Comparative Outcomes of Conservative Surgery versus Early Surgical Intervention in Diabetic Foot Ulcers
Optimizing Diabetic Foot Care: Comparing Conservative and Surgical Approaches
DOI:
https://doi.org/10.69750/dmls.01.08.066Keywords:
Diabetic foot ulcers, conservative surgery, early surgical intervention, revision surgery, biomarkers, C-reactive protein, glycated hemoglobin, wound healingAbstract
Background: Diabetic foot ulcers (DFUs) are a severe complication of diabetes, often requiring intervention. Comparing conservative treatment and early surgical intervention is essential to optimize patient outcomes.
Objectives: To evaluate the effectiveness of conservative surgery and early surgical intervention in the management of DFUs and to assess the association of clinical outcomes with biomarkers such as C-reactive protein (CRP) and glycated hemoglobin (HbA1c).
Methods: A comparative study was conducted at different tertiary care center in Lahore between January 2024 and October 2024. A total of 300 patients with DFUs (Wagner grade 2-4) were included, with 150 receiving conservative surgery and 150 undergoing early surgical intervention. Outcomes measured included wound healing time, revision surgeries, and amputation rates. The association of these outcomes with CRP and HbA1c levels was analyzed.
Results: Patients in the conservative surgery group had a higher rate of revision surgeries (53% vs. 41%, p = 0.04) and longer hospital stays (median 20 vs. 16 days, p < 0.01). Elevated CRP levels (median 58 mg/L, IQR 15–170) were significantly associated with clinical failure (HR = 1.8, p = 0.03), as were elevated HbA1c levels (median 8.2%, IQR 7.5–9.0; HR = 1.5, p = 0.02). Early surgical intervention was linked to lower revision rates and quicker recovery but at the cost of increased limb loss.
Conclusion: Conservative surgery preserves limbs but often requires revisions and longer treatment durations, while early surgery shortens recovery time but raises amputation risks. Biomarkers like CRP and HbA1c are critical for guiding personalized treatment decisions.
Downloads
References
Lei Y, Jiang P, Tian T. Comparative analysis of surgical and non-surgical wound approaches in diabetic foot ulcer treatment: Meta-analysis and systematic review. International Wound Journal. 2024;21(4):e14601.doi: https://doi.org/10.1111/iwj.14601
Yammine K, Assi C. A Meta-analysis of the Types and Outcomes of Conservative Excisional Surgery for Recalcitrant or Infected Diabetic Toe Ulcers. Foot & Ankle Specialist. 2020;13(2):152-60.doi: 10.1177/1938640019857795
Yammine K, Assi C. Surgery Versus Nonsurgical Methods in Treating Neuropathic Plantar Forefoot Ulcers: A Meta-Analysis of Comparative Studies. The International Journal of Lower Extremity Wounds. 2022;21(1):7-17.doi: 10.1177/1534734620923425
Gazzaruso C, Gallotti P, Pujia A, Montalcini T, Giustina A, Coppola A. Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study. Endocrine. 2021;71(1):59-68.doi: 10.1007/s12020-020-02431-0
Kalantar Motamedi A, Ansari M. Comparison of Metatarsal Head Resection Versus Conservative Care in Treatment of Neuropathic Diabetic Foot Ulcers. The Journal of Foot and Ankle Surgery. 2017;56(3):428-33.doi: https://doi.org/10.1053/j.jfas.2016.11.019
Schöni M, Soldevila-Boixader L, Böni T, Muñoz Laguna J, Uçkay I, Waibel FWA. Comparative Efficacy of Conservative Surgery vs Minor Amputation for Diabetic Foot Osteomyelitis. Foot & Ankle International. 2023;44(11):1142-9.doi: 10.1177/10711007231194046
Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Rojas-Bonilla JM, Murillo-Vargas C. Conservative Surgery for Diabetic Foot Osteomyelitis is not Associated With Longer Survival Time Without Recurrence of Foot Ulcer When Compared With Amputation. The International Journal of Lower Extremity Wounds. 2023;22(2):328-31.doi: 10.1177/15347346211009403
Lázaro-Martínez JL, García-Madrid M, García-Álvarez Y, Álvaro-Afonso FJ, Sanz-Corbalán I, García-Morales E. Conservative surgery for chronic diabetic foot osteomyelitis: Procedures and recommendations. Journal of Clinical Orthopaedics and Trauma. 2021;16:86-98.doi: https://doi.org/10.1016/j.jcot.2020.12.014
Yammine K, El-Alam A, Assi C. Outcomes of partial and total calcanectomies for the treatment of diabetic heel ulcers complicated with osteomyelitis. A systematic review and meta-analysis. Foot and Ankle Surgery. 2021;27(6):598-605.doi: https://doi.org/10.1016/j.fas.2020.07.014
Yammine K, Kheir N, Assi C. A Meta-Analysis of the Outcomes of Metatarsal Head Resection for the Treatment of Neuropathic Diabetic Foot Ulcers. Advances in Wound Care. 2020;10(2):81-90.doi: 10.1089/wound.2020.1261
Rosi LM, Jones AS, Topliss DJ, Bach LA. Demographics and outcomes of inpatients with diabetic foot ulcers treated conservatively and surgically in a metropolitan hospital network. Diabetes Research and Clinical Practice. 2021;175:108821.doi: https://doi.org/10.1016/j.diabres.2021.108821
Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, et al. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes/Metabolism Research and Reviews. 2016;32(S1):154-68.doi: https://doi.org/10.1002/dmrr.2707
Yammine K, Assi C. Surgical Offloading Techniques Should be Used More Often and Earlier in Treating Forefoot Diabetic Ulcers: An Evidence-Based Review. The International Journal of Lower Extremity Wounds. 2020;19(2):112-9.doi: 10.1177/1534734619888361
Yammine K, Assi C. The level of evidence of the publications on conservative surgery for the treatment of diabetic forefoot ulcers: A scoping review. The Foot. 2021;47:101784.doi: https://doi.org/10.1016/j.foot.2021.101784
Lane KL, Abusamaan MS, Voss BF, Thurber EG, Al-Hajri N, Gopakumar S, et al. Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies. Journal of Diabetes and its Complications. 2020;34(10):107638.doi: https://doi.org/10.1016/j.jdiacomp.2020.107638
Armstrong DG, Tan T-W, Boulton AJM, Bus SA. Diabetic Foot Ulcers: A Review. JAMA. 2023;330(1):62-75.doi: 10.1001/jama.2023.10578
Monami M, Ragghianti B, Nreu B, Lorenzoni V, Pozzan M, Silverii A, et al. Major Amputation In Non-Healing Ulcers: Outcomes and Economic Issues. Data from a Cohort of Patients with Diabetic Foot Ulcers. The International Journal of Lower Extremity Wounds.0(0):15347346221097283.doi: 10.1177/15347346221097283
Yammine K, Nahed M, Assi C. Metatarsal Osteotomies for Treating Neuropathic Diabetic Foot Ulcers: A Meta-analysis. Foot & Ankle Specialist. 2019;12(6):555-62.doi: 10.1177/1938640018819784
Zeun P, Gooday C, Nunney I, Dhatariya K. Predictors of Outcomes in Diabetic Foot Osteomyelitis Treated Initially With Conservative (Nonsurgical) Medical Management:A Retrospective Study. The International Journal of Lower Extremity Wounds. 2016;15(1):19-25.doi: 10.1177/1534734615596892
Andersen JC, Leong BV, Gabel JA, Murga AG, Patel ST, Abou-Zamzam AM, et al. Conservative Management of Non-Infected Diabetic Foot Ulcers Achieves Reliable Wound Healing and Limb Salvage in the Setting of Mild-Moderate Ischemia. Annals of Vascular Surgery. 2022;82:81-6.doi: https://doi.org/10.1016/j.avsg.2021.11.011
Frykberg RG, Attinger C, Smeets L, Koller A, Bal A, Kavarthapu V. Surgical strategies for prevention of amputation of the diabetic foot. Journal of Clinical Orthopaedics and Trauma. 2021;17:99-105.doi: https://doi.org/10.1016/j.jcot.2021.02.019
Downloads
Published
Issue
Section
License
Copyright (c) 2024 DEVELOPMENTAL MEDICO-LIFE-SCIENCES
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/public domain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.