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Cited by 94Diabetic Foot Ulcer Assessment and ManagementPeripheral Artery Disease ManagementWound Healing and Treatments

Early revascularization after admittance to a diabetic foot center affects the healing probability of ischemic foot ulcer in patients with diabetes.

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Elgzyri, T., Larsson, J., Nyberg, P., Thörne, J., Eriksson, K.-F., Apelqvist, J.·2014·European Journal of Vascular and Endovascular Surgery
DOI 10.1016/j.ejvs.2014.06.041
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Abstract

Objectives There is limited information about whether time from recognition of decreased perfusion to revascularization affects the probability of healing in a patient with a diabetic foot ulcer. The aim of the present study was to examine whether time to revascularization after referral to a multidisciplinary foot center was related to the outcome of foot ulcers in patients with diabetes and severe peripheral arterial disease (PAD).Methods Patients with diabetes, a foot ulcer, and a systolic toe pressure <45 mmHg or an ankle pressure <80 mmHg were prospectively included at the foot center, and considered for revascularization according to a preset protocol. All patients underwent invasive revascularization, either percutaneous transluminal angioplasty (PTA) or reconstructive vascular surgery. All patients had continuous follow-up until healing or death irrespective of the type of revascularization.Results A total of 478 patients were included (age 74 [range 66-80] years, 60% males), of whom 315 patients (66%) had PTA, and 163 (34%) had reconstructive surgery. Of the 478 patients, 217 (45%) healed primarily, 88 (19%) healed after a minor amputation, 76 (16%) healed after a major amputation and 92 patients (19%) died unhealed. The median time from inclusion in the study to revascularization was 8 weeks (3-18 weeks). Time to vascular intervention within 8 weeks (p < .001), maximum Wagner grade reached <3 (p < .001), absence of peripheral edema (p = .033), and presence of intermittent claudication (p = .001) were related to a higher probability of healing.Conclusions Time to revascularization and extent of tissue damage were related to the probability of healing of ischemic foot ulcer in patients with diabetes over time. In the presence of a decreased perfusion in a patient with diabetes and a foot ulcer not only revascularization per se but also timing of revascularization is important for the possibility of healing without a major amputation.

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Crossref · 10.1016/j.ejvs.2014.06.041

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  • A meta-analysis of 943 patients with diabetic foot ulcers from 9 randomized clinical trials reported that negative pressure wound therapy was associated with improved healing, compared with treatment with moist wound healing (OR, 3.60; 95% CI, 2.38-5.45).

    “A meta-analysis of 943 patients with diabetic foot ulcers from 9 randomized clinical trials reported that negative pressure wound therapy was associated with improved healing, compared with treatment with moist wound healing (OR, 3.60; 95% CI, 2.38-5.45;P < .001).74”

    From Diabetic Foot Ulcers (2023) · cites this paper as [74]

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  • Multiple well-designed randomized clinical trials support the use of negative pressure wound therapy to improve healing in both partial foot amputations and diabetic foot ulcers.

    “Multiple well-designed randomized clinical trials support its use to improve healing in both partial foot amputations and diabetic foot ulcers.73,74”

    From Diabetic Foot Ulcers (2023) · cites this paper as [74]

    The Study design passage describes a standardized treatment protocol but does not identify negative pressure wound therapy. The Abstract reports healing outcomes after revascularization, not randomized trials of wound therapy. Searches for negative pressure wound therapy, vacuum-assisted closure, and partial-foot amputation trials found no passage addressing the claim. (LLM, conf=0.76)

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  • In a meta-analysis of 943 patients, negative pressure wound therapy improved healing compared with standard moisture-balancing dressings (odds ratio, 3.60; 95% CI, 2.38-5.45; P < .001).

    “Negative pressure wound therapy Used in treatment of complicated and postoperative wounds in the diabetic foot Improved healing in a meta-analysis of 943 patients who received negative pressure wound therapy vs standard moisture-balancing dressings (odds ratio, 3.60; 95% CI, 2.38-5.45;P < .001).”

    From Diabetic Foot Ulcers (2023) · cites this paper as [74]

    The Factors affecting probability of healing over time section discusses revascularization timing and ulcer healing, while Table 2 in the Discussion reports hazard ratios for those factors. Searches for negative-pressure wound therapy, a 943-patient meta-analysis, and the reported odds ratio found no passage addressing the claimed dressing comparison. (LLM, conf=0.75)

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  • Negative pressure wound therapy is effective in resolving wound depth.

    “Effective in resolving wound depth.64,[73][74][75]”

    From Diabetic Foot Ulcers (2023) · cites this paper as [74]

    The Factors affecting probability of healing over time section links healing to revascularization timing and Wagner grade, not negative pressure wound therapy. Searches for negative pressure wound therapy and vacuum-assisted closure found no passage addressing their effect on wound depth. Page numbers were not provided for these passages. (LLM, conf=0.76)

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Research works printed but not linked: 2

  1. Apelqvist J, Torffvit O, Agardh CD. The effect of the non-ionic contrast medium iohexol on glomerular and tubular function in diabetic patients. Diabet Med 1996;13(5):487e92.
  2. Macfarlane RM, Jeffcoate WJ. Factors contributing to the presentation of diabetic foot ulcers. Diabet Med 1997;14(10): 867e70.

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Authors
Elgzyri, T., Larsson, J., Nyberg, P., Thörne, J., Eriksson, K.-F., & Apelqvist, J.
Affiliations
  • Skåne University Hospital (SE)
  • Helsingborgs lasarett (SE)
Corresponding author
Elgzyri, T.
ORCID
Venue
European Journal of Vascular and Endovascular Surgery
Publisher
Elsevier BV
Published
2014-10
Volume
48
Issue
4
Pages
440-446
ISSN
1078-5884 (ISSN-L)
DOI
10.1016/j.ejvs.2014.06.041
OpenAlex
W2076282370
Cited by
94
References
31
Citations by year
2026: 5 · 2025: 9 · 2024: 12 · 2023: 17 · 2022: 8 · 2021: 6 · 2020: 14 · 2019: 3 · 2018: 7 · 2017: 5 · 2016: 2 · 2015: 5 · 2014: 1
FWCI
3.48
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Vascular and Endovascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Funders
Skånes universitetssjukhus
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
Keywords
diabetic foot ulcer, ischemic foot ulcer, timing of revascularization, percutaneous transluminal angioplasty, vascular reconstruction, peripheral arterial disease, wound healing, Wagner grade, amputation, intermittent claudication
MeSH terms
Aged, Aged, 80 and over, Angiography, Angioplasty, Balloon, Female, Follow-Up Studies, Humans, Male, Patient Admission, Prospective Studies, Time Factors, Vascular Surgical Procedures, Wound Healing, Treatment Outcome, Diabetic Foot, Plastic Surgery Procedures

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