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17-11-2011 | Podiatry | Article

Two-week progress checks key to predicting foot ulcer healing

Abstract

Free abstract

MedWire News: US researchers have identified a simple characteristic that predicts whether a diabetic foot ulcer (DFU) will heal within 12 weeks.

"The ability to predict whether a DFU is following versus not following a healing trajectory could dramatically alter patient outcomes by alerting the clinician to reassess the wound condition and consider an alternate treatment regimen," explain Robert Snyder (Hospital and Medical Center, Tamarac, Florida) and co-authors.

"Thus, it is important to develop monitoring tools to identify patients with DFUs who may have early healing progress but who later fail to heal."

Early healing progress, defined as a percent area reduction (PAR) of 50% or less by 4 weeks, is used to identify patients at high risk for not healing within 12 weeks, the team notes. However, around half of patients with early progress do not heal within 12 weeks.

To investigate healing patterns further, the researchers examined data from 120 DFU patients who participated in two randomized clinical trials, and had achieved 50% or greater PAR by week 4. Of these patients, 52% did not heal completely by 12 weeks.

Analysis showed that patients who did not heal within 12 weeks began to deviate from their predicted healing course by 6 weeks. Patients who achieved reduction in their ulcer size between weeks 6 and 8 were significantly more likely to have ulcer healing by 12 weeks than those who did not (26.2 vs 60.3%).

Furthermore, patients who achieved a PAR of 90% or more at 8 weeks were 2.7 times more likely to have healed after 12 weeks than those with a lower PAR (51 vs 19%).

A PAR of 90% at 8 weeks was 66% sensitive and 71% specific for healing by week 12, with positive and negative predictive values of 51% and 82%, respectively.

"In conclusion, close monitoring of DFU healing and reporting of wound area measurements is essential," Snyder et al report in the International Wound Journal.

"A stalling in wound healing for 2 weeks or more is indicative of failure to heal, regardless of early positive healing progress."

They conclude: "These assessments complement the recommended 4-week/50% predictor and may be beneficial in the identification of changes that are impacting DFU closure rates despite early positive wound healing."

By Lynda Williams

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