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SAN DIEGO – Early wound closure prior to hospital discharge after surgical debridement of infected diabetic foot ulcers yields higher ulcer healing rates and a shorter time to healing, compared with various nonclosure wound management methods, according to a propensity-matched study.
How best to manage the open wound following nonamputative surgery of infected diabetic foot ulcers has been controversial. But early wound closure during the index hospitalization was the clear winner in this comparative study, according to Dr. Shey-Ying Chen who presented the research at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
He presented a retrospective comparison between 179 diabetic foot ulcer (DFU) patients with early wound closure after surgical debridement and an equal number of matched controls treated with various nonclosure techniques, including negative pressure wound therapy and the repeated application of moist dressings.
The two study groups were matched first on the basis of DFU location – toe, forefoot, midfoot, or rear foot – and then further propensity matched based on demographics, comorbid conditions, the presence of neuropathy, ulcer status by Wagner classification, infection severity, revascularization procedures, and other variables.
During 1 year of follow-up post discharge, ulcer healing occurred in 75% of the early wound closure group, compared with 66% of the nonclosure patients. Readmission for further treatment of the index ulcer occurred in 33% of the early closure group and 53% of the nonclosure group.
Other outcomes were also superior in the early wound closure group, noted Dr. Chen of Beth Israel Deaconess Medical Center, Boston.
Two independent predictors of DFU healing during the follow-up period emerged from a Cox regression analysis: early wound closure, with an adjusted odds ratio of 1.63, and acute as opposed to chronic DFU, with an OR of 1.35.
Ulcer healing was significantly less likely in those patients who had peripheral vascular disease, with an OR of 0.62; or neuropathy, with an OR of 0.53; and methicillin-resistant Staphylococcus aureus wound infection, with an OR of 0.59, Dr. Chen continued.
Underscoring the longer-term difficulties faced by patients with DFUs, it’s noteworthy that 11.5% of patients in both study arms underwent new amputations during the year of follow-up.
Moreover, a new diagnosis of osteomyelitis was made in 20% of the early wound closure group and 26% of the nonclosure group, a nonsignificant difference.
Dr. Adolf W. Karchmer, Dr. Chen’s senior coinvestigator, said the outcome data are too new to be able to gauge how vascular, orthopedic, and podiatric surgeons will react.
The investigators reported that they had no financial conflicts with regard to this study, which was conducted without commercial sponsorship.
With increasing prevalence of diabetes in the population, diabetic foot ulcers and infections present a significant clinical problem. Infected diabetic foot ulcers usually require an initial debridement of infected and necrotic tissue but there are many options for subsequent wound management.These included secondary wound closure, if possible, or use of adjunctive techniques for wound care, including negative pressure wound therapy, hyperbaric oxygen and a variety of wound care products designed for optimal healing.
Dr. Chen and his colleagues report their retrospective experience in 179 patients treated with early wound closure and compare outcomes with an equal number of matched controls treated with various nonclosure techniques such as negative pressure wound therapy and repeated applications of moist dressings. They found improved outcomes with the early closure group when analyzed for ulcer healing, readmission, and other outcome assessments. Specific times for healing after surgical debridement were an average of 105 days in the early wound closure group versus 136 days in those wounds managed with nonclosure techniques. As would be predicted, peripheral vascular disease and methicillin-resistant Staphylococcus aureus wound infections were found to adversely affect wound healing in both groups.
It is unclear in this report how many of the wounds were not amenable to early closure or what specific wound care regimen was used in the patients treated with continued wound care only. In addition, although it is stated that peripheral vascular disease adversely affected wound healing, it is not clear if these patients underwent revascularization as part of their comprehensive management.
Finally, Dr. Adolf W. Karchmer, the senior co-investigator in the trial, states that these data are too new to assess how other specialists will react. Clearly wound care and diabetic foot care should involve a multidisciplinary approach including wound care specialists as well as vascular surgeons, podiatrists, orthopedic surgeons, infectious disease specialists, and others. Observations and studies such as this are important to advance the science and specialty of wound care and continued data collection will help to optimize patient outcomes.
Dr. Larry Scher is a professor of clinical surgery and attending vascular surgeon at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, N.Y. He is also an associate medical editor for Vascular Specialist.
With increasing prevalence of diabetes in the population, diabetic foot ulcers and infections present a significant clinical problem. Infected diabetic foot ulcers usually require an initial debridement of infected and necrotic tissue but there are many options for subsequent wound management.These included secondary wound closure, if possible, or use of adjunctive techniques for wound care, including negative pressure wound therapy, hyperbaric oxygen and a variety of wound care products designed for optimal healing.
Dr. Chen and his colleagues report their retrospective experience in 179 patients treated with early wound closure and compare outcomes with an equal number of matched controls treated with various nonclosure techniques such as negative pressure wound therapy and repeated applications of moist dressings. They found improved outcomes with the early closure group when analyzed for ulcer healing, readmission, and other outcome assessments. Specific times for healing after surgical debridement were an average of 105 days in the early wound closure group versus 136 days in those wounds managed with nonclosure techniques. As would be predicted, peripheral vascular disease and methicillin-resistant Staphylococcus aureus wound infections were found to adversely affect wound healing in both groups.
It is unclear in this report how many of the wounds were not amenable to early closure or what specific wound care regimen was used in the patients treated with continued wound care only. In addition, although it is stated that peripheral vascular disease adversely affected wound healing, it is not clear if these patients underwent revascularization as part of their comprehensive management.
Finally, Dr. Adolf W. Karchmer, the senior co-investigator in the trial, states that these data are too new to assess how other specialists will react. Clearly wound care and diabetic foot care should involve a multidisciplinary approach including wound care specialists as well as vascular surgeons, podiatrists, orthopedic surgeons, infectious disease specialists, and others. Observations and studies such as this are important to advance the science and specialty of wound care and continued data collection will help to optimize patient outcomes.
Dr. Larry Scher is a professor of clinical surgery and attending vascular surgeon at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, N.Y. He is also an associate medical editor for Vascular Specialist.
With increasing prevalence of diabetes in the population, diabetic foot ulcers and infections present a significant clinical problem. Infected diabetic foot ulcers usually require an initial debridement of infected and necrotic tissue but there are many options for subsequent wound management.These included secondary wound closure, if possible, or use of adjunctive techniques for wound care, including negative pressure wound therapy, hyperbaric oxygen and a variety of wound care products designed for optimal healing.
Dr. Chen and his colleagues report their retrospective experience in 179 patients treated with early wound closure and compare outcomes with an equal number of matched controls treated with various nonclosure techniques such as negative pressure wound therapy and repeated applications of moist dressings. They found improved outcomes with the early closure group when analyzed for ulcer healing, readmission, and other outcome assessments. Specific times for healing after surgical debridement were an average of 105 days in the early wound closure group versus 136 days in those wounds managed with nonclosure techniques. As would be predicted, peripheral vascular disease and methicillin-resistant Staphylococcus aureus wound infections were found to adversely affect wound healing in both groups.
It is unclear in this report how many of the wounds were not amenable to early closure or what specific wound care regimen was used in the patients treated with continued wound care only. In addition, although it is stated that peripheral vascular disease adversely affected wound healing, it is not clear if these patients underwent revascularization as part of their comprehensive management.
Finally, Dr. Adolf W. Karchmer, the senior co-investigator in the trial, states that these data are too new to assess how other specialists will react. Clearly wound care and diabetic foot care should involve a multidisciplinary approach including wound care specialists as well as vascular surgeons, podiatrists, orthopedic surgeons, infectious disease specialists, and others. Observations and studies such as this are important to advance the science and specialty of wound care and continued data collection will help to optimize patient outcomes.
Dr. Larry Scher is a professor of clinical surgery and attending vascular surgeon at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, N.Y. He is also an associate medical editor for Vascular Specialist.
SAN DIEGO – Early wound closure prior to hospital discharge after surgical debridement of infected diabetic foot ulcers yields higher ulcer healing rates and a shorter time to healing, compared with various nonclosure wound management methods, according to a propensity-matched study.
How best to manage the open wound following nonamputative surgery of infected diabetic foot ulcers has been controversial. But early wound closure during the index hospitalization was the clear winner in this comparative study, according to Dr. Shey-Ying Chen who presented the research at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
He presented a retrospective comparison between 179 diabetic foot ulcer (DFU) patients with early wound closure after surgical debridement and an equal number of matched controls treated with various nonclosure techniques, including negative pressure wound therapy and the repeated application of moist dressings.
The two study groups were matched first on the basis of DFU location – toe, forefoot, midfoot, or rear foot – and then further propensity matched based on demographics, comorbid conditions, the presence of neuropathy, ulcer status by Wagner classification, infection severity, revascularization procedures, and other variables.
During 1 year of follow-up post discharge, ulcer healing occurred in 75% of the early wound closure group, compared with 66% of the nonclosure patients. Readmission for further treatment of the index ulcer occurred in 33% of the early closure group and 53% of the nonclosure group.
Other outcomes were also superior in the early wound closure group, noted Dr. Chen of Beth Israel Deaconess Medical Center, Boston.
Two independent predictors of DFU healing during the follow-up period emerged from a Cox regression analysis: early wound closure, with an adjusted odds ratio of 1.63, and acute as opposed to chronic DFU, with an OR of 1.35.
Ulcer healing was significantly less likely in those patients who had peripheral vascular disease, with an OR of 0.62; or neuropathy, with an OR of 0.53; and methicillin-resistant Staphylococcus aureus wound infection, with an OR of 0.59, Dr. Chen continued.
Underscoring the longer-term difficulties faced by patients with DFUs, it’s noteworthy that 11.5% of patients in both study arms underwent new amputations during the year of follow-up.
Moreover, a new diagnosis of osteomyelitis was made in 20% of the early wound closure group and 26% of the nonclosure group, a nonsignificant difference.
Dr. Adolf W. Karchmer, Dr. Chen’s senior coinvestigator, said the outcome data are too new to be able to gauge how vascular, orthopedic, and podiatric surgeons will react.
The investigators reported that they had no financial conflicts with regard to this study, which was conducted without commercial sponsorship.
SAN DIEGO – Early wound closure prior to hospital discharge after surgical debridement of infected diabetic foot ulcers yields higher ulcer healing rates and a shorter time to healing, compared with various nonclosure wound management methods, according to a propensity-matched study.
How best to manage the open wound following nonamputative surgery of infected diabetic foot ulcers has been controversial. But early wound closure during the index hospitalization was the clear winner in this comparative study, according to Dr. Shey-Ying Chen who presented the research at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
He presented a retrospective comparison between 179 diabetic foot ulcer (DFU) patients with early wound closure after surgical debridement and an equal number of matched controls treated with various nonclosure techniques, including negative pressure wound therapy and the repeated application of moist dressings.
The two study groups were matched first on the basis of DFU location – toe, forefoot, midfoot, or rear foot – and then further propensity matched based on demographics, comorbid conditions, the presence of neuropathy, ulcer status by Wagner classification, infection severity, revascularization procedures, and other variables.
During 1 year of follow-up post discharge, ulcer healing occurred in 75% of the early wound closure group, compared with 66% of the nonclosure patients. Readmission for further treatment of the index ulcer occurred in 33% of the early closure group and 53% of the nonclosure group.
Other outcomes were also superior in the early wound closure group, noted Dr. Chen of Beth Israel Deaconess Medical Center, Boston.
Two independent predictors of DFU healing during the follow-up period emerged from a Cox regression analysis: early wound closure, with an adjusted odds ratio of 1.63, and acute as opposed to chronic DFU, with an OR of 1.35.
Ulcer healing was significantly less likely in those patients who had peripheral vascular disease, with an OR of 0.62; or neuropathy, with an OR of 0.53; and methicillin-resistant Staphylococcus aureus wound infection, with an OR of 0.59, Dr. Chen continued.
Underscoring the longer-term difficulties faced by patients with DFUs, it’s noteworthy that 11.5% of patients in both study arms underwent new amputations during the year of follow-up.
Moreover, a new diagnosis of osteomyelitis was made in 20% of the early wound closure group and 26% of the nonclosure group, a nonsignificant difference.
Dr. Adolf W. Karchmer, Dr. Chen’s senior coinvestigator, said the outcome data are too new to be able to gauge how vascular, orthopedic, and podiatric surgeons will react.
The investigators reported that they had no financial conflicts with regard to this study, which was conducted without commercial sponsorship.
