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Conservative Wound Care: A Relevant Approach to Manage Diabetic Foot Ulcers 08

Primary outcome
Diabetes Initial healing of the index wound using a

Conservative Wound Care: A Relevant Approach to Manage Diabetic Foot Ulcers conservative wound management approach.
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Endorsed by: Dr. Paresh R. Pai, Vascular and Endovascular Surgeon, Mumbai
Secondary outcomes

Background Time to wound healing (time interval between
first clinic visit to no further requirement of
The prevalence of critical limb threatening ischemia (CLTI) is rapidly increasing due to aging treatment)
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population and high prevalence of end-stage renal disease (ESRD) and diabetes. 1
Wound recurrence 8

Delayed revascularization to achieve healing 8
The combination of diabetes with peripheral arterial disease often presents with challenging wounds Failure of conservative care (after 6 weeks, index

with poor functional outcomes and tissue loss. 2,3
wound fail to heal leading to limb loss,
revascularization, or surgical bypass) 8 b) Risk of amputation
Guidelines for critical limb threatening ischemia salvage advocate for a structured and tailored Very low risk : 1-year limb
8
approach to define etiologic and anatomic characteristics of CLTI. 4-10 Results loss risk of 3%

a) Patient demographics
Besides revascularization, a conservative approach to wound healing focusing on wound care has Amongst 1,113 patients prospectively enrolled in Low risk : 1-year limb loss
8
been validated as safe and effective in the setting of mild to moderate ischemia. 4,7 the PAVE program, 89 (122 limbs) met the risk of 8%

inclusion criteria for the conservative group.
This current study explored the use of conservative wound care approaches to patients with Mean ankle-brachial index was 0.86 ± 0.31 and Moderate risk : 1-year limb
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non-infected, diabetic foot ulcers with mild to moderate ischemia, in a multidisciplinary limb average TcPO measurements were 47.4 ± 17.6 loss risk of ~25% = 43%
2
preservation program at a Veterans Affairs Hospital. 11 mm Hg (table 1). 11 patients.

Study design Inclusion criteria

The Prevention of Amputation in Veterans Age: ≥ 18 years
Everywhere (PAVE) is a veteran-specific, Presence of peripheral arterial disease and

prospectively maintained database that includes tissue loss
all patients with CLTI and tissue loss. 11 With mild to moderate ischemia

(transcutaneous partial pressure of oxygen
A multidisciplinary team was also established (TcPO ) of 30-59 mmHg)
2
and included PAVE coordinator, vascular An ankle-brachial index (ABI) < 0.9
surgeons, podiatrists, physiatrists, pharmacists, Absent pedal pulses

prosthetists, nurses, infectious disease Presence of tissue loss or ulceration
specialists, and nutritionists. 7,11 Comorbidities: diabetes mellitus (DM),

smoking history, hypertension (HTN), chronic
kidney disease (CKD), and/or end-stage renal

disease (ESRD).