While not the most common pathology treated in a typical outpatient wound care center, the diabetic foot ulcer(DFU) can be the most complicated. There are multiple factors in both the patient and the natural history of the ulcer that can make these some of the most challenging cases you will handle. Add in the increased risk of complications such as infection and amputation and the diabetic foot ulcer is the most complex ulcer etiology you will manage.

Much like in venous leg ulcer (VLU) there are clinical features of diabetic foot ulcerations which can predict poor wound healing. The “Foundation” article again this week is by Dr. Margolis and his group. They were able to identify a handful of baseline DFU features which are associated with poor wound healing at a 20 week time period.  The sample size of patients studied was large, at 27,630 patients.

Negative prognostic indicators

Ulcer present >2 months

Ulcer size >2cm2

Grade >3

Each prognostic factor is given a value of one point and the odds of healing based on that point scale are as follows. The likelihood that a wound would not heal was 0.35 for a count of 0, 0.47 for a count of 1, 0.66 for a count of 2, and 0.81 for a count of 3 in the validation data set.

Understanding the factors associated with wound healing is important for several reasons. It allows you to have a frank and honest discussion with the patient regarding their potential for healing and helps to identify which patient’s may likely need advanced adjuvant therapies such as biologic grafts, advanced offloading and hyperbaric oxygen therapy.

Diabetic neuropathic foot ulcers: predicting which ones will heal. Margolis, David J et al. The American Journal of Medicine, Volume 115, Issue 8, 627-631