Sen Chandan K, Gordillo Gayle M, Roy Sashwati, Jahnke Jordan, Sinha Mithun, Timsina Lava, Mathew-Steiner Shomita S, Conte Michael S, Holmes Crystal, Jones Teresa L Z, Pop-Busui Rodica, Kolenic Giselle, Spino Cathie, Gurtner Geoffrey C
McGowan Institute for Regenerative Medicine, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Indiana Center for Regenerative Medicine and Engineering, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Diabetes Care. 2025 Jul 1;48(7):1233-1240. doi: 10.2337/dc25-0300.
The National Institute of Diabetes and Digestive and Kidney Diseases Diabetic Foot Consortium tested the hypothesis that compromised restoration of the skin barrier function of closed diabetic foot ulcers (DFUs), as measured by high transepidermal water loss (TEWL), is associated with an increased risk of DFU recurrence.
This was a multicenter noninterventional study measuring TEWL in 418 adult participants with diabetes and a recently healed DFU. TEWL was measured at the center of the closed wound and at an anatomically similar reference area on the contralateral foot within 2 weeks of wound closure (visit 1); measurements were repeated at a wound closure confirmation visit 2 weeks later (visit 2). Participants were observed for up to 16 weeks to assess for wound recurrence. Participant self-reported and clinician assessments of DFU wound recurrence were recorded.
DFU recurrence by week 16 occurred in 21.5% of participants. Mean TEWL at the center of the healed DFU at visit 1 was higher for those with recurrence compared with those without (P = 0.006). Among participants with high TEWL (>30.05 g · m-2 · h-1), 35% reported wound recurrence by 16 weeks versus 17% of those with low TEWL. The odds ratio for recurrence for participants with high TEWL was 2.66 (P < 0.001). Self-reported wound recurrence was highly concordant with clinician assessment of wound recurrence.
Compromised wound healing mechanisms culminating in wound closure associated with defective skin barrier function is associated with increased risk of DFU recurrence. Measurement of TEWL has value as a predictor of functional wound healing and could affect clinical practice, leading to better outcomes.
美国国立糖尿病、消化和肾脏疾病研究所糖尿病足联盟检验了以下假设：通过高经皮水分流失（TEWL）测量，闭合性糖尿病足溃疡（DFU）皮肤屏障功能恢复受损与DFU复发风险增加相关。
这是一项多中心非干预性研究，对418名患有糖尿病且近期愈合的DFU成年参与者测量TEWL。在伤口闭合后2周内（访视1），于闭合伤口中心及对侧足部解剖学相似的参考区域测量TEWL；2周后在伤口闭合确认访视时（访视2）重复测量。观察参与者长达16周以评估伤口复发情况。记录参与者对DFU伤口复发的自我报告及临床医生评估。
到第16周时，21.5%的参与者出现DFU复发。复发者在访视1时愈合DFU中心的平均TEWL高于未复发者（P = 0.006）。在TEWL高（>30.05 g·m-2·h-1）的参与者中，35%在16周时报告伤口复发，而TEWL低的参与者中这一比例为17%。TEWL高的参与者复发的优势比为2.66（P < 0.001）。自我报告的伤口复发与临床医生对伤口复发的评估高度一致。
导致伤口闭合的愈合机制受损并伴有皮肤屏障功能缺陷与DFU复发风险增加相关。TEWL测量作为功能性伤口愈合的预测指标具有价值，可能会影响临床实践，从而带来更好的结果。
