Analyzing Risk Factor for Wound Healing after Delayed Primary Closure of Diabetic Foot

Abstract

Category: Diabetes; Other Introduction/Purpose: Part of hospitalized diabetic foot disease patients with infectious necrosis develop wound dehiscence after delayed primary closure for improved wound status without erythema and induration following appropriate wound management, amputation, and vascular intervention. Dehisced wound could be the source of reinfection, further admission, financial burden. We aimed to analyze predictors for failure of wound management. Methods: We retrospectively reviewed medical records and find 105 patients with delayed primary closure among 403 ischemic and/or infectious diabetic foot admitted cases from 2013 to 2021. Vascular intervention was performed for patient with ankle brachial index (ABI) less than 0.8. Total stitches were removed two to three weeks after delayed primary closure. Wound dehiscence was decided when it was developed within two weeks. Eighty-two cases (78.1%) with wound healing were designated as group I, and twenty-three cases (21.9%) with dehiscence were designated as group II. Two groups were compared for various demographic, laboratory and physical state. Then, multivariate logistic regression analysis was done to find predictors for failure of wound management. Results: In univariate analysis between two groups, smoking, wound site, initial C-reactive protein (CRP), White blood cell count (WBC), albumin (initial and adjacent to closure) and sequential negative culture result between two groups among 22 potential risk factors. In multivariate logistic regression analysis performed with variables showing p <0.05 during univariate comparison, there was no significant predictor. Conclusion: The wound healing ratio for delayed primary closure reached to 78.1% in patients with improved wound status and ABI more than 0.8 in ischemic and/or infectious diabetic foot disease irrelevant to specific factors.