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

  1. Lawrence A. Lavery, DPM, MPH1,
  2. Sunni A. Barnes, PHD2,
  3. Michael S. Keith, PHD, PHARMD2,
  4. John W. Seaman, Jr., PHD3 and
  5. David G. Armstrong, DPM, PHD4
  1. 1Department of Surgery, Scott & White Memorial Hospital at Texas A&M University, Georgetown, Texas
  2. 2Kinetic Concepts, Inc., Health Outcomes Research, San Antonio, Texas
  3. 3Department of Statistical Science, Baylor University, Waco, Texas
  4. 4Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
  1. 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

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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 12 October 2007. DOI: 10.2337/dc07-1300.

    L.L. is a member of the speakers’ bureau and the scientific advisory board for and has received speakers fees from Kinetic Concepts, Inc. (KCI), and D.G.A. has received speaking fees from KCI.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted October 10, 2007.
    • Received July 7, 2007.
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  1. Published online before print October 12, 2007, doi: 10.2337/dc07-1300 Diabetes Care January 2008 vol. 31 no. 1 26-29
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