Recurrent diabetic foot ulcers: Results of a maximal multidisciplinary approach including reconstructive foot/ankle surgery

Wouter Brekelmans; Wilbert van Laar; Nicole J. Tolen; Rigo Hoencamp; Boudewijn L.S. Borger van der Brug

doi:10.1111/iwj.14045

Recurrent diabetic foot ulcers: Results of a maximal multidisciplinary approach including reconstructive foot/ankle surgery

Wouter Brekelmans^*, Wilbert van Laar, Nicole J. Tolen, Rigo Hoencamp, Boudewijn L.S. Borger van der Brug

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

The diabetic foot ulcer (DFU) and Charcot Neuroarthropathy (CN) are serious complications of diabetes mellitus in which wound closure is complex to achieve. Treating recurrent DFU in patients with a combination of infection, ischemia, and deformities is extremely challenging and this group of patients has a very poor outcome. This case series describes the outcomes of patients with a recurrent DFU and CN, with a mean SINBAD score of 4 and of which 40% had a TCS of D3, using a multidisciplinary protocol that includes reconstructive foot and ankle surgery. In 24/35 (69%) of patients, wound closure was achieved after a mean of 75 days postoperatively. The mean ulcer-free period was 358 days. The mean number of interventions was 6.7 (range 3–9). Post treatment 27/35 (77%) of patients was mobile, without additional amputation or ulcer recurrence. This study shows that wound closure and a long ulcer-free period can be achieved in patients with a DFU and CN and its multifactorial underlying diseases when treated in a multidisciplinary team, including reconstructive foot and ankle surgery.

Original language	English
Pages (from-to)	1866-1873
Number of pages	8
Journal	International Wound Journal
Volume	20
Issue number	6
Early online date	5 Jan 2023
DOIs	https://doi.org/10.1111/iwj.14045
Publication status	Published - Aug 2023

Bibliographical note

Funding Information:
The authors would like to thank the entire diabetic foot multidisciplinary team for their tremendous contribution to the multidisciplinary treatment of diabetic foot patients in our region; P.P.A. Hedeman Joosten, A.J. Ploeg, R.J. Brouwer, N.M. Delfos, M. van der Feltz, P. Warmerdam-Elbers, C.F.A. Eustatia-Rutten, J.J. Kerremans, M.J. Becker, K.A. Heemstra, J.R. van Ingen, L van Gils, R. Ostijn, M.L.A. Morssinkhof, W. Eilander, M. Kroon, Orthopaedic cast technician team of the Alrijne Hospital and all interventional radiologists of the Alrijne hospital.

Publisher Copyright:
© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.

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10.1111/iwj.14045Licence: CC BY-NC-ND

Recurrent diabetic foot ulcers Results of a maximal multidisciplinary approach including reconstructive foot ankle surgeryFinal published version, 1.47 MBLicence: CC BY-NC-ND

Cite this

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title = "Recurrent diabetic foot ulcers: Results of a maximal multidisciplinary approach including reconstructive foot/ankle surgery",

abstract = "The diabetic foot ulcer (DFU) and Charcot Neuroarthropathy (CN) are serious complications of diabetes mellitus in which wound closure is complex to achieve. Treating recurrent DFU in patients with a combination of infection, ischemia, and deformities is extremely challenging and this group of patients has a very poor outcome. This case series describes the outcomes of patients with a recurrent DFU and CN, with a mean SINBAD score of 4 and of which 40\% had a TCS of D3, using a multidisciplinary protocol that includes reconstructive foot and ankle surgery. In 24/35 (69\%) of patients, wound closure was achieved after a mean of 75 days postoperatively. The mean ulcer-free period was 358 days. The mean number of interventions was 6.7 (range 3–9). Post treatment 27/35 (77\%) of patients was mobile, without additional amputation or ulcer recurrence. This study shows that wound closure and a long ulcer-free period can be achieved in patients with a DFU and CN and its multifactorial underlying diseases when treated in a multidisciplinary team, including reconstructive foot and ankle surgery.",

author = "Wouter Brekelmans and \{van Laar\}, Wilbert and Tolen, \{Nicole J.\} and Rigo Hoencamp and \{Borger van der Brug\}, \{Boudewijn L.S.\}",

note = "Funding Information: The authors would like to thank the entire diabetic foot multidisciplinary team for their tremendous contribution to the multidisciplinary treatment of diabetic foot patients in our region; P.P.A. Hedeman Joosten, A.J. Ploeg, R.J. Brouwer, N.M. Delfos, M. van der Feltz, P. Warmerdam-Elbers, C.F.A. Eustatia-Rutten, J.J. Kerremans, M.J. Becker, K.A. Heemstra, J.R. van Ingen, L van Gils, R. Ostijn, M.L.A. Morssinkhof, W. Eilander, M. Kroon, Orthopaedic cast technician team of the Alrijne Hospital and all interventional radiologists of the Alrijne hospital. Publisher Copyright: {\textcopyright} 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley \& Sons Ltd.",

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AU - Hoencamp, Rigo

AU - Borger van der Brug, Boudewijn L.S.

N1 - Funding Information: The authors would like to thank the entire diabetic foot multidisciplinary team for their tremendous contribution to the multidisciplinary treatment of diabetic foot patients in our region; P.P.A. Hedeman Joosten, A.J. Ploeg, R.J. Brouwer, N.M. Delfos, M. van der Feltz, P. Warmerdam-Elbers, C.F.A. Eustatia-Rutten, J.J. Kerremans, M.J. Becker, K.A. Heemstra, J.R. van Ingen, L van Gils, R. Ostijn, M.L.A. Morssinkhof, W. Eilander, M. Kroon, Orthopaedic cast technician team of the Alrijne Hospital and all interventional radiologists of the Alrijne hospital. Publisher Copyright: © 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc (3M) and John Wiley & Sons Ltd.

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N2 - The diabetic foot ulcer (DFU) and Charcot Neuroarthropathy (CN) are serious complications of diabetes mellitus in which wound closure is complex to achieve. Treating recurrent DFU in patients with a combination of infection, ischemia, and deformities is extremely challenging and this group of patients has a very poor outcome. This case series describes the outcomes of patients with a recurrent DFU and CN, with a mean SINBAD score of 4 and of which 40% had a TCS of D3, using a multidisciplinary protocol that includes reconstructive foot and ankle surgery. In 24/35 (69%) of patients, wound closure was achieved after a mean of 75 days postoperatively. The mean ulcer-free period was 358 days. The mean number of interventions was 6.7 (range 3–9). Post treatment 27/35 (77%) of patients was mobile, without additional amputation or ulcer recurrence. This study shows that wound closure and a long ulcer-free period can be achieved in patients with a DFU and CN and its multifactorial underlying diseases when treated in a multidisciplinary team, including reconstructive foot and ankle surgery.

AB - The diabetic foot ulcer (DFU) and Charcot Neuroarthropathy (CN) are serious complications of diabetes mellitus in which wound closure is complex to achieve. Treating recurrent DFU in patients with a combination of infection, ischemia, and deformities is extremely challenging and this group of patients has a very poor outcome. This case series describes the outcomes of patients with a recurrent DFU and CN, with a mean SINBAD score of 4 and of which 40% had a TCS of D3, using a multidisciplinary protocol that includes reconstructive foot and ankle surgery. In 24/35 (69%) of patients, wound closure was achieved after a mean of 75 days postoperatively. The mean ulcer-free period was 358 days. The mean number of interventions was 6.7 (range 3–9). Post treatment 27/35 (77%) of patients was mobile, without additional amputation or ulcer recurrence. This study shows that wound closure and a long ulcer-free period can be achieved in patients with a DFU and CN and its multifactorial underlying diseases when treated in a multidisciplinary team, including reconstructive foot and ankle surgery.

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JO - International Wound Journal

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IS - 6

ER -

Recurrent diabetic foot ulcers: Results of a maximal multidisciplinary approach including reconstructive foot/ankle surgery

Abstract

Bibliographical note

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