title: Prediction of healing for postoperative diabetic foot wounds based on early wound area progression.
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 >or=15% PWAR at 1 week or >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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Scott & White Memorial Hospital at Texas A&M University, Georgetown, Texas, USA. lklavery@yahoo.com
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.forename: Sunni A
authors.initials: SA
authors.lastname: Barnes
authors.forename: Michael S
authors.initials: MS
authors.lastname: Keith
authors.forename: John W
authors.initials: JW
authors.lastname: Seaman
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D000368:Aged; D017719:Diabetic Foot / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010781:Photography; D011184:Postoperative Period; D011336:Probability; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*