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Arch Surg. 2000 Dec;135(12):1405-9.

Improvement in healing with aggressive edema reduction after debridement of foot infection in persons with diabetes.

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1
Department of Surgery, Southern Arizona Veterans Affairs Medical Center, 3601 S Sixth Ave, Tucson, AZ, USA. armstrong@usa.net

Abstract

BACKGROUND:

Infected foot wounds in patients with diabetes are the most common reason for diabetes-related hospital admission in the United States. Nonhealing foot wounds are the major precipitant of lower-extremity amputation in the diabetic population.

HYPOTHESIS:

The null hypothesis was that there would be no difference in proportion of healing with or without use of a foot-level mechanical compression device.

DESIGN:

Twelve-week, double-blind, randomized, controlled trial.

SETTING:

A university teaching hospital and related clinics.

PATIENTS:

One hundred fifteen patients with diabetes, 74% male, with foot infections requiring incision and debridement.

INTERVENTION:

All patients received either a functioning or placebo (nonfunctioning) foot compression device (Kinetic Concepts Inc, San Antonio, Tex). Patients and investigators were blinded to the functionality of the device.

PRIMARY OUTCOME MEASURE:

Proportion of wound healing in each group.

RESULTS:

There was a significantly higher proportion of healing in the active group than in the placebo group (39 [75%] of 52 patients vs 23 [51%] of 45; chi(2) = 6.0; P<.02; odds ratio, 2.9; 95% confidence interval, 1. 2-6.8). In the placebo group, there was no difference in proportion of healing between those identified as compliant (>/=50 hours of use per week) vs noncompliant (P =.10). In patients receiving active units, more patients in the compliant subgroup experienced wound healing (P<.03). When compared as a whole, there was a significant trend toward an increasing proportion of healing from the placebo-noncompliant to the placebo-compliant to the active-noncompliant to the active-compliant groups (chi(2)(trend) = 8.3; P<.005).

CONCLUSIONS:

Edema reduction achieved in this study by way of a pump and wrap system may increase the proportion of wound healing in patients after debridement of foot infections in patients with diabetes. Furthermore, the data suggest a potential association between increased compliance with use of the device and an increased trend toward wound healing. Arch Surg. 2000;135:1405-1409

Comment in

  • ACP J Club. 2001 Jul-Aug;135(1):15.
PMID:
11115342
[Indexed for MEDLINE]
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