The Degree of Blood Supply and Infection Control Needed to Treat Diabetic Chronic Limb-Threatening Ischemia with Forefoot Osteomyelitis

Abstract

Background: Diabetic foot ulcers combined with ischemia and infection can be difficult to treat. Few studies have quantified the level of blood supply and infection control required to treat such complex diabetic foot ulcers. We aimed to propose an index for ischemia and infection control in diabetic chronic limb-threatening ischemia (CLTI) with forefoot osteomyelitis.

The researchers retrospectively evaluated 30 patients with diabetic chronic limb-threatening ischemia combined with forefoot osteomyelitis who were treated surgically from January 2009 to December 2016. After 44 surgeries, patients were compared on their  background (age, sex, hemodialysis), infection status (preoperative and 1- and 2-week postoperative C-reactive protein [CRP] levels), surgical bone margin (with or without osteomyelitis), vascular supply (skin perfusion pressure), ulcer size, and time to wound healing between patients with healing ulcers and those with nonhealing ulcers. A c-reactive protein test measures the level of c-reactive protein in your blood. CRP is a protein made by your liver. It’s sent into your bloodstream in response to inflammation. Inflammation is your body’s way of protecting your tissues if you’ve been injured or have an infection. It can cause pain, redness, and swelling in the injured or affected area. Some autoimmune disorders and chronic diseases can also cause inflammation.

Preoperative CRP levels and the ratio of severe ulcers were significantly lower and skin perfusion pressure was significantly higher in the healing group than in the non healing group . No other significant differences were found between groups.

Conclusions: This study demonstrates that debridement should be performed first to control infection if the preoperative CRP level is greater than 40 mg/L. Skin perfusion pressure of 55 mm Hg is strongly associated with successful treatment. This research could improve the likelihood of salvaging limbs in patients with diabetes with diabetic chronic limb-threatening ischemia.

Source APMA