was required. Patients who underwent negative pressure dressing (23/66; 34.8%) required a median of 26 (IQR 13‐33) cycles to achieve healing. Amputation free survival (AFS) was 72% and 68% at 6‐ and 12‐months, respectively. Mortality rate was 16.7% and 19.7% at 6‐ and 12‐months, respectively. Low albumin level and initial Rutherford class were independent predictors of worse 6‐month AFS. Outcomes of heel ulcers post revascularisation may not be as poor as previously described. Persistent attention to wound care with multidisciplinary effort is needed for optimal healing.

Classification of foot ulcers in people with diabetes: A systematic review

“…showed that, in the same setting in which the system was internally validated, those in stage 4 had a higher number of hospital admissions (mean of 3 vs. 2) and also higher overall costs (61,744 vs. 4653 US$) in comparison to those in stage 1. The three studies 140,142,143 that included mortality that had a clinical outcome were not able to show an association between this system and death at 1 year.…”

“…The three studies 140,142,143 that included mortality that had a clinical outcome were not able to show an association between this system and death at 1 year. -25 of 32 costs, and quality of life.…”

“…Two studies (from Linn et al and Pena et al 142,143 ), externally validating this classification for major LEA-free survival at 1 year, reported that higher grades led to significantly lower chances of being alive without a major LEA, but without adjusting for potential confounders. Hicks et al 133 showed that, in the same setting in which the system was internally validated, those in stage 4 had a higher number of hospital admissions (mean of 3 vs. 2) and also higher overall costs (61,744 vs. 4653 US$) in comparison to those in stage 1.…”