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

• Published in: International wound journal Vol. 20; no. 6; pp. 1866 - 1873
• Main Authors: Brekelmans, Wouter, Laar, Wilbert, Tolen, Nicole J., Hoencamp, Rigo, Borger van der Burg, Boudewijn L. S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2023; John Wiley & Sons, Inc
• Subjects: Amputation; Amputation, Surgical; Ankle; Ankle - surgery; Antibiotics; Diabetes; Diabetes Mellitus; Diabetic Foot - surgery; diabetic foot ulcer; Foot diseases; Humans; Infections; Ischemia; Leg ulcers; Lower Extremity - surgery; multidisciplinary team; Multidisciplinary teams; Original; Orthopedics; Oxygen therapy; Pathology; Patients; Peripheral neuropathy; Plastic Surgery Procedures; Reconstructive surgery; recurrence; Retrospective Studies; Statistical analysis; Wound healing; United States > US; Netherlands; Texas; recurrence; wound healing; diabetic foot ulcer; multidisciplinary team; reconstructive surgery
• ISSN: 1742-4801; 1742-481X
• DOI: 10.1111/iwj.14045

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.