Jason Zhang, Mikel Sadek, Lou Iannuzzi, Caron Rockman, Karan Garg, Allison Taffet, Molly Ratner, Todd Berland, Thomas Maldonado, Glenn Jacobowitz, Frank Ross
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Subgroup analysis was performed on patients undergoing peripheral intervention.</p><p><strong>Results: </strong>152 patients underwent TCC. Mean age was 58.8 ± 12.1 years, 79.6% were male, and 26.3% had PAD. Mean DFU size was 8.27 ± 9.9 cm<sup>2</sup>, with mean depth 0.61 ± 0.49 cm. 112 patients had palpable pedal pulses on the affected extremity (73.7%). Average ABI was 1.12 ± 0.22 (n = 90). Complete healing was observed in 122 (80.3%) patients, with average healing time of 81.5 ± 57.1 days. Thirteen (8.6%) patients eventually required amputation (3 major). When compared to patients with healed DFUs, those without healing had higher rates of amputation (39.1% vs 3.1%, <i>P</i> < .001), intervention (43.4% vs 17.8%, <i>P</i> = .006), and noncompliance (39.1% vs 20.2%, <i>P</i> = .046). Thirty-three patients underwent revascularization, undergoing angioplasty (81.8%), atherectomy (63.6%), stent (15.2%), and/or bypass (9.1%). Interventions were performed in aortoiliac (3.0%), femoropopliteal (45.5%), and tibial (72.7%) segments. Twenty-two (66.7%) patients who underwent revascularization completely healed. Patients requiring revascularization were more likely to have previous intervention (57.6% vs 13.4%, <i>P</i> < .0001) and incompressible vessels (36.4% vs 7.6%, <i>P</i> < .00001), with lower ABIs (0.94 ± 0.25 vs 1.17 ± 0.18, <i>P</i> = .0008) compared to patients without intervention.</p><p><strong>Conclusions: </strong>TCC remains an effective option for treatment of DFUs, as most were completely healed. Patients with PAD may benefit from TCC and revascularization, however, healing rates are lower in this cohort, necessitating the need for close observation.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744241301171"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Total Contact Casting Remains an Effective Modality for Treatment of Diabetic Foot Ulcers.\",\"authors\":\"Jason Zhang, Mikel Sadek, Lou Iannuzzi, Caron Rockman, Karan Garg, Allison Taffet, Molly Ratner, Todd Berland, Thomas Maldonado, Glenn Jacobowitz, Frank Ross\",\"doi\":\"10.1177/15385744241301171\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Total contact casting (TCC) is used to promote wound closure in diabetic foot ulcers (DFUs); however, this technique is underused today. This study aims to further evaluate the efficacy of TCC in a large cohort, including patients with peripheral artery disease (PAD).</p><p><strong>Methods: </strong>This was a retrospective analysis of patients with DFUs who underwent TCC from 2017 to 2021. PAD was defined as absence of pedal pulse or ABI <0.9. Demographic data, DFU characteristics, and peripheral arterial intervention were evaluated. Outcomes included complete healing, healing time, and rate of major amputation. Subgroup analysis was performed on patients undergoing peripheral intervention.</p><p><strong>Results: </strong>152 patients underwent TCC. Mean age was 58.8 ± 12.1 years, 79.6% were male, and 26.3% had PAD. Mean DFU size was 8.27 ± 9.9 cm<sup>2</sup>, with mean depth 0.61 ± 0.49 cm. 112 patients had palpable pedal pulses on the affected extremity (73.7%). Average ABI was 1.12 ± 0.22 (n = 90). Complete healing was observed in 122 (80.3%) patients, with average healing time of 81.5 ± 57.1 days. Thirteen (8.6%) patients eventually required amputation (3 major). When compared to patients with healed DFUs, those without healing had higher rates of amputation (39.1% vs 3.1%, <i>P</i> < .001), intervention (43.4% vs 17.8%, <i>P</i> = .006), and noncompliance (39.1% vs 20.2%, <i>P</i> = .046). Thirty-three patients underwent revascularization, undergoing angioplasty (81.8%), atherectomy (63.6%), stent (15.2%), and/or bypass (9.1%). Interventions were performed in aortoiliac (3.0%), femoropopliteal (45.5%), and tibial (72.7%) segments. Twenty-two (66.7%) patients who underwent revascularization completely healed. Patients requiring revascularization were more likely to have previous intervention (57.6% vs 13.4%, <i>P</i> < .0001) and incompressible vessels (36.4% vs 7.6%, <i>P</i> < .00001), with lower ABIs (0.94 ± 0.25 vs 1.17 ± 0.18, <i>P</i> = .0008) compared to patients without intervention.</p><p><strong>Conclusions: </strong>TCC remains an effective option for treatment of DFUs, as most were completely healed. Patients with PAD may benefit from TCC and revascularization, however, healing rates are lower in this cohort, necessitating the need for close observation.</p>\",\"PeriodicalId\":94265,\"journal\":{\"name\":\"Vascular and endovascular surgery\",\"volume\":\" \",\"pages\":\"15385744241301171\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-11-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Vascular and endovascular surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/15385744241301171\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Vascular and endovascular surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15385744241301171","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：全接触铸造（TCC）可用于促进糖尿病足溃疡（DFU）的伤口闭合；然而，这种技术目前还未得到充分利用。本研究旨在进一步评估包括外周动脉疾病（PAD）患者在内的大样本人群中全接触式石膏疗法的疗效：这是对2017年至2021年接受TCC治疗的DFU患者的回顾性分析。PAD定义为无足底脉搏或ABI 结果：152名患者接受了TCC：152名患者接受了TCC。平均年龄为 58.8 ± 12.1 岁，79.6% 为男性，26.3% 患有 PAD。DFU 平均大小为 8.27 ± 9.9 平方厘米，平均深度为 0.61 ± 0.49 厘米。112名患者（73.7%）的患肢可触及足底搏动。平均 ABI 为 1.12 ± 0.22（n = 90）。122名患者（80.3%）观察到完全愈合，平均愈合时间为 81.5 ± 57.1 天。13例（8.6%）患者最终需要截肢（3例为大截肢）。与已愈合的 DFU 患者相比，未愈合患者的截肢率（39.1% vs 3.1%，P < .001）、干预率（43.4% vs 17.8%，P = .006）和不依从率（39.1% vs 20.2%，P = .046）均较高。33名患者接受了血管重建术，包括血管成形术（81.8%）、粥样硬化切除术（63.6%）、支架术（15.2%）和/或搭桥术（9.1%）。介入治疗在主动脉髂段（3.0%）、股浅动脉段（45.5%）和胫骨段（72.7%）进行。22名（66.7%）接受血管重建术的患者完全愈合。与未接受干预的患者相比，需要血管再通的患者更有可能既往接受过干预（57.6% vs 13.4%，P < .0001），也更有可能血管不可压缩（36.4% vs 7.6%，P < .00001），ABI 更低（0.94 ± 0.25 vs 1.17 ± 0.18，P = .0008）：结论：TCC仍是治疗DFU的有效方法，因为大多数患者都能完全治愈。结论：TCC仍是治疗DFU的有效方法，因为大多数患者的DFU都能完全愈合。PAD患者可能会从TCC和血管重建中获益，但这部分患者的愈合率较低，因此需要密切观察。
Total Contact Casting Remains an Effective Modality for Treatment of Diabetic Foot Ulcers.
Objectives: Total contact casting (TCC) is used to promote wound closure in diabetic foot ulcers (DFUs); however, this technique is underused today. This study aims to further evaluate the efficacy of TCC in a large cohort, including patients with peripheral artery disease (PAD).
Methods: This was a retrospective analysis of patients with DFUs who underwent TCC from 2017 to 2021. PAD was defined as absence of pedal pulse or ABI <0.9. Demographic data, DFU characteristics, and peripheral arterial intervention were evaluated. Outcomes included complete healing, healing time, and rate of major amputation. Subgroup analysis was performed on patients undergoing peripheral intervention.
Results: 152 patients underwent TCC. Mean age was 58.8 ± 12.1 years, 79.6% were male, and 26.3% had PAD. Mean DFU size was 8.27 ± 9.9 cm2, with mean depth 0.61 ± 0.49 cm. 112 patients had palpable pedal pulses on the affected extremity (73.7%). Average ABI was 1.12 ± 0.22 (n = 90). Complete healing was observed in 122 (80.3%) patients, with average healing time of 81.5 ± 57.1 days. Thirteen (8.6%) patients eventually required amputation (3 major). When compared to patients with healed DFUs, those without healing had higher rates of amputation (39.1% vs 3.1%, P < .001), intervention (43.4% vs 17.8%, P = .006), and noncompliance (39.1% vs 20.2%, P = .046). Thirty-three patients underwent revascularization, undergoing angioplasty (81.8%), atherectomy (63.6%), stent (15.2%), and/or bypass (9.1%). Interventions were performed in aortoiliac (3.0%), femoropopliteal (45.5%), and tibial (72.7%) segments. Twenty-two (66.7%) patients who underwent revascularization completely healed. Patients requiring revascularization were more likely to have previous intervention (57.6% vs 13.4%, P < .0001) and incompressible vessels (36.4% vs 7.6%, P < .00001), with lower ABIs (0.94 ± 0.25 vs 1.17 ± 0.18, P = .0008) compared to patients without intervention.
Conclusions: TCC remains an effective option for treatment of DFUs, as most were completely healed. Patients with PAD may benefit from TCC and revascularization, however, healing rates are lower in this cohort, necessitating the need for close observation.
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