Prediction of healing for postoperative diabetic foot wounds based on early wound area progression

Lawrence A. Lavery, Sunni A. Barnes, Michael S. Keith, John W. Seaman, David G Armstrong

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

OBJECTIVE - To evaluate the probability of wound healing based on percentage of wound area reduction (PWAR) at 1 and 4 weeks in individuals with large, chronic, nonischemic diabetic foot wounds following partial foot amputation. METHODS - Data from a 16-week randomized clinical trial (RCT) of 162 patients were analyzed to compare outcomes associated with negative-pressure wound therapy (NPWT) delivered through the V.A.C. Therapy System (Kinetic Concepts, San Antonio, TX) (n=77) versus standard moist wound therapy (MWT) (n=85). The 1- and 4-week regression models included 153 and 129 of the RCT patients, respectively. RESULTS - Early changes in PWAR were predictive of final healing at 16 weeks. Specifically, wounds that reached ≥15% PWAR at 1 week or ≥60% PWAR at 4 weeks had a 68 and 77% (respectively) probability of healing vs. a 31 and 30% probability if these wound area reductions were not achieved. Patients receiving NPWT were 2.5 times more likely to achieve both a 15% PWAR at 1 week and a 60% area reduction at 1 month (odds ratios 2.51 and 2.49, respectively) compared with those receiving MWT. CONCLUSION - Results of this study suggest that clinicians can calculate the PWAR of a wound as early as 1 week into treatment to predict the likelihood of healing at 16 weeks. This might also assist in identifying a rationale to reevaluate the wound and change wound therapies.

Original languageEnglish (US)
Pages (from-to)26-29
Number of pages4
JournalDiabetes Care
Volume31
Issue number1
DOIs
StatePublished - Jan 2008
Externally publishedYes

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Diabetic Foot
Wounds and Injuries
Negative-Pressure Wound Therapy
Randomized Controlled Trials
Therapeutics
Amputation
Wound Healing
Foot

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Prediction of healing for postoperative diabetic foot wounds based on early wound area progression. / Lavery, Lawrence A.; Barnes, Sunni A.; Keith, Michael S.; Seaman, John W.; Armstrong, David G.

In: Diabetes Care, Vol. 31, No. 1, 01.2008, p. 26-29.

Research output: Contribution to journalArticle

Lavery, Lawrence A. ; Barnes, Sunni A. ; Keith, Michael S. ; Seaman, John W. ; Armstrong, David G. / Prediction of healing for postoperative diabetic foot wounds based on early wound area progression. In: Diabetes Care. 2008 ; Vol. 31, No. 1. pp. 26-29.
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abstract = "OBJECTIVE - To evaluate the probability of wound healing based on percentage of wound area reduction (PWAR) at 1 and 4 weeks in individuals with large, chronic, nonischemic diabetic foot wounds following partial foot amputation. METHODS - Data from a 16-week randomized clinical trial (RCT) of 162 patients were analyzed to compare outcomes associated with negative-pressure wound therapy (NPWT) delivered through the V.A.C. Therapy System (Kinetic Concepts, San Antonio, TX) (n=77) versus standard moist wound therapy (MWT) (n=85). The 1- and 4-week regression models included 153 and 129 of the RCT patients, respectively. RESULTS - Early changes in PWAR were predictive of final healing at 16 weeks. Specifically, wounds that reached ≥15{\%} PWAR at 1 week or ≥60{\%} PWAR at 4 weeks had a 68 and 77{\%} (respectively) probability of healing vs. a 31 and 30{\%} probability if these wound area reductions were not achieved. Patients receiving NPWT were 2.5 times more likely to achieve both a 15{\%} PWAR at 1 week and a 60{\%} area reduction at 1 month (odds ratios 2.51 and 2.49, respectively) compared with those receiving MWT. CONCLUSION - Results of this study suggest that clinicians can calculate the PWAR of a wound as early as 1 week into treatment to predict the likelihood of healing at 16 weeks. This might also assist in identifying a rationale to reevaluate the wound and change wound therapies.",
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