The Role of Surgical Off-loading to Prevent Recurrent Ulcerations

Fontaine, Javier La; Lavery, Lawrence A.; Hunt, Nathan A.; Murdoch, Douglas P.

doi:10.1177/1534734614555002

Cited by 20 publications

(22 citation statements)

References 94 publications

(126 reference statements)

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“…In the literature these ulcers are termed recurrent ulcer, reulceration, new ulcer, and transfer ulcer . Often there is no definition of ulcer recurrence at all . To be able to compare treatment strategies and for identifying risk factors and prevention of new foot ulcers there is a need for more uniform definitions of new ulcers.…”

Section: Discussionmentioning

confidence: 99%

“…There is a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and with no uniform definitions of recurrent and other new ulcers …”

mentioning

confidence: 99%

“…2,3 There is a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and with no uniform definitions of recurrent and other new ulcers. [4][5][6][7][8][9][10][11][12][13][14][15][16] The aim of this study was to evaluate the outcome in a 2-year follow-up study of a large cohort of consecutively treated patients with diabetes mellitus and a healed plantar forefoot ulcer with regard to development, characteristics, and outcome of recurrent and other new ulcers.…”

mentioning

confidence: 99%

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Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer

Örneholm

Apelqvist

Larsson

et al. 2017

Wound Repair Regeneration

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Diabetic foot ulcer is a serious complication in patients with diabetes. In most outcome studies of this condition, there is a combination of various types of ulcer and ulcer locations. Plantar ulcers are usually localized to the forefoot, and constitute a quarter of all diabetic foot ulcers. There are a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and there are no uniform definitions of recurrent and other new ulcers. The aim of this study was to evaluate the outcome of a large cohort of consecutively treated patients with diabetes mellitus and a healed planter forefoot ulcer (n = 617) with regard to development, characteristics, and outcome of recurrent and other new ulcers. Patients were followed consecutively and prospectively with a 2-year follow-up, according to a preset protocol. Out of 617 patients, 250 (41%) did not develop any new ulcer, 262 (42%) developed a new ulcer, 87 (14%) died and 18 (3%) were lost at 2 years following healing of a plantar forefoot ulcer. Thirty-four percent developed other new ulcers (112 on the same foot and 99 on the contralateral foot), whereas 51 patients (8%) developed a recurrent ulcer (at the same site and foot). Of the patients who died within 2 years, 30 patients had developed other new ulcers. The risk of a recurrent ulcer in patients with diabetes and a healed plantar forefoot ulcer was only 8% within 2 years, whereas other new ulcers, on the same foot or on the contralateral foot, was seen in 4 out of 10 patients indicating the need for further preventive measures and surveillance in these patients. We suggest a concise definition for new ulcer to be used in future research.

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Section: Discussionmentioning

confidence: 99%

“…There is a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and with no uniform definitions of recurrent and other new ulcers …”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer

Örneholm

Apelqvist

Larsson

et al. 2017

Wound Repair Regeneration

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“…49,95 Surgical offloading is a term that (as its name implies) refers to the surgical management of foot deformities causing high pressures resulting in chronic ulcerations. [96][97][98] While not generally considered a primary treatment for most neuropathic DFUs, those that prove to be recalcitrant to standard wound bed preparation and effective offloading should be considered for surgical internal decompression. Many such procedures have been reported as effective over the last several decades.…”

Section: Chronic Wound Challengesmentioning

confidence: 99%

Challenges in the Treatment of Chronic Wounds

Frykberg

Banks

2015

Advances in Wound Care

1,687

1,429

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Significance: Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients.Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention toward managing these perturbations can often lead to successful healing.Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection of an appropriate therapy is often not evidence based.Future Directions: Basic tenets of care need to be routinely followed, and a systematic evaluation of patients and their wounds will also facilitate appropriate care. Underlying pathologies, which result in the failure of these wounds to heal, differ among various types of chronic wounds. A better understanding of the differences between various types of chronic wounds at the molecular and cellular levels should improve our treatment approaches, leading to better healing rates, and facilitate the development of new more effective therapies. More evidence for the efficacy of current and future advanced wound therapies is required for their appropriate use.

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“…If unsuccessful and ulceration persists plantar to the metatarsal head, single or pan metatarsal resection can facilitate healing. 27 …”

Section: Surgical Correction Of Skeletal Abnormalitiesmentioning

confidence: 99%

Offloading the diabetic foot: toward healing wounds and extending ulcer-free days in remission

Boghossian¹,

Miller²,

Armstrong³

2017

CWCMR

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Management of the diabetic foot is multifaceted and requires constant monitoring from patients and health care providers. The alarmingly high rate of recurrence of ulcerations in diabetic foot requires a change in our approach to care and to the vernacular in the medical literature. With its high rates of morbidity and recurrence, care of the complex diabetic foot may be aptly comparable to many forms of cancer. Therefore, our efforts should be not only in rapid healing of open wounds but also in maximizing ulcer-free days for the patient in diabetic foot remission. One facet of the multidisciplinary approach in managing wounds is achieved by reducing peak plantar pressures by offloading the foot with various conservative and surgical techniques aimed at reducing areas of stress caused by ambulation and improper shoe gear. Evidence supports the use of total contact casts as the gold standard for offloading open wounds; however, other methods have gained popularity as well. Novel approaches in surgical techniques and advances in wearable technology appear to show promise in measuring and modulating dangerous pressure and inflammation to extend remission and improve quality of life for these most complex patients. Keywords: diabetic foot, ulcer, remission, amputation, offloading, wearables Diabetes and other noncommunicable diseases of decay are now the leading cause of global mortality in the developed and developing world.1 As the continuously growing epidemic of diabetes further expands, it inflicts affected patients with a myriad of subsequent diabetic complications and comorbidities that necessitate further financial investments in managing these patients in a multidisciplinary setting to save limbs from amputation. There are several well-known guidelines for prolonging remission from ulceration in the diabetic foot with the mind-set of "active prevention", including having a heightened awareness of these risk factors associated with ulceration, patient education, staying active, frequent inspection of the feet, reducing friction by wearing diabetic socks and proper footwear, avoiding self-injurious behavior such as walking barefoot, and long-term management of the various comorbid systemic diseases associated with diabetes. 2,3 Due to the economic, physical, and psychological cost of diabetic foot ulcers (DFUs), efforts to delay or prevent their development are a prudent use of medical resources. Remarkably, people with DFUs have a risk of hospitalization that is comparable to or exceeding heart failure, pulmonary disease, renal disease, and most cancers. 4 Patients with diabetes mellitus (DM) undergoing treatment of DFUs often present with confounding factors and subsequently experience high rates of recurrence. Of the individuals who successfully heal a DFU, the risk of ulcer recurrence within

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The Role of Surgical Off-loading to Prevent Recurrent Ulcerations

Cited by 20 publications

References 94 publications

Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer

Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer

Challenges in the Treatment of Chronic Wounds

Offloading the diabetic foot: toward healing wounds and extending ulcer-free days in remission

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