title: A multidisciplinary diabetic foot ulcer treatment programme significantly improved the outcome in patients with infected diabetic foot ulcers.
abstract: BACKGROUND
  Diabetic foot ulcers (DFUs) superimposed by infection and ischaemia may result in amputation without prompt and adequate management. We investigated whether the diabetic foot ulcer treatment programme (DFUTP) involving immediate debridement within 12 h, flap coverage and/or revascularisation improved the outcome of patients with infected DFUs.
  
  
  METHODS
  Between 2006 and 2009, we randomly enrolled 350 patients in the DFUTP group and compared them with control patients (the non-DFUTP group, n = 386) in Taiwan. Inclusion criteria consisted of infected diabetic foot ulcers with or without ischaemia. The risk factors, dynamics and outcome of amputation and re-amputation were analysed in terms of patient demographics, glycaemic control and infection.
  
  
  RESULTS
  The results of logistic regression analyses indicated that risk factors of amputation in both groups were HbA1c (odds ratio (OR) = 1.63, 95% confidence interval (CI) 1.31-2.02) and C reactive protein (OR = 1.12, 95% CI 1.01-1.24). The DFUTP group showed a lower amputation rate than the non-DFUTP group (p = 0.001). The association between the amputation and University of Texas (UT) classification was not statistically significant. The Kaplan-Meier estimate showed that the time to complete recovery of the sugar level in the DFUTP group was faster than in the non-DFUTP group (p = 0.001). For patients at stage D, the hospital stay in the non-DFUTP group was longer than in the DFUTP group (p = 0.014).
  
  
  CONCLUSIONS
  The DFUTP provides an effective treatment programme for decreasing the amputation rate with infected DFUs. Immediate debridement and flap reconstruction decrease the amputation and re-amputation rate respectively.
authors.affiliation: Department of General Surgery, Chi-Mei Medical Center, Chia Nan University of Pharmacy and Science, Tainan, Taipei Medical University, Taiwan.
authors.forename: Chong-Chi
authors.initials: CC
authors.lastname: Chiu
authors.forename: Chen-Ling
authors.initials: CL
authors.lastname: Huang
authors.forename: Shuen-Fu
authors.initials: SF
authors.lastname: Weng
authors.forename: Lei-Ming
authors.initials: LM
authors.lastname: Sun
authors.forename: Yu-Lien
authors.initials: YL
authors.lastname: Chang
authors.forename: Feng-Chou
authors.initials: FC
authors.lastname: Tsai
mesh_terms: D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003646:Debridement / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D017719:Diabetic Foot / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013524:Surgical Flaps / Q000098:blood supply*; D015996:Survival Rate; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D014946:Wound Infection / Q000382:microbiology / Q000401:mortality / Q000628:therapy*