Parekh Rushabh A, Athavale Virendra, Kelshikar Saili
Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Cureus. 2024 Sep 11;16(9):e69164. doi: 10.7759/cureus.69164. eCollection 2024 Sep.
Diabetic foot ulcers (DFUs) stand out as a prevalent and debilitating condition. Furthermore, the progression of diabetes-related hyperglycemia and associated conditions such as peripheral arterial disease exacerbates the risks of DFUs, including complications like infection and gangrene. Given the significant burden of DFUs, there is a pressing need to improve preventive and therapeutic strategies. This study investigates the clinical profiles of patients with DFUs, including the importance of smoking and intermittent claudication, evaluates management strategies based on the vascular status assessed through Doppler scans, and provides insights into the importance of ankle-brachial pressure index (ABPI) and toe brachial index (TBI) values, which play a vital role in predicting and managing ulcer healing outcomes, highlighting the importance of vascular assessment in treatment planning.
The study aims to assess the clinical profile of patients with DFUs based on their vascularity status using Doppler scans, predict the outcome of the ulcer using indexes like ABPI and TBI values, and decide on further management.
This prospective study was conducted over 24 months, from August 2022 to July 2024, at the Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. The study included 50 patients presenting with DFUs. Approval was obtained from the Institutional Ethics Committee, and informed consent was obtained from all participants. A detailed history was taken, including the history of smoking and intermittent claudication, and a thorough examination of the ulcer was performed. HbA1c levels were measured, Doppler scans of the lower limbs were done, and the ABPI and TBI values were calculated. Management strategies were determined based on the assessed vascular status, leading to either medical or surgical interventions.
Twenty-one (42%) patients who presented with DFUs had a positive history of intermittent claudication, demonstrating a significant association between the history of intermittent claudication and the Doppler findings. Thirty-seven (74%) patients gave a positive history of smoking, which revealed a significant association between the history of smoking and Doppler findings. Thirty-eight (76%) patients had an ABPI of <0.9, out of which 33 (66%) patients showed an improved outcome of the ulcer after necessary management. There is also a statistically significant association between the ABPI and Doppler findings. Sixteen (32%) of patients had a TBI of <0.65, of which all showed an improvement. There is a highly significant association between TBI and the Doppler findings.
This study concludes that integrated routine assessment of ABPI and TBI into DFU management protocols is necessary to guide treatment decisions and monitor response to therapy. Treatment and prevention of diabetes-related complications affecting the lower extremities require a dedicated interdisciplinary approach.
糖尿病足溃疡（DFU）是一种常见且使人衰弱的病症。此外，糖尿病相关的高血糖进展以及诸如外周动脉疾病等相关病症会加剧DFU的风险，包括感染和坏疽等并发症。鉴于DFU的重大负担，迫切需要改进预防和治疗策略。本研究调查了DFU患者的临床特征，包括吸烟和间歇性跛行的重要性，基于通过多普勒扫描评估的血管状况评估管理策略，并深入探讨踝肱压力指数（ABPI）和趾肱指数（TBI）值的重要性，这些值在预测和管理溃疡愈合结果中起着至关重要的作用，突出了血管评估在治疗规划中的重要性。
本研究旨在基于使用多普勒扫描的血管状况评估DFU患者的临床特征，使用ABPI和TBI值等指标预测溃疡的结果，并决定进一步的管理措施。
这项前瞻性研究于2022年8月至2024年7月在浦那皮姆普里的DY帕蒂尔医学院、医院和研究中心普通外科进行，为期24个月。该研究纳入了50例患有DFU的患者。获得了机构伦理委员会的批准，并获得了所有参与者的知情同意。记录了详细的病史，包括吸烟和间歇性跛行史，并对溃疡进行了全面检查。测量了糖化血红蛋白水平，对下肢进行了多普勒扫描，并计算了ABPI和TBI值。根据评估的血管状况确定管理策略，从而进行药物或手术干预。
21例（42%）患有DFU的患者有间歇性跛行的阳性病史，表明间歇性跛行史与多普勒检查结果之间存在显著关联。37例（74%）患者有吸烟阳性史，这表明吸烟史与多普勒检查结果之间存在显著关联。38例（76%）患者的ABPI<0.9，其中33例（66%）患者在必要的管理后溃疡结果有所改善。ABPI与多普勒检查结果之间也存在统计学上的显著关联。16例（32%）患者的TBI<0.65，其中所有患者均有改善。TBI与多普勒检查结果之间存在高度显著关联。
本研究得出结论，将ABPI和TBI的综合常规评估纳入DFU管理方案对于指导治疗决策和监测治疗反应是必要的。治疗和预防影响下肢的糖尿病相关并发症需要专门的多学科方法。
