title: Reconstructive vascular surgery and the extent of tissue damage due to diabetic foot ulcers relates to risk of new ulceration in patients with PAD.
abstract: OBJECTIVE
  There is limited information regarding new ulceration following the healing of ischaemic foot ulcers in diabetic patients. Our aim is to study new ulcerations in the same foot as the previous ulcer(s) in patients with diabetes and severe peripheral artery disease (PAD).
  
  
  METHODS
  Patients with diabetes and severe PAD who healed from previous ulcer(s) (Wagner grade 1-5, at or below the ankle), were recruited for the prospective study from the time of healing of their ulcer. Patients were followed up regarding new ulceration, and their treatments and ulcer status noted either directly or on examination of medical records.
  
  
  RESULTS
  We analysed the data on 602 patients with diabetes and severe PAD with healed foot ulcers, either primarily (n=443, 74%) or after minor amputation (n=159, 26%). Of these 51% (n=305) had revascularisation before healing from the previous ulcer, 34% (n=202) developed a new ulcer on the same foot within 15 months (range 0-106). Amputation was required by 22% (n=45) of patients, with a new ulcer on the same foot. The median survival time of all patients (n=602) was 54 months. By regression analysis, a low maximal Wagner grade for the previous ulcer and reconstructive vascular surgery was related to a decreased risk of developing new ulcers in the same foot.
  
  
  CONCLUSIONS
  Patients with diabetes and ischaemic foot ulcers have a high-risk for developing new ulcers and amputation in the same foot after healing. The extent of tissue involvement in the previous ulcer and reconstructive vascular surgery affected the risk for development of new ulcers.
authors.affiliation: Senior Consultant, Associate Professor, Department of Endocrinology, Skåne University Hospital, Malmö
authors.forename: T
authors.initials: T
authors.lastname: Elgzyri
authors.affiliation: Senior Consultant, Department of Orthopaedic Surgery, Skåne University Hospital, Lund.
authors.forename: J
authors.initials: J
authors.lastname: Larsson
authors.affiliation: Associate Professor, Department of Occupational Medicine, Skåne University Hospital, Lund.
authors.forename: P
authors.initials: P
authors.lastname: Nyberg
authors.affiliation: Senior Consultant, Department of Surgery, Helsingborg's Hospital, Helsingborg.
authors.forename: J
authors.initials: J
authors.lastname: Thörne
authors.affiliation: Senior Consultant, Associate Professor, Vascular Department, Skåne University Hospital, Malmö.
authors.forename: K-F
authors.initials: KF
authors.lastname: Eriksson
authors.affiliation: Senior Consultant, Associate Professor, Department of Endocrinology, Skåne University Hospital, Malmö
authors.forename: J
authors.initials: J
authors.lastname: Apelqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000150:complications* / Q000628:therapy*; D005260:Female; D016523:Foot Ulcer / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000601:surgery*; D014945:Wound Healing
keywords: PAD; amputation; diabetic foot; new ulceration; peripheral artery disease; re vascularisation