Recurrent foot ulcers in patients with diabetes mellitus in out-patient care
OBJECTIVE. Relapses of diabetic foot ulcers are an urgent problem of outpatient surgery, however, risk factors for relapse, as well as the definition of relapse itself remain a subject of discussion. The presented study investigates the frequency of relapses of ulcerative foot defects in diabetes me...
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Pavlov First Saint Petersburg State Medical University
2022-11-01
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| Series: | Вестник хирургии имени И.И. Грекова |
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| Online Access: | https://www.vestnik-grekova.ru/jour/article/view/1800 |
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| author | V. B. Bregovskiy A. G. Demina I. A. Karpova |
| author_facet | V. B. Bregovskiy A. G. Demina I. A. Karpova |
| author_sort | V. B. Bregovskiy |
| collection | DOAJ |
| description | OBJECTIVE. Relapses of diabetic foot ulcers are an urgent problem of outpatient surgery, however, risk factors for relapse, as well as the definition of relapse itself remain a subject of discussion. The presented study investigates the frequency of relapses of ulcerative foot defects in diabetes mellitus, the risk factors for their development and treatment outcomes, based on the definition of relapse as the development of a repeated defect in the same place as the healed defect.METHODS AND MATERIALS. The data of 1714 patients with foot ulcers (2213 ulcerative defects) from 01.2012 to 01.2017 were studied. Patients were divided into two groups: with relapses (n=239, 13.9%) and without them (n=1475). Risk factors for relapse, characteristics of patients and ulcerative defects, and treatment outcomes were evaluated.RESULTS. Relative risk for relapse: type 1 diabetes mellitus (1.36); Charcot foot (1.65); history of amputation of the great toe (1.35); severe polyneuropathy (1.25); neuropathic foot (1.37). Relapses/single ulcer (%): superficial lesion 72.8/63.3 (р<0.01); primary healing: 61.1/52.7 (p=0.025); healing after surgery (amputations excluded): 4.2/4.5 (ns); amputations: 7.1/6.6 (ns) of which major 5.9/20.6 (p=0.01); non-healing (%): 11.7/5.5 (р=0.001); loss of follow-up (%): 15.9/30.7 (р=0.0001). Median duration of the treatment (days) of relapses/single ulcer: conservative 147/114; healing after surgery (amputations excluded) 241/170; after amputation 286/182. Revascularization in relapses – 7 (100%), with single ulcers – 66 (59.5% of patients with critical ischemia).CONCLUSION. 5-years relapse rate was 13.9 %. Patients with Charcot foot, postoperative deformities and with neuropathic form of diabetic foot syndrome are more prone for foot reulceration. Recurrent ulcers are characterized with longer duration of the treatment however their primary healing rate is higher compared with single ulcer group. The results of the study were significantly influenced by the high frequency of loss of follow-up in both groups. |
| format | Article |
| id | doaj-art-38accd6419de4ca1a935f31279ae0c29 |
| institution | DOAJ |
| issn | 0042-4625 |
| language | Russian |
| publishDate | 2022-11-01 |
| publisher | Pavlov First Saint Petersburg State Medical University |
| record_format | Article |
| series | Вестник хирургии имени И.И. Грекова |
| spelling | doaj-art-38accd6419de4ca1a935f31279ae0c292025-08-20T03:23:30ZrusPavlov First Saint Petersburg State Medical UniversityВестник хирургии имени И.И. Грекова0042-46252022-11-011812495610.24884/0042-4625-2022-181-2-49-561406Recurrent foot ulcers in patients with diabetes mellitus in out-patient careV. B. Bregovskiy0A. G. Demina1I. A. Karpova2City Consultative and Diagnostic Center № 1City Consultative and Diagnostic Center № 1City Consultative and Diagnostic Center № 1OBJECTIVE. Relapses of diabetic foot ulcers are an urgent problem of outpatient surgery, however, risk factors for relapse, as well as the definition of relapse itself remain a subject of discussion. The presented study investigates the frequency of relapses of ulcerative foot defects in diabetes mellitus, the risk factors for their development and treatment outcomes, based on the definition of relapse as the development of a repeated defect in the same place as the healed defect.METHODS AND MATERIALS. The data of 1714 patients with foot ulcers (2213 ulcerative defects) from 01.2012 to 01.2017 were studied. Patients were divided into two groups: with relapses (n=239, 13.9%) and without them (n=1475). Risk factors for relapse, characteristics of patients and ulcerative defects, and treatment outcomes were evaluated.RESULTS. Relative risk for relapse: type 1 diabetes mellitus (1.36); Charcot foot (1.65); history of amputation of the great toe (1.35); severe polyneuropathy (1.25); neuropathic foot (1.37). Relapses/single ulcer (%): superficial lesion 72.8/63.3 (р<0.01); primary healing: 61.1/52.7 (p=0.025); healing after surgery (amputations excluded): 4.2/4.5 (ns); amputations: 7.1/6.6 (ns) of which major 5.9/20.6 (p=0.01); non-healing (%): 11.7/5.5 (р=0.001); loss of follow-up (%): 15.9/30.7 (р=0.0001). Median duration of the treatment (days) of relapses/single ulcer: conservative 147/114; healing after surgery (amputations excluded) 241/170; after amputation 286/182. Revascularization in relapses – 7 (100%), with single ulcers – 66 (59.5% of patients with critical ischemia).CONCLUSION. 5-years relapse rate was 13.9 %. Patients with Charcot foot, postoperative deformities and with neuropathic form of diabetic foot syndrome are more prone for foot reulceration. Recurrent ulcers are characterized with longer duration of the treatment however their primary healing rate is higher compared with single ulcer group. The results of the study were significantly influenced by the high frequency of loss of follow-up in both groups.https://www.vestnik-grekova.ru/jour/article/view/1800diabetes mellitusdiabetic footfoot ulcerulcer relapse |
| spellingShingle | V. B. Bregovskiy A. G. Demina I. A. Karpova Recurrent foot ulcers in patients with diabetes mellitus in out-patient care Вестник хирургии имени И.И. Грекова diabetes mellitus diabetic foot foot ulcer ulcer relapse |
| title | Recurrent foot ulcers in patients with diabetes mellitus in out-patient care |
| title_full | Recurrent foot ulcers in patients with diabetes mellitus in out-patient care |
| title_fullStr | Recurrent foot ulcers in patients with diabetes mellitus in out-patient care |
| title_full_unstemmed | Recurrent foot ulcers in patients with diabetes mellitus in out-patient care |
| title_short | Recurrent foot ulcers in patients with diabetes mellitus in out-patient care |
| title_sort | recurrent foot ulcers in patients with diabetes mellitus in out patient care |
| topic | diabetes mellitus diabetic foot foot ulcer ulcer relapse |
| url | https://www.vestnik-grekova.ru/jour/article/view/1800 |
| work_keys_str_mv | AT vbbregovskiy recurrentfootulcersinpatientswithdiabetesmellitusinoutpatientcare AT agdemina recurrentfootulcersinpatientswithdiabetesmellitusinoutpatientcare AT iakarpova recurrentfootulcersinpatientswithdiabetesmellitusinoutpatientcare |