Ulcer-free survival following management of foot ulcers in diabetes.

Full Abstract

AIMS: Measures of healing rate may not give a complete indication of the effectiveness of overall management of diabetic foot ulcers. Apart from healing and speed of healing, the outcomes of greatest importance to the patient are avoidance of any amputation and remaining free from any recurrence. We have documented the number of patients presenting with diabetic foot ulcers who become ulcer free and examined the value of documenting ulcer-free survival. METHODS: All referrals to a specialist diabetic foot clinic over a 31-month period were analysed and outcomes were determined after a minimum follow-up of 6 months. RESULTS: Three hundred and seventy patients were referred with a total of 1031 ulcers. One hundred and twenty-one (32.7%) never became ulcer free: 56 (46.3% of 121) remained unhealed, the ulcers of 12 (9.9% of 121) had been resolved by amputation, two remained unhealed after amputation (1.7% of 121) and 51 (13.8% of 370) had died. Two hundred and thirty-one (62.4% of 370) became ulcer free at some stage. Five of these were excluded because of an earlier amputation. Ninety-one of the remaining 226 (40.3%) developed a recurrent or new ulcer after a median 126 days. Of the 135 who did not have a recurrence, 133 (58.8% of 226; 35.9% of 370) survived ulcer free and with limbs intact, while two died. Outcome was unknown in 18 (4.9%). Those who never became ulcer free were older (P < 0.001) and with a greater prevalence of ischaemia (P < 0.001). Those who healed but went on to suffer a new ulcer had a greater prevalence of neuropathy (P = 0.027) than those who remained ulcer free. CONCLUSIONS: The use of ulcer-free survival can be used as an indication of the effectiveness of foot ulcer management. It could be adopted as a measure to compare performance between different specialist units.

Author information

Author/s: Pound, N (N); Chipchase, S (S); Treece, K (K); Game, F (F); Jeffcoate, W (W);

Affiliation: Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, City Hospital, Nottingham, UK. npound(-atsign-)futu.co.uk

Journal and publication information

Publication Type: Journal Article

Journal: Diabetic medicine : a journal of the British Diabetic Association (Diabet Med), published in England. (Language: eng)

Reference: 2005-Oct; vol 22 (issue 10) : pp 1306-9

Dates: Created 2005/09/22; Completed 2006/01/30;

PMID: 16176187, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Diabet Med. 2005 Oct;22(10):1293-4. (PMID: 16176185)

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