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Heal or no heel: Outcomes of ischaemic heel ulcers following lower limb revascularization from a multi‐ethnic Asian Cohort in Singapore
- Source :
- International Wound Journal
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- Ischaemic diabetic heel ulcers are difficult to treat and prognosis is often guarded. The aim was to document our outcome of treating heel ulcers following revascularization in a predominantly diabetic Asian cohort presenting with chronic limb threatening ischaemia from Singapore. Retrospective cohort study (n = 66, 66 limbs) over a 5‐year period. Data were collected from hospital electronic health records. Outcomes included time to healing, amputation free survival (AFS), and mortality. Minimum follow‐up period was 6 months. Multivariate regression analysis was performed to look for factors associated with poor outcome. Mean age was 67.4 ± 8.8 years. 62/66 (93.9%) were diabetics. Mean wound size at presentation was 3.6 ± 2.3 cm. Mean Wound, Ischaemia, Foot Infection (WIFI) score was 5 ± 1.6. 12/66 (18%) patients had a patent posterior tibial artery pre‐operatively. Straight line flow was restored in only 31/66 (46.9) patients but 47/66 (71.2%) had successful limb salvage. Median time to wound healing was 90.0 (IQR 60‐180) days. A median of 1 (IQR 0‐2) wound debridement was required. Patients who underwent negative pressure dressing (23/66; 34.8%) required a median of 26 (IQR 13‐33) cycles to achieve healing. Amputation free survival (AFS) was 72% and 68% at 6‐ and 12‐months, respectively. Mortality rate was 16.7% and 19.7% at 6‐ and 12‐months, respectively. Low albumin level and initial Rutherford class were independent predictors of worse 6‐month AFS. Outcomes of heel ulcers post revascularisation may not be as poor as previously described. Persistent attention to wound care with multidisciplinary effort is needed for optimal healing.
- Subjects :
- medicine.medical_specialty
Heel
medicine.medical_treatment
Ischemia
Dermatology
Revascularization
Amputation, Surgical
030207 dermatology & venereal diseases
03 medical and health sciences
Wound care
0302 clinical medicine
Risk Factors
medicine.artery
diabetic
medicine
Humans
030212 general & internal medicine
Ulcer
Aged
Retrospective Studies
posterior tibial artery
Singapore
Wound Healing
heel ulcer
business.industry
Mortality rate
Retrospective cohort study
Original Articles
Limb Salvage
medicine.disease
Surgery
Posterior tibial artery
Treatment Outcome
medicine.anatomical_structure
Lower Extremity
Cohort
outcome
endovascular
Original Article
revascularization
business
Subjects
Details
- ISSN :
- 1742481X and 17424801
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- International Wound Journal
- Accession number :
- edsair.doi.dedup.....9934c2766743267a351ed7779c7290f4