Abstract
The management of complex diabetic foot wounds with large skin defects poses a challenge for surgeons. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 and October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm2 (range, 4.71–66.76 cm2).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm2/day, ranging from 0.29 cm2/day to 8.35 cm2/day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistical difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach to complex diabetic foot wounds. Nevertheless, more attention should be paid to the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.
Highlights
Diabetes mellitus (DM) is a severe and complex disease with significant socioeconomic and health care implications, both in developed and developing nations
The results were considered statistically significant at the level of P < 0.05 in all applied analyses. This retrospective observational clinical study analyzed the outcome of 16 patients with complex diabetic foot wounds residual
We presented the results of this retrospective observation of patients with diabetic foot ulcers (DFUs) and large skin defects residual after debridement
Summary
Diabetes mellitus (DM) is a severe and complex disease with significant socioeconomic and health care implications, both in developed and developing nations. The prevalence of diabetic foot ulcers (DFUs) is up to 15% among the patients with DM [3]. This is secondary to a variety of diabetes-related risk factors, such as peripheral neuropathy and vascular disease. Diabetic foot ulcers (DFUs) are associated with a high rate of hospitalization and a 20-fold increased risk of lower limb amputations [5]. NPWT has proved to be an effective method of accelerating the healing of DFUs. for complex diabetic foot wounds with large skin defects that cannot be stitched together by low tension, wound reduction is limited with application of NPWT alone. In order to solve the problem of large skin defects, many skin stretching devices have been brought in. All of them are designed to reduce local mechanical loads on skin and take advantage of the skin mechanical properties of creep and stress relaxation for the wound closure [11]
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