title: The use of a dermal substitute to preserve maximal foot length in diabetic foot wounds with tendon and bone exposure following urgent surgical debridement for acute infection.
abstract: In this study, we evaluated the utility of a dermal substitute for preserving maximal foot length after urgent surgical debridement. Patients referred to our Diabetic Foot Center with foot lesions were assessed for sensory-motor neuropathy, infection and critical limb ischaemia. The presence of acute foot infection indicated the need for immediate surgical debridement. The degree of amputation, if necessary, was based on the amount of apparently non infected vital tissue. When vital tendon/bone tissue remained exposed, the lesion was covered with a dermal substitute. From January to December 2008, 393 patients underwent surgical treatment for diabetic foot syndrome; 30 patients underwent immediate surgical debridement resulting in exposed tendon and/or bone tissues. An average of 4.4 +/- 2.1 days following surgical debridement, all 30 patients underwent dermal regeneration template grafting to cover-exposed healthy tendon and bone tissues, instead of achieving primary wound closure with a proximal amputation. After 21 days, a skin graft was performed. Complete wound healing occurred in 26 patients (86.7%). In these patients, the amputation level was significantly more distal (P < 0.003) with respect to that potentially required for immediate wound closure. The average healing time was 74.1 +/- 28.9 days. Four patients underwent a more proximal amputation. No patients underwent major amputation. The use of the dermal substitute for treating exposed tendon and bone tissues allowed timely wound healing and preserved maximal foot length. Continued follow-up will allow assessment of long-term relapse and complication rates. Such treatment could constitute part of the comprehensive management of diabetic wounds.
authors.affiliation: IRCCS Multimedica, Diabetic Foot Unit, 20099 Sesto San Giovanni, Milan, Italy. info@giacomoclerici.it
authors.forename: Giacomo
authors.initials: G
authors.lastname: Clerici
authors.forename: Maurizio
authors.initials: M
authors.lastname: Caminiti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Curci
authors.forename: Antonella
authors.initials: A
authors.lastname: Quarantiello
authors.forename: Ezio
authors.initials: E
authors.lastname: Faglia
mesh_terms: D000208:Acute Disease; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000379:methods; D001424:Bacterial Infections / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016009:Chi-Square Distribution; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D003646:Debridement / Q000009:adverse effects / Q000379:methods*; D017719:Diabetic Foot / Q000150:complications*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012775:Shoes; D016038:Skin Transplantation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen