title: Outcome of severe diabetic foot ulcers after standardised management in a specialised unit.
abstract: OBJECTIVE
  The primary objective was to evaluate the efficacy in terms of limb salvage and healing time of standardised multidisciplinary management for high-grade diabetic foot ulcers. The secondary objective was to retrospectively identify the factors that influenced time to healing.
  
  
  METHODS
  Over a 2-year period, 157 patients with diabetic foot ulcers were managed in our specialised unit using a standard treatment strategy; 118 were followed until healing or for at least 7 months (range, 7-29) after hospital discharge and form the basis for this study. Predetermined criteria were used to diagnose and manage the lesions. The number of major amputations and the time to healing were the main outcome measures. Univariable and multivariable analyses were done retrospectively to look for factors associated with time to healing.
  
  
  RESULTS
  The limb salvage rate was 97.5% and the healing rate was 50% after 10 months and 70% after 16 months. Factors significantly associated with healing time were arterial disease without bypass surgery (p<0.001) and renal replacement therapy (p<0.05). Osteomyelitis, as managed in this study, did not increase the healing time (p > 0.6).
  
  
  CONCLUSIONS
  In high-grade diabetic foot ulcers, standardised conservative management with second-line bone-sparing surgery, if needed, yields an acceptable limb salvage rate. With combined medical and surgical treatment, osteomyelitis is not a poor prognosis factor.
authors.affiliation: Department of Diabetology and Metabolism, Pitié Salpêtrière Teaching Hospital, Paris, France. agnes.heutier@psl.ap-hop-paris.fr
authors.forename: A
authors.initials: A
authors.lastname: Hartemann-Heurtier
authors.forename: G
authors.initials: G
authors.lastname: Ha Van
authors.forename: J P
authors.initials: JP
authors.lastname: Danan
authors.forename: F
authors.initials: F
authors.lastname: Koskas
authors.forename: S
authors.initials: S
authors.lastname: Jacqueminet
authors.forename: J L
authors.initials: JL
authors.lastname: Golmard
authors.forename: A
authors.initials: A
authors.lastname: Grimaldi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D017719:Diabetic Foot / Q000145:classification / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D005602:France; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*