Clinical features and outcomes of recalcitrant ulcers in diabetic foot patients: a retrospective cohort study

• Elena Yu. Komelyagina
• Mikhail B. Antsiferov

Abstract

The aim of this study was to evaluate the proportion, clinical characteristics and outcomes of recalcitrant diabetic foot ulcers in a diabetic foot department.

Material and methods. This is a retrospective cohort study of diabetic foot patients from the specialized outpatient diabetic foot clinic. The ulcer considered to be recalcitrant in case where it did not heal in 12 months using the international standards of care.

Results and discussion. Data from the 324 diabetic foot ulcers, except ulcers associated with Charcot foot, managed in out-patient diabetic foot department were analyzed. 20 (6%) ulcers were found to be recalcitrant. These wounds were mostly neuropathic (90%), with plantar localization (80%), confined to skin and subcutaneous tissue (80%). As compared with healed ulcers, there was significant difference in the number of wounds with size >1 cm² (p<0.0001), specialized care referral (14 vs 67 days, p<0.001) and non-postoperative ulcers (p<0.0001). In 75% of cases healing of the recalcitrant ulcers was achieved after surgery [reconstructive orthopedic (65%) or plastic].

Conclusion. We found that in cohort of diabetic foot patients managed in the diabetic foot department the proportion of recalcitrant ulcers was 6%. The influence of limb ischemia, infection and depth for ulcer stagnation was not found. Late referral, non-postoperative etiology of wounds and size >1 cm² were significantly associated with long-term non-healing status.

Keywords:diabetic foot syndrome; recalcitrant ulcers, SINBAD

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