Thng Coeway Boulder, Wong Keng Lin, Wong Allen Wei-Jiat, Chew Khong Yik, Leow Kimberley, Alvis Leon Timothy Charles, Leong Sum, Irani Farah Gillan, Png Wenxian, Cher Eric Wei Liang, Ma Zhongzheng, Moksin Mardiana Binte, Wong Merng Koon, Tan Pearlie Woon Woon, Kok Yee Onn, Feng Jiajun
Department of Plastic, Reconstructive, and Aesthetic Surgery, Sengkang General Hospital, Singapore.
Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore.
J Wound Care. 2024 Dec 2;33(12):926-932. doi: 10.12968/jowc.2023.0008.
Diabetic foot ulcer (DFU) is a common complication in patients with diabetes. With current treatment, only two-thirds of patients heal, with a median duration of 3-6 months. Hard-to-heal DFUs are a major source of morbidity and mortality. Improving wound healing via soft tissue reconstruction may be the key to improving clinical outcomes. Thus, the Diabetic Limb Salvage (DLS) service in Sengkang General Hospital, Singapore, was established to provide patients with a streamlined, one-stop, comprehensive service dedicated to DFU soft tissue reconstruction. The reconstruction was carried out using secondary closure, skin grafting, local flaps or free flaps, depending on the severity of the wound and patient suitability. This study aims to audit the early outcomes of the DLS service.
Patients with DFUs treated by the DLS service were compared with patients with DFUs treated prior to the launch of the DLS service (control). Outcomes including major and minor amputation rates, wound healing rate, mortality and DFU recurrence rates were analysed statistically.
A total of 103 patients took part in the study (50 in the DLS service cohort and 53 in the control cohort). There was no significant difference in demographics, comorbidities and wound profiles between the two cohorts. All (100%) patients in the DLS service cohort received soft tissue reconstruction versus only 13% in the control group. The DLS service cohort had a significantly higher healing rate (96% versus 68%, respectively), shorter healing duration (77±30 days versus 111±43 days, respectively), reduced major amputation rate (0% versus 9%, respectively), and reduced recurrence rate (6% versus 25%, respectively) compared with the control cohort within the one-year follow-up.
The findings of this study showed that an orthoplastic multidisciplinary approach focused on DFU soft tissue reconstruction improved wound healing rates, shortened healing duration and, as a result, lowered amputation rates and reduced recurrence.
糖尿病足溃疡（DFU）是糖尿病患者常见的并发症。在目前的治疗下，只有三分之二的患者能够愈合，中位愈合时间为3至6个月。难愈合的DFU是发病和死亡的主要原因。通过软组织重建改善伤口愈合可能是改善临床结局的关键。因此，新加坡盛康综合医院设立了糖尿病肢体挽救（DLS）服务，为患者提供专门针对DFU软组织重建的简化、一站式综合服务。根据伤口的严重程度和患者的适用性，采用二期缝合、皮肤移植、局部皮瓣或游离皮瓣进行重建。本研究旨在评估DLS服务的早期效果。
将接受DLS服务治疗的DFU患者与DLS服务推出前接受治疗的DFU患者（对照组）进行比较。对主要和次要截肢率、伤口愈合率、死亡率和DFU复发率等结果进行统计学分析。
共有103名患者参与了该研究（DLS服务队列50名，对照组53名）。两个队列在人口统计学、合并症和伤口情况方面没有显著差异。DLS服务队列中的所有患者（100%）都接受了软组织重建，而对照组中只有13%的患者接受了该治疗。与对照组相比，在一年的随访期内，DLS服务队列的愈合率显著更高（分别为96%和68%），愈合时间更短（分别为77±30天和111±43天），主要截肢率降低（分别为0%和9%），复发率降低（分别为6%和25%）。
本研究结果表明，专注于DFU软组织重建的整形多学科方法提高了伤口愈合率，缩短了愈合时间，从而降低了截肢率并减少了复发。
