The correct diagnosis can lead to early recognition and management of patient and wound care challenges.
The EURODIALE study1 reported that infection predicted nonhealing in individuals with diabetic foot ulcers (DFU), but only in subjects with peripheral arterial disease (PAD), making rapid awareness of PAD a high priority guiding care decisions and expected outcomes for DFU. Other risk factors for nonhealing, identified by logistic regression in this prospective cohort study of 1,088 subjects with a DFU, included larger DFU size, male gender, older age, inability to stand or walk without assistance, and prior heart failure or renal disease as independent baseline predictors of non-healing with or without amputation during 1 year of followup.
Do the same findings apply to a patient with diabetes who has venous insufficiency? What if diabetes is removed from the equation? Does infection predict nonhealing for all those with a chronic wound only if its blood supply is compromised? We are only beginning to understand how interactions among different disease states such as PAD, venous insufficiency, and diabetes change the equations predicting whether or not an individual will proceed to healing. The 2 articles reviewed below highlight an early warning technique for identifying PAD and other danger signals indicating when a DFU may not be on the path to healing.