title: Why a multidisciplinary team may represent a key factor for lowering the inferior limb loss rate in diabetic neuro-ischaemic wounds: application in a departmental institution.
abstract: INTRODUCTION/AIM OF THE STUDY: To assess the influence of a multidisciplinary approach on the limb salvage rates in the treatment of patients suffering from diabetic ischaemic inferior limb ulcers.
  
  
  METHODS
  From September 2001 until March 2008, a consecutive series of 183 limbs with diabetic ischaemic wounds in 163 patients were treated by combined multi-level angioplasties as the primary revascularization approach in an institutional diabetic programme (two departmental hospitals). The avoidance of limb loss was retrospectively analyzed before and after the year 2005, as a landmark for implementing a "multidisciplinary diabetic foot clinic" in the routine daily care.
  
  
  RESULTS
  Initial technical success for endovascular revascularization was noted in 152 limbs (83%). The aggregate limb salvage proportions at 12, 24, 32, 60 and 66 months (+/- SEM) were: 87% (+/- 2.8), 80% (+/- 3.9), 77% (+/- 4.4) and thereafter 77% (+/- 4.4), respectively. A comparison between the limb salvage rates before and after initiating the multidisciplinary group showed a significant difference (p = 0.040, CI: 1.040-5.311, HR: 2.35, Chi square = 4.22) with better results in the latest interval, employing effective team activity. No statistical deviation was found regarding the technique itself for revascularization at the same intervals (p = 0.381).
  
  
  CONCLUSIONS
  Our experience suggests that limb salvage for diabetic ischaemic wounds may be favourably influenced by a co-ordinated multidisciplinary group. Although appropriate revascularization is crucial for limb rescue, a pluralist control of the attending risk factors influencing wound healing might be of matchless importance as well.
authors.affiliation: Department of Vascular and Thoracic Surgery, Princesse Paola Hospital Marche-en-Famenne, Belgium. v.alex@skynet.be
authors.forename: V
authors.initials: V
authors.lastname: Alexandrescu
authors.forename: G
authors.initials: G
authors.lastname: Hubermont
authors.forename: V
authors.initials: V
authors.lastname: Coessens
authors.forename: Y
authors.initials: Y
authors.lastname: Philips
authors.forename: B
authors.initials: B
authors.lastname: Guillaumie
authors.forename: Chr
authors.initials: C
authors.lastname: Ngongang
authors.forename: G
authors.initials: G
authors.lastname: Vincent
authors.forename: K
authors.initials: K
authors.lastname: Azdad
authors.forename: G
authors.initials: G
authors.lastname: Ledent
authors.forename: C
authors.initials: C
authors.lastname: De Marre
authors.forename: C
authors.initials: C
authors.lastname: Macoir
mesh_terms: D000800:Angioplasty, Balloon; D002985:Clinical Protocols; D017719:Diabetic Foot / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage / Q000706:statistics & numerical data*; D010348:Patient Care Team; D012189:Retrospective Studies; D014654:Vascular Patency; D014945:Wound Healing