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Published online October 12, 2007
Diabetes Care 31:26-29, 2008
DOI: 10.2337/dc07-1300
© 2008 by the American Diabetes Association
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Clinical Care/Education/Nutrition/Psychosocial Research
Original Research

Prediction of Healing for Postoperative Diabetic Foot Wounds Based on Early Wound Area Progression

Lawrence A. Lavery, DPM, MPH1, Sunni A. Barnes, PHD2, Michael S. Keith, PHD, PHARMD2, John W. Seaman, Jr., PHD3 and David G. Armstrong, DPM, PHD4

1 Department of Surgery, Scott & White Memorial Hospital at Texas A&M University, Georgetown, Texas
2 Kinetic Concepts, Inc., Health Outcomes Research, San Antonio, Texas
3 Department of Statistical Science, Baylor University, Waco, Texas
4 Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois

Address correspondence and reprint requests to Lawrence A. Lavery, Texas A&M Health Science Center, Scott & White Georgetown Clinic, 703 Highland Spring Ln., Georgetown, Texas 78628. E-mail: lklavery{at}yahoo.com

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.

Abbreviations: MWT, moist wound therapy • NPWT, negative-pressure wound therapy • PWAR, percentage of wound area reduction • RCT, randomized clinical trial


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