Healing times of pedal ulcers in diabetic immunosuppressed patients after transplantation

• Published in: Archives of physical medicine and rehabilitation Vol. 80; no. 8; pp. 935 - 940
• Main Author: Sinacore, David R.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.08.1999; Elsevier
• Subjects: Adult; Aged; Analysis of Variance; Associated diseases and complications; Biological and medical sciences; Case-Control Studies; Casts, Surgical - statistics & numerical data; Chronic Disease; Diabetes. Impaired glucose tolerance; Diabetic Foot - etiology; Diabetic Foot - physiopathology; Diabetic Foot - rehabilitation; Diabetic Neuropathies - complications; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; Immunocompromised Host - physiology; Male; Medical sciences; Middle Aged; Organ Transplantation - physiology; Time Factors; Treatment Outcome; Wound Healing; Endocrinopathy; Human; Skin disease; Nervous system diseases; Diabetes mellitus; Lower limb; Transplantation; Case control study; Method; Homotransplantation; Peripheral neuropathy; Foot; Immunosuppression; Treatment; Surgery; Complication; Ulcer; Peripheral nerve disease; Cicatrization
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/S0003-9993(99)90086-2

Objective: To compare the healing time of neuropathic plantar ulcers treated by total-contact casting (TCC) in diabetic, immunosuppressed patients after organ transplantation with the healing time of plantar ulcers in control nonimmunosuppressed patients. Design: A case-control design with the control group matched for age, race, sex, body dimensions (height, weight, and body mass index), presence of sensory neuropathy, foot deformity presence and location, and pedal ulcer area and depth. Setting: An outpatient physical therapy clinic in a regional tertiary-care hospital and academic medical center. Participants: Nine patients with chronic diabetes mellitus and a previous organ transplantation who were currently receiving lifelong immunosuppressive drug therapy were treated for a neuropathic plantar ulcer by means of TCC. Fourteen group-matched control subjects with diabetes mellitus and a plantar ulcer but who had never had an organ transplantation and were not taking immunosuppressive agents were also studied. Interventions: TCC with partial weight-bearing using an assistive device until ulcers healed. Main Outcome Measure: Healing time was defined as the number of days in the total-contact cast until the skin completely closed. Results: All diabetic foot ulcers healed with casting. Immunosuppressed/transplanted patients healed in a mean time of 111 ± 25 days; ulcers of control subjects healed in 47 ± 18 days ( p < .05). All patients returned to ambulation using prescribed therapeutic footwear. None of the patients required a lower extremity amputation throughout the follow-up period. Conclusions: TCC is a highly effective and rapid method of healing neuropathic pedal ulcers in diabetic immunosuppressed/ transplantation patients, although it may take several weeks longer than it would for patients who were not immunocompromised.