Pecoraro RE, Ahroni JH, Boyko EJ, Stensel VL, et al.
Diabetes. Date of publication 1991 Oct 1;volume 40(10):1305-13.
1. Diabetes. 1991 Oct;40(10):1305-13.
Chronology and determinants of tissue repair in diabetic lower-extremity ulcers.
Pecoraro RE(1), Ahroni JH, Boyko EJ, Stensel VL.
Author information:
(1)Medical Service, Seattle Veterans Affairs Medical Center, Seattle, Washington
98108.
The natural history of tissue repair and the critical determinants of faulty
healing of diabetic ulcers remain obscure despite recent advances in our
knowledge of the cellular physiology of normal cutaneous healing. To characterize
the chronology and identify important factors affecting healing, we applied an
objective method to quantify the rate of wound healing of full-thickness
lower-extremity ulcers in 46 diabetic outpatients who received local wound care
under a standardized clinical protocol. The initial ulcer healing rate, eventual
status of tissue repair, and definitive clinical outcome were not significantly
associated with age; diabetes type, duration, or treatment; level or change in
glycosylated hemoglobin; current smoking; presence of sensory neuropathy; ulcer
location or class; initial infection; or frequency of recurrent infections.
However, direct measures of local cutaneous perfusion, estimated by periwound
measurements of transcutaneous O2 tension (TcPo2) and transcutaneous CO2 tension
(TcPco2), were significantly associated with the initial rate of tissue repair (P
= 0.003 and 0.005, respectively). The strong prediction of early healing by these
parameters of local skin perfusion was independent from the effects of segmental
Doppler arterial blood pressure at the dorsalis pedis, although eventual ulcer
reepithelialization was significantly related to foot blood pressure and
periwound TcPo2 and TcPco2. We conclude that periwound cutaneous perfusion is the
critical physiological determinant of diabetic ulcer healing, indicating a
39-fold increased risk of early healing failure when the average periwound TcPo2
is less than 20 mmHg.
DOI: 10.2337/diab.40.10.1305
PMID: 1936593 [Indexed for MEDLINE]
