Lavery Lawrence A, Reyes Mario C, Najafi Bijan, Coye Tyler L, Chung Jayer, Siah Michael C, Tarricone Arthur N
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Wound Repair Regen. 2025 Jan-Feb;33(1):e13235. doi: 10.1111/wrr.13235.
Our objective was to assess the incidence, risk factors and clinical outcomes of dehiscence after foot surgery in diabetic patients. We used pooled patient-level data from two randomised clinical trials with 240 diabetic patients who required foot surgery for infections. Most patients (n = 180, 75.0%) had surgical wound closure. We defined dehisced surgical wounds (DSW) when the surgical site was not completely epithelialized with no drainage after sutures/staples were removed with a 2-week validation of healing. We evaluated the time to heal, re-infection, re-ulceration, hospital admissions and amputations. Moderate and severe infection was based on criteria of the International Working Group on the Diabetic Foot. We used χ and t-test and Mann-Whitney U for comparison of clinical events, with α of <0.05. DSW occurred in 137 (76.1%) patients. DSW patients were more likely to have hypertension (62.8% vs. 81.8%, p = 0.01), high ESR (59.1 ± 37.9 vs. 75.9 ± 37.6, p = 0.01), low toe brachial indices (0.8 ± 0.2) (0.7 ± 0.2, p = 0.005), toe brachial indices <0.6 (16.7% vs. 40.9%, p = 0.008), and low skin perfusion pressure measurements (dorsal medial 71.0 ± 29.4 vs. 59.3 ± 23.3, p = 0.01, and plantar medial 81.8 ± 24.9 vs. 72.2 ± 20.4, p = 0.02). During 12-month follow-up, DSW patients were 12.9 times more likely to have re-infection (0% vs. 12.4%, p = 0.02) and 6.8 times more likely to require amputation (2.3% vs. 13.9%, p = 0.04). The median healing time (28, 22.5-35.0 vs. 114.0, 69.0; 365, p = 0.001), and median length of hospitalisation were longer in DSW patients (12.0, 9.01-9.0 vs. 15.0, 11.0-24.0, p = 0.04). There was a high incidence of DSW, associated with poor clinical outcomes.
我们的目标是评估糖尿病患者足部手术后伤口裂开的发生率、危险因素及临床结局。我们使用了两项随机临床试验中240例因感染需要足部手术的糖尿病患者的汇总个体水平数据。大多数患者（n = 180，75.0%）进行了手术伤口缝合。我们将手术伤口裂开（DSW）定义为在缝线/吻合钉拆除后手术部位未完全上皮化且无引流，愈合情况经2周验证。我们评估了愈合时间、再次感染、再次溃疡、住院情况和截肢情况。中度和重度感染依据糖尿病足国际工作组的标准判定。我们使用χ检验、t检验和曼-惠特尼U检验来比较临床事件，α值<0.05。137例（76.1%）患者发生了DSW。DSW患者更易患高血压（62.8%对81.8%，p = 0.01）、血沉（ESR）升高（59.1±37.9对75.9±37.6，p = 0.01）、趾臂指数较低（0.8±0.2对0.7±0.2，p = 0.005）、趾臂指数<0.6（16.7%对40.9%，p = 0.008）以及皮肤灌注压测量值较低（内侧背侧71.0±29.4对59.3±23.3，p = 0.01，内侧足底81.8±24.9对72.2±20.4，p = 0.02）。在12个月的随访期间，DSW患者再次感染的可能性高12.9倍（0%对12.4%，p = 0.02），需要截肢的可能性高6.8倍（2.3%对13.9%，p = 0.04）。DSW患者的中位愈合时间（28天，22.5 - 35.0天对114.0天，69.0 - 365天，p = 0.001）和中位住院时间更长（12.0天，9.01 - 9.0天对15.0天，11.0 - 24.0天，p = 0.04）。DSW的发生率很高，且与不良临床结局相关。
