Wound Morphology and Topography in the Diabetic Foot: Hurdles in Implementing Angiosome-Guided Revascularization
Purpose. Angiosome-guided revascularization is an approach that improves wound healing but requires a surgeon to determine which angiosomes are ischemic. This process can be more difficult than anticipated because diabetic foot (DF) wounds vary greatly in quantity, morphology, and topography. This p...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2014-01-01
|
| Series: | International Journal of Vascular Medicine |
| Online Access: | http://dx.doi.org/10.1155/2014/672897 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832567873688567808 |
|---|---|
| author | Dimitri Aerden Nathalie Denecker Sarah Gallala Erik Debing Pierre Van den Brande |
| author_facet | Dimitri Aerden Nathalie Denecker Sarah Gallala Erik Debing Pierre Van den Brande |
| author_sort | Dimitri Aerden |
| collection | DOAJ |
| description | Purpose. Angiosome-guided revascularization is an approach that improves wound healing but requires a surgeon to determine which angiosomes are ischemic. This process can be more difficult than anticipated because diabetic foot (DF) wounds vary greatly in quantity, morphology, and topography. This paper explores to what extent the heterogeneous presentation of DF wounds impedes development of a proper revascularization strategy. Methods. Data was retrieved from a registry of patients scheduled for below-the-knee (BTK) revascularization. Photographs of the foot and historic benchmark diagrams were used to assign wounds to their respective angiosomes. Results. In 185 limbs we detected 345 wounds. Toe wounds (53.9%) could not be designated to a specific angiosome due to dual blood supply. Ambiguity in wound stratification into angiosomes was highest at the heel, achilles tendon, and lateral/medial side of the foot and lowest for malleolar wounds. In 18.4% of the DF, at least some wounds could not confidently be categorized. Proximal wounds (coinciding with toe wounds) further steered revascularization strategy in 63.6%. Multiple wounds required multiple BTK revascularization in 8.6%. Conclusion. The heterogeneous presentation in diabetic foot wounds hampers unambiguous identification of ischemic angiosomes, and as such diminishes the capacity of the angiosome model to optimize revascularization strategy. |
| format | Article |
| id | doaj-art-7503b5e8fda247c1a07fdea07a0915d2 |
| institution | Kabale University |
| issn | 2090-2824 2090-2832 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Vascular Medicine |
| spelling | doaj-art-7503b5e8fda247c1a07fdea07a0915d22025-02-03T01:00:17ZengWileyInternational Journal of Vascular Medicine2090-28242090-28322014-01-01201410.1155/2014/672897672897Wound Morphology and Topography in the Diabetic Foot: Hurdles in Implementing Angiosome-Guided RevascularizationDimitri Aerden0Nathalie Denecker1Sarah Gallala2Erik Debing3Pierre Van den Brande4Diabetic Foot Clinic, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, BelgiumDiabetic Foot Clinic, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, BelgiumDepartment of Vascular Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, BelgiumDepartment of Vascular Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, BelgiumDepartment of Vascular Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, BelgiumPurpose. Angiosome-guided revascularization is an approach that improves wound healing but requires a surgeon to determine which angiosomes are ischemic. This process can be more difficult than anticipated because diabetic foot (DF) wounds vary greatly in quantity, morphology, and topography. This paper explores to what extent the heterogeneous presentation of DF wounds impedes development of a proper revascularization strategy. Methods. Data was retrieved from a registry of patients scheduled for below-the-knee (BTK) revascularization. Photographs of the foot and historic benchmark diagrams were used to assign wounds to their respective angiosomes. Results. In 185 limbs we detected 345 wounds. Toe wounds (53.9%) could not be designated to a specific angiosome due to dual blood supply. Ambiguity in wound stratification into angiosomes was highest at the heel, achilles tendon, and lateral/medial side of the foot and lowest for malleolar wounds. In 18.4% of the DF, at least some wounds could not confidently be categorized. Proximal wounds (coinciding with toe wounds) further steered revascularization strategy in 63.6%. Multiple wounds required multiple BTK revascularization in 8.6%. Conclusion. The heterogeneous presentation in diabetic foot wounds hampers unambiguous identification of ischemic angiosomes, and as such diminishes the capacity of the angiosome model to optimize revascularization strategy.http://dx.doi.org/10.1155/2014/672897 |
| spellingShingle | Dimitri Aerden Nathalie Denecker Sarah Gallala Erik Debing Pierre Van den Brande Wound Morphology and Topography in the Diabetic Foot: Hurdles in Implementing Angiosome-Guided Revascularization International Journal of Vascular Medicine |
| title | Wound Morphology and Topography in the Diabetic Foot: Hurdles in Implementing Angiosome-Guided Revascularization |
| title_full | Wound Morphology and Topography in the Diabetic Foot: Hurdles in Implementing Angiosome-Guided Revascularization |
| title_fullStr | Wound Morphology and Topography in the Diabetic Foot: Hurdles in Implementing Angiosome-Guided Revascularization |
| title_full_unstemmed | Wound Morphology and Topography in the Diabetic Foot: Hurdles in Implementing Angiosome-Guided Revascularization |
| title_short | Wound Morphology and Topography in the Diabetic Foot: Hurdles in Implementing Angiosome-Guided Revascularization |
| title_sort | wound morphology and topography in the diabetic foot hurdles in implementing angiosome guided revascularization |
| url | http://dx.doi.org/10.1155/2014/672897 |
| work_keys_str_mv | AT dimitriaerden woundmorphologyandtopographyinthediabeticfoothurdlesinimplementingangiosomeguidedrevascularization AT nathaliedenecker woundmorphologyandtopographyinthediabeticfoothurdlesinimplementingangiosomeguidedrevascularization AT sarahgallala woundmorphologyandtopographyinthediabeticfoothurdlesinimplementingangiosomeguidedrevascularization AT erikdebing woundmorphologyandtopographyinthediabeticfoothurdlesinimplementingangiosomeguidedrevascularization AT pierrevandenbrande woundmorphologyandtopographyinthediabeticfoothurdlesinimplementingangiosomeguidedrevascularization |