Comparison of characteristics and healing course of diabetic foot ulcers by etiological classification: neuropathic, ischemic, and neuro-ischemic type.
OBJECTIVE
To identify differences in the characteristics of patients with diabetic foot ulcers (DFUs) according to their etiological classification and to compare their healing time.


METHODS
Over a 4.5-year period, 73 patients with DFUs were recruited. DFUs were etiologically classified as being of neuropathic, ischemic, or neuro-ischemic origin. Descriptive analyses were performed to characterize study subjects, foot-related factors, and healing outcome and time. Duration of healing was assessed using the Kaplan-Meier method. Healing time among the three types was compared using the log rank test.


RESULTS
The number of patients manifesting neuropathic, ischemic, and neuro-ischemic ulcers was 30, 20, and 14, respectively. Differences were identified for age, diabetes duration, body mass index, hypertension, and estimated glomerular filtration rate. Patients with neuro-ischemic ulcers had better ankle-brachial index, skin perfusion pressure (SPP), and transcutaneous oxygen pressure values compared to those with ischemic ulcers. The average time in which 50% of patients had healed wounds was 70, 113, and 233 days for neuropathic, neuro-ischemic, and ischemic ulcers, respectively. Main factors associated with healing were age and SPP values.


CONCLUSIONS
Based on the etiological ulcer type, DFU healing course and several patient factors differed. Failure to consider the differences in DFU etiology may have led to heterogeneity of results in previous studies on DFUs.
Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan. Electronic address: yotsurie@hotmail.com.
Rie Roselyne
RR
Yotsu
Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Ngoc Minh
NM
Pham
Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Makoto
M
Oe
Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Takeshi
T
Nagase
Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Hiromi
H
Sanada
Division of Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Hisao
H
Hara
Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
Shoji
S
Fukuda
Department of Rehabilitation, National Center for Global Health and Medicine, Tokyo, Japan.
Junko
J
Fujitani
Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Ritsuko
R
Yamamoto-Honda
Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Hiroshi
H
Kajio
Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Mitsuhiko
M
Noda
Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
Takeshi
T
Tamaki
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply*; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014945:Wound Healing
Age; Diabetic foot ulcer; Healing time; Outcome; Risk factor; Skin perfusion pressure