SLR - July 2016 - Bret Brennan
Reference: Sinkin, JC, Reilly M, Cralley A, Kim PJ, Steinberg JS, Cooper P, Evans KK, Attinger CE. Multidisciplinary Approach to Soft-Tissue Reconstruction of the Diabetic Charcot Foot. Plast Reconstr Surg. 2015 Feb; 135 (2): 611-6.
Scientific Literature Review
Reviewed By: Bret Brennan, DPM
Residency Program: James A. Haley Veterans Hospital, Tampa, FL
Podiatric Relevance: In the United States, approximately eight percent of the population or 26 million people are affected by diabetes. Of those patients, 15–20 percent will develop a diabetic foot ulcer at some point in their life. Diabetics are prone to ulceration for a combination of reasons, including ischemia, immune impairment, and biomechanical and skeletal abnormalities associated with neuropathic arthropathy of the foot. This study focuses on the multidisciplinary approach to diabetic foot ulcerations, complicated by skeletal abnormality to successfully heal their wounds.
Methods: A retrospective chart review was performed of past medical and billing records of patients seen by the senior author over a period of the previous 7 years.
Results: Of the initial 314 wounds identified, 193 wounds with detailed follow-up data were reviewed. The majority of the wounds were located on the midfoot totaling 37.8 percent. The remaining wounds were evenly distributed at the forefoot, hindfoot and ankle. On average, the wounds were debrided surgically 4 times with the majority of patients undergoing bioengineered alternative tissue placement. The remaining patients had attempted primary and secondary closures, and autologous skin grafts. Forty-eight patients or 31.6 percent of the 193 patients underwent major amputation, and 95 wounds or 65.1 percent of the patients who did not have an amputation had healed wounds at the final follow-up.
Conclusions: The majority of ulcerations in the study required multiple surgical debridements in order to achieve a healthy wound base. Once a healthy wound base was obtained, several different therapeutic modalities were used to attempt to heal the wounds with a healing rate of only 65 percent. These statistics demonstrate the difficulty in healing diabetic foot ulcerations in the setting of structural abnormalities associated with Charcot arthropathy. This outlines the importance to not only focus on diligent wound debridement to achieve a healthy wound bed for healing, but also to address the underlying structural cause of the wound to prevent a more proximal amputation.