Determinants of Diabetic Foot Wound Healing Rate
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- Category: Vol. 81, June 2013
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Determinants of Diabetic Foot Wound Healing Rate,AL-HUSSEIN A. AL-MENAWAR, FAHAD S. ALSHEHRI and OSSAMA A. MOSTAFA
Abstract
Objective: To explore the impact of some risk factors on delayed healing of foot ulcers among diabetics, especially suboptimal glycemic control.
Patients and Methods: All records of diabetic patients with foot ulcers registered at the "Diabetes Center" of "King Abdul-Aziz" University Hospital in Riyadh City, Kingdom of Saudi Arabia within 2009-2011 (n=145) were analyzed. The ulcer size (area in cm2) was calculated by multiplying its length by its width. Wounds were graded and staged using the University of Texas Diabetic Wound Classification System.
Results: Neuropathic wounds are the most frequent type of wounds (71.7%). Diabetic ulcer affected 40% of patients while 16.6% of patients had undergone amputation. Callus and footwear affected about one third of wounds (35.9% and 32.4%, respectively). Heat was the cause for ulcers in 15.2% of cases. Dorsal infections were more frequent than planter infections (54.5% vs. 45.5%, respectively). Almost three-fourths of wounds were infected (72.4%). Toe deformity was the most frequent deformity (80.6%), followed by pes cavus (57.9%). Texas classification (B) was the most frequent (69%), followed by A (28.3%), while Texas Grade (I) was the most frequent (64.8%). The duration of healing of 48.3% was more than two months. The mean duration of healing was 100.2± 110.3 days. Off-loading was practiced by 50.3% of patients. The wound size in about two thirds of patients was less than 5cm2, while the wounds of 13.8% of patients were more than 10cm2. Rate of healing of more than three-fourths of patients' wounds was very slow, i.e., less than 1 cm2/week. Duration of wound healing is not significantly dependent upon the initial wound size at presentation. Mean rate of healing (cm2/week) is significantly dependent upon type of diabetes, being significantly slower among type 2 diabetics (p=0.01). It did not differ significantly according to level of diabetes control or site of wound. Mean rate of wound healing (cm2/week) was significantly delayed among patients with history of ulcer or amputation (p0.012 andp=0.017, respec-tively). Off-loading significantly improved the rate of wound healing (p=0.013). There was a significant negative correlation between age of diabetic patient and the rate of wound healing (r=-0.201, p=0.015) and a significant negative correlation between duration of diabetes and the rate of wound healing (r=-0.256, /;0.002) and a negative, non-significant correlation existed between level of glycosylated hemoglobin of diabetic patients and the rate of wound healing (r=-0.128, p=0.126).
Conclusions: Rate of ulcer healing among diabetics is very slow, which is significantly dependent upon type of diabetes, being significantly slower among type 2 diabetics. There is a significant negative correlation between rate of wound healing with both age of diabetic patient and duration of diabetes. Rate of wound healing is significantly delayed among patients with history of ulcer or amputation. Off-loading significantly improves the rate of wound healing. Rate of wound healing does not differ significantly according to level of glycemic control.
Recommendations: The present study recommends that better glycemic control of diabetic patients with foot ulcers needs to be emphasized. Since rate of ulcer healing among diabetics is very slow, the application of preventive strategies for foot ulceration is crucial. Special health care should be specially provided to patients with risk factors of delayed wound healing. Off-loading is highly recommended for patients with diabetic foot ulcers.